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Development of a parent-report computer-adaptive test to assess physical functioning in children with cerebral palsy
Carole A Tucker1, Kathleen Montpetit, Nathalie Bilodeau
1Temple University, Philadelphia, PA 19140, USA. tuckerc@temple.edu
Insights
This study validated a computer-adaptive test (CAT) for assessing upper-extremity function in children with cerebral palsy (CP), showing it accurately measures skills and distinguishes between functional levels.
Area of Science:
- Pediatric Rehabilitation
- Clinical Measurement
- Biostatistics
Background:
- Children and adolescents with cerebral palsy (CP) often experience upper-extremity impairments affecting daily activities.
- Accurate and efficient measurement tools are crucial for monitoring progress and guiding interventions in pediatric CP.
- Existing assessments may lack the precision or adaptability needed for diverse CP populations.
Purpose of the Study:
- To psychometrically evaluate an item bank for upper-extremity skills in children with CP.
- To assess the performance of a simulated computer-adaptive test (CAT) using this item bank.
- To examine the validity and reliability of the CAT against established measures and clinical classifications.
Main Methods:
- Developed and calibrated an item bank for upper-extremity skills in 180 children/adolescents with CP (ages 2-21).
- Utilized confirmatory factor analysis to establish unidimensionality of the item pool.
- Simulated CATs (5, 10, 15 items) and evaluated accuracy, correlation with PODCI, and discrimination across Manual Ability Classification System (MACS) levels.
Main Results:
- A unidimensional model was supported for 49 of 53 upper-extremity items.
- Simulated CATs showed excellent accuracy (ICC >0.93) and high correlation with the PODCI upper-extremity core scale (ICC 0.79).
- The CAT effectively discriminated between different MACS levels, indicating good discriminant validity.
Conclusions:
- The developed item bank and simulated CAT demonstrate strong psychometric properties for assessing upper-extremity function in pediatric CP.
- The CAT shows promise as an accurate, valid, and efficient tool for evaluating physical function in children and adolescents with CP.
- This work supports the future development and refinement of CATs for parent-reported physical function in this population.
Abstract:
The specific aims of this study were to (1) examine the psychometric properties (unidimensionality, differential item functioning, scale coverage) of an item bank of upper-extremity skills for children and adolescents with cerebral palsy (CP); (2) evaluate a simulated computer-adaptive test (CAT) using this item bank; (3) examine the concurrent validity of the CAT with the Pediatric Outcomes Data Collection Instrument (PODCI) upper-extremity core scale; and (4) determine the discriminant validity of the simulated CAT with Manual Ability Classification System (MACS) levels and CP type (i.e. diplegia, hemiplegia, or quadriplegia). Parents (n=180) of children and adolescents with CP (spastic diplegia 49%, hemiplegia 22%, or quadriplegia 28%) consisting of 102 males and 78 females with a mean age of 10 years 6 months (SD 4y 1mo, range 2-21y), and MACS levels I through V participated in calibration of an item pool and completed the PODCI. Confirmatory factor analyses supported a unidimensional model using 49 of the 53 upper-extremity items. Simulated CATs of 5, 10, and 15 items demonstrated excellent accuracy (intraclass correlation coefficient [ICCs] >0.93) with the full item bank, had high correlations with the PODCI upper-extremity core scale score (ICC 0.79), and discriminated among MACS levels. The simulated CATs demonstrated excellent overall content coverage over a wide age span and severity of upper-extremity involvement. The future development and refinement of CATs for parent report of physical function in children and adolescents with CP is supported by our work.
