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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2014 Ottobre;50(5):543-56
A new scale for the assessment of performance and capacity of hand function in children with hemiplegic cerebral palsy: reliability and validity studies
Rosa-Rizzotto M. 1, Visonà Dalla Pozza L. 1, Corlatti A. 2, Luparia A. 3, Marchi A. 2, Molteni F. 4, Facchin P. 1, Pagliano E. 2, Fedrizzi E. 2 ✉
1 Epidemiology and Community Medicine Unit, Department of Pediatrics, University of Padua, Padua, Italy;
2 Division of Developmental Neurology, C. Besta National Neurological Institute, Milan, Italy;
3 Department of Child Neurology and Psychiatry, IRCCS C. Mondino Institute of Neurology, University of Pavia, Pavia, Italy;
4 Scientific Research Institute Eugenio Medea, Bosisio Parini, Lecco, Italy
BACKGROUND: In hemiplegic children, the recognition of the activity limitation pattern and the possibility of grading its severity are relevant for clinicians while planning interventions, monitoring results, predicting outcomes.
OBJECTIVE: Aim of the study is to examine the reliability and validity of Besta Scale, an instrument used to measure in hemiplegic children from 18 months to 12 years of age both grasp on request (capacity) and spontaneous use of upper limb (performance) in bimanual play activities and in ADL.
DESIGN: Psychometric analysis of reliability and of validity of the Besta scale was performed.
SETTING: Outpatient study sample.
METHODS: Reliability study: A sample of 39 patients was enrolled. The administration of Besta scale was video-recorded in a standardized manner. All videos were scored by 20 independent raters on subsequent viewing. 3 raters randomly selected from the 20-raters group rescored the same video two years later for intra-rater reliability. Intra and inter-rater reliability were calculated using Intraclass Correlation Coefficient (ICC) and Kendall’s coefficient (K), respectively. Internal consistency reliability was assessed using Alpha’s Chronbach coefficient. Validity study: a sample of 105 children was assessed 5 times (at t0 and 2, 3, 6 and 12 months later) by 20 independent raters. Each patient underwent at the same time to QUEST and Besta scale administration and assessment. Criterion validity was calculated using rho-Pearson coefficient.
RESULTS: Reliability study: The inter-rater reliability calculated with Kendall’s coefficient resulted moderate K=0.47. The intra-rater (or test-retest) reliability for 3 raters was excellent (ICC=0.927). The Cronbach’s alpha for internal consistency was 0.972. Validity study: Besta scale showed a good criterion validity compared to QUEST increasing by age and severity of impairment. Rho Pearson’s correlation coefficient r was 0.81 (P<0.0001).
Limitations. Besta scales in infants finds hard to distinguish between mild to moderately impaired hand function.
CONCLUSIONS: Besta scale scoring system is a valid and reliable tool, utilizable in a clinical setting to monitor evolution of unimanual and bimanual manipulation and to distinguish hand’s capacity from performance.