Test-retest, inter-assessor and intra-assessor reliability of the modified Touwen examination

Interest in the Touwen examination (1979) for the assessment of minor neurological dysfunction (MND) is growing. However, information on psychometric properties of this assessment is scarce. Therefore the present study aimed at assessing the test's test-retest, inter- and intra-assessor reliability. Eleven boys and 14 girls, visiting a mainstream school, aged 4-12 years, were tested neurologically by 3 investigators. Inter- and intra-assessor reliability were based on videotapes of the assessments. To determine test-retest reliability children were re-assessed after about 1 month. The various forms of reliability were calculated for neurological classification (normal, simple MND, complex MND), clusters of dysfunction and single items. Twelve girls and 7 boys showed a normal neurological condition; 2 girls and 1 boy were classified as having simple MND and 3 boys as having complex MND. The 3 forms of reliability for neurological classification were good (kappa=0.71-0.83). Reliability for the majority of cluster scores was good. Test-retest agreement was moderate for the clusters reflexes and coordination and poor for fine manipulation; inter-assessor agreement was moderate for the clusters coordination and fine manipulation; intra-assessor agreement moderate for fine manipulation. Reliability for the majority of items was good. In conclusion, the Touwen examination has a moderate to good reliability when applied in a relatively healthy population. Whether reliability is similarly good in populations of children with minor developmental disorders has to be determined.