Date Presented 04/13/21
This study assesses reliability and accuracy of the Head Control Scale (HCS) when used by inexperienced raters. Physical therapy and OT students used the HCS to rate five videotaped pediatric subjects. The kappa coefficient for interrater reliability among students was "almost perfect" (>.80). In one subscale, when comparing student raters with clinicians, there was strong agreement in grading between each group. The HCS may be consistently used by both new and experienced raters.
Primary Author and Speaker: Amy Armstrong-Heimsoth
Additional Authors and Speakers: Emily Mei Chun, Elizabeth Diane Hesse, Kelsey E. Ranneklev, and Camila E. Sanchez
PURPOSE: There is not currently a widely implemented and validated objective instrument to assess head control in children. Because of this, the Head Control Scale (HCS) was developed (Thomas et al., 2019). The HCS was designed to be used with minimal training or expertise; however, its reliability for this use has not yet been investigated. The purpose of this study is to determine inter-rater reliability of the HCS when used by inexperienced raters. Previous research determined the HCS to have almost perfect inter-rater reliability when utilized by experienced clinicians. This study examines if clinical experience is required to use the scale for assessment of head control in a reliable and effective manner.
DESIGN: This study was a quasi-experimental study, and participants were occupational and physical therapy students, over the age of 18. The study was conducted at a university campus. These participants were recruited during class time with permission from the course instructors. Participation was voluntary with no impact on course grade, and informed consent was collected prior to data collection from all raters. The participants rated five different videotaped pediatric subjects; these included a 3-year-old child with cerebral palsy, a 17-month-old child with Down syndrome, and three typically-developing children aged 16 months old, 6 weeks old, and 10 days old.
METHODS: First and second year physical and occupational therapy students were shown five videotaped subjects of varying ages and abilities. Each video showed subjects for 30-40 seconds in each of four positions (supine, prone, supported sitting, and pull-to-sit). Students then utilized the HCS to rate each subject on a 0-4 rating scale for each of the four positions.
RESULTS: Based on the kappa coefficient statistic, inter-rater reliability among all students was ‘almost perfect’ in each of the positions and in the total overall rating of head control (> 0.80). Among the students, the positions supine and pull-to-sit had no evidence of inconsistent rating. For the pull-to-sit subscale, it also appeared that there was homogeneity between the ratings of the students and experienced clinicians, and that each group used the scale in the same way across all five videos for the given subscale. However, among the other positions assessed, (prone, supine, and sitting), there was evidence of significant differences in scale use between the two groups (p < 0.05).
CONCLUSION: The Head Control Scale has almost perfect inter-rater reliability when used with first and second year PT and OT students. However, these inexperienced raters were sometimes inconsistent in grading when compared to the ratings provided by experienced clinicians. When compared to experienced clinicians, inexperienced raters (students) show mixed consistency in using the HCS to grade different subjects. It is likely that inexperienced raters may be able to use the HCS for low complexity cases, but more clinical experience may be required to utilize the HCS effectively and reliably with higher complexity cases. Overall, it is clear that the HCS has the potential to be scored consistently by inexperienced raters, such as students and new practitioners. This research is applicable and timely because there is currently no gold standard assessment tool to measure pediatric head control, which is an important developmental milestone and impacts overall motor development.
IMPACT STATEMENT: This study is important to practice because it further establishes the reliability and range of use for one of the only pediatric head control assessment tools available for use with infants and children.
References
Thomas, J., Armstrong-Heimsoth, A., & Laurent, R. S. (2019). The Head Control Scale: Development, inter-rater reliability, and utility. Journal of pediatric rehabilitation medicine, 12(3), 295–303. https://doi.org/10.3233/PRM-180574
Barbosa, V. M., Campbell, S. K., Smith, E., & Berbaum, M. (2005). Comparison of test of infant motor performance (TIMP) item responses among children with cerebral palsy, developmental delay, and typical development. American Journal of Occupational Therapy, 59(4), 446–456. https://doi.org/10.5014/ajot.59.4.446
Lee, H. M., & Galloway, J. C. (2012). Early intensive postural and movement training advances head control in very young infants. Physical therapy, 92(7), 935–947. https://doi.org/10.2522/ptj.20110196
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