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Symptomatic asymmetry in very young infants: a Delphi study on the development of a screening instrument
J Nuysink1, I C van Haastert, T Takken
1Child Development and Exercise Center, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. j.nuysink@umcutrecht.nl
Insights
Pediatric physiotherapists developed a new screening tool to identify infant head posture asymmetry. This instrument aids in differentiating symptomatic asymmetries in infants under six months old.
Area of Science:
- Pediatrics
- Physical Therapy
- Developmental Pediatrics
Background:
- Asymmetric head posture is common in infants.
- Distinguishing symptomatic from non-symptomatic asymmetry is crucial for timely intervention.
- Existing clinical evaluation methods may lack standardized criteria for differentiating causes.
Purpose of the Study:
- To develop a screening instrument for pediatric physiotherapists.
- To aid in distinguishing symptomatic asymmetry in infants with asymmetric head posture.
- To establish clear clinical diagnostic criteria (CDC) and identify red flags.
Main Methods:
- Utilized a two-round Delphi design and nominal group technique for expert consensus.
- Involved six medical specialists and seven pediatric physiotherapists.
- Assessed 17 diagnoses and 69 clinical diagnostic criteria, refined to 10 diagnoses and 21 CDC, plus 8 red flags.
Main Results:
- Achieved high panel consistency (Cronbach's-α = 0.89) in the Delphi rounds.
- Developed a differential diagnostic screening instrument comprising a classification scheme, CDC, and red flags.
- The instrument is based on literature review and expert consensus.
Conclusions:
- A consensus-based screening instrument was successfully developed.
- The instrument aims to improve the accuracy of differentiating causes of asymmetric head posture in infants.
- Future research will focus on the cross-validity and reliability of this new tool.
Abstract:
The objective of this study was to develop a screening instrument for pediatric physiotherapists to distinguish a symptomatic asymmetry in the clinical evaluation of young infants (age <6 months) with an asymmetric head posture. We chose two consensus methods, a two-round Delphi design and an expert meeting using nominal group technique, for reaching agreement about classification of diagnoses and clinical diagnostic criteria (CDC). Seventeen diagnoses with an expression of asymmetry with 69 matching CDC were assessed. In two Delphi rounds, six medical specialists and seven pediatric physiotherapists were polled anonymously on the classification, completeness, and relevance of the diagnoses and the CDC. Panel consistency in round 2, expressed as Cronbach's-α, was 0.89. In round 3, a face-to-face meeting with eight therapists, the previously selected diagnoses and CDC were prioritised, reduced to 10 diagnoses and 21 CDC, and completed with eight hard clinical signs (red flags). Finally, a differential diagnostic screening instrument, containing a classification scheme, the CDC for differential diagnostics, and a list of "red flags" was established on the basis of literature search and expert consensus. Cross-validity and reliability of the instrument will be investigated in future research.
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