Inter-observer reliability using the General Movement Assessment is influenced by rater experience.

Area of Science:

• Neurology
• Developmental Pediatrics
• Movement Science

Background:

• Cerebral palsy (CP) is a common motor disability in children.
• Early detection of CP is crucial for timely intervention.
• The General Movement Assessment (GMA) is a validated tool for assessing neurological development in infants.

Purpose of the Study:

• To evaluate the inter-observer reliability of the Prechtl General Movement Assessment (GMA).
• To assess the impact of rater experience on GMA reliability.
• To examine the reliability of classifying fidgety movements (FMs) in high-risk infants.

Main Methods:

• 150 infants at high risk for CP were video-assessed at 10-15 weeks corrected age.
• Three Prechtl GMA-certified observers with varying experience rated the videos.
• Inter-observer agreement was analyzed using Gwet's AC1 statistic for FM temporal organization.

Main Results:

• Fair to moderate agreement was found for subcategories of normal FMs (AC1 = 0.32-0.57).
• Moderate to near-perfect agreement was achieved when normal FM categories were combined (AC1 = 0.60-0.95).
• Higher reliability was observed among more experienced raters (AC1 = 0.57-0.98) compared to less experienced ones (AC1 = 0.32-0.61).

Conclusions:

• The GMA demonstrates high reliability among experienced raters for categorizing normal FMs.
• Caution is advised when using the GMA to differentiate between continuous and intermittent FMs.
• The GMA is a reliable tool for assessing infants at high risk for CP, especially with experienced observers.