||Reliability and Concurrent Validity of the Assessment of General Movements
||Department of Physical Therapy
背景和目的：過去文獻探討整體動作評估(Assessment of General Movements)信度和效度的結果有些不一致。因此，本研究目的有兩個。第一、探討整體動作評估的再測和受測者間信度，且討論類別評分和二分法是否有差異。第二、比較整體動作評估在不同的動作時期，分別與摩根或漢默史密斯新生兒神經行為評估、阿爾伯塔嬰幼兒動作評估量表或皮巴迪動作發展量表第二版的同時效度。
方法：本研究共招募64位有發展遲緩危險因子(實驗組)和20位正常足月產的新生兒(控制組)。受試者分別在整體動作的三個時期(早產、扭動運動和不安運動時期)拍攝動作影片。共收集148和237個影片分別進行信度和同時效度的分析。影片拍攝同時，受試者在足月前，使用摩根新生兒神經行為評估；在足月至妊娠週數48週，使用漢默史密斯新生兒神經行為評估；在足月至妊娠週數60週，使用阿爾伯塔嬰幼兒動作評估量表；在妊娠週數49至60週，使用皮巴迪動作發展量表第二版。整體動作品質在早產和扭動運動時期分為正常、單調性、痙攣同步性和混亂性；不安運動時期分為正常、異常性及不安運動缺乏。所有影片用類別方式評分，進行分析時再將分數二分為正常和不正常兩類。受測者間信度是比較三位物理治療師間的一致性，再測信度是比較一個月後再測的一致性。在信度分析，使用百分比和Cohen’s Kappa係數分析整體動作評估使用類別評分法的信度，二分法則是用百分比和Prevalence Adjusted and Biased Adjusted Kappa(PABAK)係數進行分析。在同時效度分析，使用百分比和Cramer’s V相關係數探討不同評估工具間的相關性。
Background and Purpose: The results by previous studies which examined the reliability and validity of The assessment of general movements (GMsA) were inconsistent. Therefore, the purpose of this study was to determine the intra- and inter-rater reliability of GMsA in categorical and dichotomous ratings ,and concurrent validity of GMsA in comparison with the Morgan (MNNE) or Hammersmith Neonatal Neurobehavioral examination (HNNE), the Alberta Infants Motor Scale (AIMS), and the Peabody Developmental Motor Scales 2nd (PDMS-Ⅱ) on infants with term, typical development and high risk of developmental disorders.
Methods: Sixty four high risk (experimental group) and 20 normal infants (control group) were recruited. There were a total of 148 and 237 recordings to determine reliability and concurrent validity, respectively. Spontaneous movements were recorded in preterm, writhing, and fidgety period, respectively. The recording time was about 1 hour in preterm period, and at least 15 minutes in writhing and fidgety period. At the time of recording, each infant were assessed with one or two assessment tools to determine concurrent validities. At preterm age, MNNE were assessed. At age of 38 to 42 weeks gestational age (GA), HNNE was assessed. From term age to 60 weeks GA, AIMS was assessed. At age of 49 to 60 weeks GA, PDMS-II was assessed. The quality of GMs was classified as normal, poor repertoire, chaotic, and cramped-synchronized general movements in preterm and writhing period, and normal, abnormal and absent fidgety movements in fidgety period. All recordings were assessed by categorical rating, and further classified to dichotomous rating for analysis. The inter-rater reliability examined the agreements between three physical therapists, and the intra-rater reliability examined the agreements on the same recording after one month later. Percentage of agreement and Cohen’s kappa were used to examine the reliability in categorical rating, and the percentage of agreement and Prevalence Adjusted and Biased Adjusted Kappa (PABAK) was used to determine the reliability in dichotomous rating. Percentage of agreement and Cramer’s V correlation coefficient were used to determine the correlations between GMsA and concurrent examinations.
Results and Discussions: The results showed that the intra- and inter-rater reliabilities were fair to moderate (mean percentage: 69%) and low to fair (mean percentage: 54%) in categorical rating, respectively, and fair to substantial (mean percentage: 78%) and low to fair (mean percentage: 67%) in dichotomous rating, respectively. The agreements within or between raters in this study were not good due to several possible reasons. First, the training method by the conception of seed teacher, self-learning and discussions were insufficient. Second, few recordings for practice caused that raters were lack of confidence in using the assessment. Third, twenty percentage of recordings was in the transition phase of GMs and caused of increasing the difficulty of assessing. Fourth, the procedure (assessing together, time of each assessment and duration between first and second rating) was different from previous studies. The concurrent validities of GMsA were various in comparison with different examinations. The correlation between GMsA and MNNE or HNNE were low. It might be cause by limited reliability of neonatal examinations because of fragile and unstable infants in preterm life and early infancy. The correlation between GMsA and the AIMS were moderate and highest in comparison to other examinations. The correlation between GMsA and PDMS-II was fair. The results also showed that the correlation between GMsA and fine motor quotient of PDMS-II was higher than between GMsA and gross motor quotient of PDMS-II. It agreed with the results of previous study which found that fidgety movements related to later fine motor development.
Conclusions: The results indicated the reliabilities of GMsA were general fair and more discussion and practices for the raters who did not attend training course was needed. The concurrent validities with other assessment tools were various. The correlations between GMsA and other examinations were various. However, the age of the participants in each period was various in this study. Further research could examine the concordance with other examinations at a certain age.
Chapter 1 The Research Objective 1
1.1 Introduction 1
1.2 Purpose 7
1.3 Specific aims 8
1.4 Definitions 8
1.5 Delimitations 9
1.6 Significances of the study 10
Chapter 2 Literature Review 12
2.1 Neuronal Group Selection Theory (NGST) 12
2.2 Reliability of GMsA 13
2.2.1 Intra-rater reliability 13
2.2.2 Inter-rater reliability 14
2.3 Concurrent validity of GMsA 17
2.4 Predictive power of GMsA 19
2.4.1 Cerebral palsy (CP) 19
2.4.2 Minor neurological dysfunction (MND) 21
2.4.3 Behavior problems 22
2.4.4 Cognition disorders 24
2.4.5 Genetic disorders 25
22.214.171.124 Down syndrome (DS) 25
126.96.36.199 Rett disorder (RTT) 26
Chapter 3 Methodology 28
3.1 The setting 28
3.2 Research design 28
3.3 Participants 28
3.4 Instruments 30
3.5 Procedure 34
3.5.1 Data collection of recordings and concurrent
3.5.2 Assessment of the GMs 36
3.6 Statistical Analysis 37
Chapter 4 Results 39
4.1 Reliability 39
4.1.1 Intra-rater reliability 40
4.1.2 Inter-rater reliability 45
4.2 Concurrent validity 50
4.2.1 Preterm period 51
4.2.2 Writhing period 53
4.2.3 Fidgety period 54
Chapter 5 Discussions 57
5.1 Reliability 58
5.1.1 Practices 59
5.1.2 Training 61
5.1.3 Recordings in transition phase of spontaneous
5.1.4 Procedures 63
5.2 Concurrent validity 67
5.2.1 Preterm period 69
5.2.2 Writhing period 69
5.2.3 Fidgety period 71
5.3 Limitations 74
Chapter 6 Conclusions 76
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