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Construct validity of the Quality of Upper Extremity Skills Test for children with cerebral palsy
Megan Thorley1, Natasha Lannin, Anne Cusick
1The Rehabilitation Studies Unit, University of Sydney and Queensland Cerebral Palsy Health Service, Royal Children's Hospital, Brisbane, Australia. m.thorley@uq.edu.au
Insights
The Quality of Upper Extremity Skills Test (QUEST) is not a unidimensional measure for children with cerebral palsy (CP). Reporting domain and limb-specific scores is recommended over total scores for better validity.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Biomedical Engineering
Background:
- Cerebral palsy (CP) significantly impacts upper extremity function in children.
- The Quality of Upper Extremity Skills Test (QUEST) is commonly used to assess these functional limitations.
- Understanding the psychometric properties of assessment tools is crucial for accurate clinical evaluation.
Purpose of the Study:
- To evaluate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in pediatric cerebral palsy.
- To determine if the QUEST functions as a unidimensional measure for children with CP.
- To identify specific areas of the QUEST that may require revision for improved clinical utility.
Main Methods:
- A retrospective analysis of 170 QUEST assessments from 94 children with cerebral palsy (GMFCS levels I-V) was conducted.
- Data from children involved in clinical and research treatment programs were utilized.
- Statistical methods were employed to assess the unidimensionality and item fit of the QUEST.
Main Results:
- The QUEST did not demonstrate unidimensionality when analyzing total scores.
- Item fit improved when domains and individual limbs were analyzed separately.
- Items related to elbow flexion and forearm pronation showed low sensitivity; grasp domain posture items exhibited erratic behavior and poor correlation with total scores.
Conclusions:
- Total scores from the QUEST are not recommended for use in children with CP due to poor construct validity.
- Reporting results segmented by domain and by limb is advised for more accurate interpretation.
- The removal of grasp domain posture items from the QUEST is recommended due to their lack of relationship with overall scores.
Aim:
The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP).
Method:
A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD 2y 11mo, range 2-16y; Gross Motor Function Classification System levels I-V) were reviewed.
Results:
The QUEST was not unidimensional; many items demonstrated poor fit when total scores were analysed; goodness of fit improved when domains were considered independently and limbs separately examined. QUEST items involving elbow flexion and/or forearm in pronation were easily achieved, thus reducing test sensitivity. Postures items in the grasp domain behaved erratically, with little total score relationship.
Interpretation:
Calculating total scores is discouraged. Reporting QUEST results separately for domains and each limb is recommended. Posture items in the grasp domain had little relationship with total scores and it is recommended that they be removed from the test.
