Researchers who created a Southampton Hand Assessment Procedure for pediatric use found that participants were able to perform all objects and tasks with better intra-rater reliability compared with inter-rater reliability, according to study results.
“Children [who] have their upper limbs affected by conditions, such as congenital reduction defects or spasticity, or acquired injuries may suffer from a certain degree of impairment. Health care professionals working with this group of patients need a functional test that could be applied across any type of condition in order to assess the functionality level with the affected upper limb,” Ecaterina Vasluian, MSc, student of rehabilitation medicine at the University Medical Center Groningen, University of Groningen, The Netherlands, told O&P Business News. “Applicable for adults only, the Southampton Hand Assessment procedure (SHAP) is a measurement instrument assessing the functionality of any type of hands — from normal, injured or even prosthetic hands, [which] are often used by children with upper limb reduction deficiencies … Therefore, the purpose of the study was to make the first steps in creating a SHAP for children.”
Along with Corry K van der Sluis, MD, PhD, professor of rehabilitation medicine in the Department of Rehabilitation Medicine at the University of Groningen, and colleagues, Vasluian adapted the SHAP for pediatric use (SHAP-C) by downsizing some objects and assigning the timing of each task to a rater instead of the participant. Assessment of intra-rater and inter-rater reliability was performed for 24 children with unimpaired hands and repeatability coefficients (RC) were calculated. Mean SHAP-C task values were considered good reliability if they had a RC of 75% or less.
According to study results, all participants were able to perform all SHAP-C tasks with means for abstract objects ranging from 0.75 seconds to 1.21 seconds and means for activities of daily living (ADL) ranging from 0.64 seconds to 19.13 seconds. In light extension, heavy lateral, heavy extension, pour water from jug and open/close a zipper tasks, girls were slower than boys, while participants performing tasks with their dominant hand were faster in heavy extension, food cutting and page turning.
When it came to intra-rater reliability, researchers found light power, light tip, light extension, heavy tripod and heavy power had relative RCs greater than 75%, while the other seven tasks had relative RC values of 75% or less. Relative RCs for ADL tasks only exceeded 75% in undo buttons, food cutting, rotate a key 90° and open/close a zipper.
Except for the heavy sphere task, the relative RC values for inter-rater reliability were all greater than 75% for abstract objects. In the majority of ADLs, researchers found relative RCs were greater than 75%. Relative RCs were 75% or less for pick up coins, pour water from jug, pour water from carton and move a tray.
“The fact that all the SHAP-C objects and tasks were suitable for children demonstrated that the functional test has great potential for its applicability in clinical practice,” Vasluian said. “SHAP-C may be used reliably when one rater records the task times. The functional scores of SHAP-C derived from more than one rater should be interpreted with caution, especially in individual cases. Since the differences in task means were small between different raters on a group level, [the research] suggests that using SHAP-C for group comparisons is acceptable.”
Causes of variation in performance
Throughout the study, researchers found unreliability among some of the tasks. While these variations in performance may be due to variability in reaction times of the assessors or variability in motor development among the participants, another risk factor for variation in performance could be distraction among the participants. Although assessors created a playful atmosphere and rewarded performance with positive reinforcement, candy, the opportunity to color and draw and animal stickers, researchers found the motivation of some children varied during different tasks and sessions. The researchers believe substituting some tasks with play and using colorful objects, as well as providing clear instructions may improve motivation and reduce distraction.
“Possible reasons for the poor inter-rater reliability may be natural variability or lack of motivation in children, or variability in reaction time of the assessors when timing the performance,” Vasluian said. “Therefore, focusing on improving or diminishing these possible factors influencing reliability would help develop a reliable functional test for clinicians.” — by Casey Tingle
For more information:
Vasluian E. BMC Musculoskelet Disord. 2014;doi:10.1186/1471-2474-15-199.
Disclosure: Vasluian has no relevant financial disclosures. Funding was provided by ZonMW, Fonds Nuts, Revalidatiefonds, Stichting Beatrixoord and OIM Stichting.