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Seager A1,2
1Royal College of Surgeons in Ireland, Physiotherapy Department, Dublin, Ireland, 2Temple Street Children's University Hospital, Physiotherapy Department, Dublin, Ireland
Background: Torticollis is a clinical sign of asymmetric cervical spine (CSp) posture, which may be the result of a variety of underlying disorders. A thorough assessment of CSp function is essential as part of the diagnosis and management of torticollis. There is a lack of reliable and valid measurement tools for the assessment of CSp postural side-flexion(head tilt) and active rotation in the upright position. The majority of physiotherapists use visual estimation as their main method of assessment of CSp function in infants with torticollis, which has not been adequately tested for reliability in this population.
Purpose: To examine the reliability of visual estimation as a method of assessment of head tilt and active CSp rotation in the upright position on infants with torticollis by physiotherapists.
To examine the impact of the physiotherapists' clinical experience on their reliability.
Methods: This was an observational (reliability) study, which involved the recruitment of 26 physiotherapists and 31 infants (aged 4-24 months, diagnosed with torticollis). Videos were taken of the infants in an upright position, in order to record their head position in the frontal plane (anterior view) and active CSp rotation (lateral view). Using a Virtual Learning Environment, the videos were observed by the physiotherapists and assessed using visual estimation, on two occasions, a minimum of one week apart. Inter-rater and intra-rater reliability was calculated using the intra-class correlation coefficient (ICC) and Standard Error of Measurement (SEM). Information regarding the physiotherapists' clinical experience was collected by questionnaire, and the relationship between this and their intra-rater reliability analysed using a Pearson product-moment correlation coefficient.
Results: Inter-rater reliability was good (ICC: 0.68 ± 0.20, 0.13 - 0.98; SEM: 5.1° ± 2.1°, 1-12°). When divided into head tilt and rotation, the rotation videos had better reliability (ICC: 0.79 ± 0.14) than the head tilt videos (ICC: 0.58 ± 0.20). The intra-rater reliability was excellent (ICC: 0.85 ± 0.09, 0.55 to 0.94). When divided into head tilt and rotation, both had excellent reliability (ICC: 0.84 ± 0.08 for head tilt and 0.85 ± 0.09 for rotation). There was no correlation between the intra-rater reliability of the physiotherapists and their clinical experience, determined by years of clinical experience, years of experience with torticollis or self-rated confidence in assessing an infant with torticollis.
Conclusion(s): Visual estimation has excellent intra-rater reliability and good inter-rater reliability in the assessment of head tilt and active CSp rotation in the upright position for infants with torticollis. In both cases, assessment of rotation was more reliable than that of head tilt. Using an ICC value of ≥0.7 for a test to be clinically acceptable, inter-rater reliability of head tilt was found to be unacceptable. There was a wide variation in reliability and no correlation was found between reliability and clinical experience.
Implications: If using visual estimation, it is recommended that physiotherapists test their reliability if possible, particularly for inter-rater reliability. It is also recommended that an alternative tool for the assessment of head tilt in the upright position be explored.
Keywords: Torticollis of Infancy, Visual Estimation, Assessment
Funding acknowledgements: Temple Street Foundation, Temple Street Children´s University Hospital, Dublin, Ireland.
Purpose: To examine the reliability of visual estimation as a method of assessment of head tilt and active CSp rotation in the upright position on infants with torticollis by physiotherapists.
To examine the impact of the physiotherapists' clinical experience on their reliability.
Methods: This was an observational (reliability) study, which involved the recruitment of 26 physiotherapists and 31 infants (aged 4-24 months, diagnosed with torticollis). Videos were taken of the infants in an upright position, in order to record their head position in the frontal plane (anterior view) and active CSp rotation (lateral view). Using a Virtual Learning Environment, the videos were observed by the physiotherapists and assessed using visual estimation, on two occasions, a minimum of one week apart. Inter-rater and intra-rater reliability was calculated using the intra-class correlation coefficient (ICC) and Standard Error of Measurement (SEM). Information regarding the physiotherapists' clinical experience was collected by questionnaire, and the relationship between this and their intra-rater reliability analysed using a Pearson product-moment correlation coefficient.
Results: Inter-rater reliability was good (ICC: 0.68 ± 0.20, 0.13 - 0.98; SEM: 5.1° ± 2.1°, 1-12°). When divided into head tilt and rotation, the rotation videos had better reliability (ICC: 0.79 ± 0.14) than the head tilt videos (ICC: 0.58 ± 0.20). The intra-rater reliability was excellent (ICC: 0.85 ± 0.09, 0.55 to 0.94). When divided into head tilt and rotation, both had excellent reliability (ICC: 0.84 ± 0.08 for head tilt and 0.85 ± 0.09 for rotation). There was no correlation between the intra-rater reliability of the physiotherapists and their clinical experience, determined by years of clinical experience, years of experience with torticollis or self-rated confidence in assessing an infant with torticollis.
Conclusion(s): Visual estimation has excellent intra-rater reliability and good inter-rater reliability in the assessment of head tilt and active CSp rotation in the upright position for infants with torticollis. In both cases, assessment of rotation was more reliable than that of head tilt. Using an ICC value of ≥0.7 for a test to be clinically acceptable, inter-rater reliability of head tilt was found to be unacceptable. There was a wide variation in reliability and no correlation was found between reliability and clinical experience.
Implications: If using visual estimation, it is recommended that physiotherapists test their reliability if possible, particularly for inter-rater reliability. It is also recommended that an alternative tool for the assessment of head tilt in the upright position be explored.
Keywords: Torticollis of Infancy, Visual Estimation, Assessment
Funding acknowledgements: Temple Street Foundation, Temple Street Children´s University Hospital, Dublin, Ireland.
Topic: Paediatrics; Outcome measurement
Ethics approval required: Yes
Institution: Temple Street Children's University Hospital, Dublin, Ireland
Ethics committee: Research Ethics Committee, Temple Street Children's University Hospital, Dublin, Ireland
Ethics number: 13032
All authors, affiliations and abstracts have been published as submitted.
