• Orthopaedic Pediatrics

There has been a gap in how to evaluate physical functioning and gait in ambulatory school-aged children and youth with Cerebral Palsy. Two novel assessments has been developed. Before recommending the interpretation in clinic and research, it is crucial to investigate their applicability.
This PhD project presents the reliability, validity and feasibility of the Challenge assessment and the Gait Outcomes Assessment List questionnaire. Subsequently, their applicability for evaluation of a group-based motor skills programme were investigated.
This PhD project addresses the need for appropriate outcome measures for assessing, planning and evaluating advanced motor skills and functional activities in ambulatory school-aged children and young people with cerebral palsy. The project seeks answer to two main questions: How can we best and most objectively assess their physical functions and gait and at the same time include the children's own perspectives on their functioning in daily activities? Moreover, how we can estimate change after a group-based motor skills enhancement intervention?
Health care professionals use various different outcome measures for assessment of advanced gross motor functions. Evidence from the literature underscores the importance of using cerebral palsy-specific assessments. In addition to the use of objective outcome measures, it is also recommended to use patient-reported outcome measures (PROMs) for planning and evaluation of the results of an intervention.

This dissertation encompasses three studies that explored the applicability of two novel assessment instruments: The Challenge assessment and the Gait Outcome Assessment List (GOAL) questionnaire. Before recommending a particular assessment for planning and evaluation of an intervention, it is critical to investigate its reliability, validity and feasibility. Prior to assessing the usability of the outcome measures of Challenge and GOAL, it was necessary to translate and adapt them to the Danish setting. Participants’ satisfaction with and adherence to the assessments were also studied. Finally, we investigated whether an improvement in patients’ motor skills could be measured after they had participated in a 10-week group-based motor skills enhancement program.

Study I The English version of Challenge was translated into Danish. Subsequently its reliability (interrater-, intra-rater- and test-retest reliability) was evaluated. Results revealed excellent reliability of the Danish Challenge for live assessment and video recorded assessments alike. The Danish version of Challenge maintained a minimal detectable change of less than five points.

Study II The English version of GOAL, child and parents proxy versions, was translated into Danish. Subsequently its validity (face and content-, discriminative validity) and test-retest reliability were evaluated. The correlation of child and parents’ ratings and the concurrent validity of GOAL and Challenge were evaluated. The results revealed excellent reliability of the Danish GOAL-Child and good reliability of GOAL-Parent. GOAL discriminated between Gross Motor Function Classification levels I and II with the highest scores being obtained in children at level I. Children’s and parents’ scores were positive correlated. However, children consequently scored themselves higher than their parents did. We found a weak correlation between GOAL and Challenge.

Study III We investigated the combined use of Challenge and GOAL as the primary outcomes in a 10-week group-based intervention with individual supervision named: ‘Moving Together’, in Danish: ‘Sammen i Bevæglese’. Assessments were performed at four time-points before and after the intervention, and at three and six months of follow-up. The intervention encompassed six group-based training sessions and four training sessions conducted in activity centres in the community and six individual sessions of supervision. Ten ambulatory children aged 7-14 years and their parents participated. Satisfaction with assessments was high for Challenge and moderate for GOAL. Assessment time and attendance met the preset thresholds. Overall, the children and their parents were satisfied with the intervention as evidenced by an attendance rate of 83%, meeting the preset threshold. The children achieved enhanced positive motor skills measured with Challenge and GOAL. Moreover, children’s and parents’ free-text statements from the intervention aligned with all dimensions in relation to the International Classification of Functioning framework (ICF).

To our knowledge, this is the first study to study the combined use of Challenge and GOAL. The results suggest that both instruments are feasible in a group-based motor skills enhancement intervention. They provide various and important information when assessing advanced motor skills in walking school-aged children. Moreover, attendance, satisfaction and the magnitude of the positive change scores suggest that the ‘Moving Together’ conducted intervention was viable and applicable. In addition, children were able to improve their advanced gross motor functions.

Reliability and minimal detectable change of the Challenge, an advanced motor skills test for
children with cerebral palsy, Danish version.
Kirsten Nordbye-Nielsen, Thomas Maribo, F. Virginia Wright, Ole Rahbek & Bjarne Møller-Madsen

Published: https://doi.org/10.1080/09638288.2021.1906332