Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The Hand–Object Observation Tool is a valid systematic observational tool developed to measure upper extremity functioning in children with bilateral cerebral palsy. Using a valid systematic strategy to observe hand–object interaction during daily activities provides clinicians with the much-needed information regarding upper extremity function and optimal object placement to facilitate hand use, task completion, and participation in daily activities.
Primary Author and Speaker: Amanda Sarafian
Contributing Authors: Katherine Dimitropoulou, Madhabi Chatterji, and Andrew Gordon
PURPOSE: The purpose of this study was to (a) develop an observational tool, the Hand-object Observation Tool (HOOT), to evaluate upper extremity functioning in children with bilateral cerebral palsy (BCP) during everyday tasks, and (b) determine the tool's content validity, preliminary inter-rater reliability, and internal consistency.
DESIGN: A theory-based domain framework on upper extremity movement and functioning was developed to design and validate a formal observational tool of hand-object interaction during daily activities in children with BCP, more specifically, children and youth between the ages of 5 and 17, classified as GMFCS Levels III, IV, and V. We used a mixed methods approach to examine the content validity of the tool and a quantitative approach for establishing preliminary interrater reliability and internal consistency.
METHOD: The HOOT was developed, standardized, and evaluated for content validity via expert review and feedback regarding relevance for children with BCP. To establish content validity, we administered the tool to three children (n = 3; mean age = 12 years) diagnosed with BCP, GMFCS III (triplegia), IV, and V (quadriplegia). Eight expert clinicians (n = 8; mean years of clinical experience working with children with cerebral palsy = 19.75 years; 2 physical therapists and 6 occupational therapists) completed the content validity index (CVI). Qualitative feedback, regarding item relevance to upper extremity functioning in children with BCP, was analyzed utilizing classical content analysis. For preliminary reliability, six children and youth (n = 6; mean age = 12.55 years) diagnosed with BCP, GMFCS III, IV and V and occupational therapists (n = 3) participated in the study. The three licensed therapists observed and scored video-recordings of the tool administration. For the interrater reliability, scores from each therapist were compared to scores of the primary investigator (gold standard). Cohen’s kappa was used to determine inter-rater reliability and preliminary internal consistency of items was analyzed using Cronbach’s alpha coefficient.
RESULTS: The content of the HOOT was consistent with expert opinions of upper extremity functioning in children with BCP. All HOOT items met the criteria for excellent content validity index for single items (I-CVI within.75 to 1.0) and the overall scale index (S-CVI/Ave = .90). This study further suggests that HOOT scores are reliable indicators of upper extremity functioning in children with BCP. Rater agreement between occupational therapy raters and the gold standard was almost perfect when scoring hand-object interaction (touch, grasp, transport, manipulate, place, and release). Inter-rater reliability coefficients ranged from .81 to 1.0 (Cohen k). Rater agreement was substantial to almost perfect (.61 to 1.0) for hand use and poor to almost perfect (0-1.0) for maintenance of posture during tasks. Preliminary internal consistency coefficient for the scale (sum) score was 1.0 which provides some evidence for further evaluation of HOOT scores.
CONCLUSION: The pediatric upper extremity functioning assessment, developed and validated in this study, fills a gap in the literature regarding the quality of reaching and grasping abilities in children with BCP, GMFCS III-V, and provides the unique opportunity for clinicians to better understand and systematically measure upper extremity functioning and abilities in children with BCP. Further research is required to (a) gather additional data from trained clinicians administering the HOOT in community-based settings to more than 30 children with BCP, and (b) analyze scores and performance to determine internal consistency of HOOT items and complete tool refinement and dissemination.
References
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