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Psychometric properties of functional postural control tests in children: A systematic review
Charlotte Johnson1, Ann Hallemans2, Mieke Goetschalckx3
1Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, 2610 Wilrijk, Belgium; Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, 3590 Diepenbeek, Belgium.
Insights
Pediatric postural control tests show good reliability but inconsistent validity. Only two tests, Kids-BESTest and FAB, cover all postural control systems, highlighting a need for further research.
Area of Science:
- Pediatric physiotherapy
- Motor control research
- Clinical assessment tools
Background:
- Postural control deficits are common in pediatric physiotherapy, necessitating accurate evaluation for treatment planning and efficacy assessment.
- Currently, no gold standard exists for evaluating pediatric postural control deficits, despite increased research into functional test psychometric properties.
Approach:
- A systematic review following PRISMA guidelines was conducted, searching PubMed, Web of Science, and Scopus.
- Studies were selected using the PICOS method, focusing on pediatric populations, functional postural control tools, and psychometric properties.
- Risk of bias was assessed using the COSMIN checklist, and evidence levels determined by GRADE, with postural control systems mapped for each test.
Key Points:
- Seventy studies evaluated 26 postural control tests, primarily in healthy children or those with cerebral palsy.
- While most tests demonstrated good reliability (ICC>0.70), validity results were inconsistent across studies.
- Only the Kids-BESTest and FAB assessments covered all postural control systems; evidence for measurement properties was generally low to very low.
Conclusions:
- Currently, only two functional tests fully encompass the construct of postural control in children.
- Test reliability is generally good, but validity is influenced by the specific task, child's age, and underlying pathology.
- Future research should prioritize test batteries and investigate structural validity and responsiveness in diverse pediatric populations using robust methodologies.
Background:
Postural control deficits are one of the most common impairments treated in pediatric physiotherapeutic practice. Adequate evaluation of these deficits is imperative to identify postural control deficits, plan treatment and assess efficacy. Currently, there is no gold standard evaluation for postural control deficits. However, the number of studies investigating the psychometric properties of functional pediatric postural control tests has increased significantly.
Objective:
To facilitate the selection of an appropriate pediatric functional postural control test in research and clinical practice.
Methods:
Systematic review following the PRISMA guidelines. PubMed, Web of Science and Scopus were systematically searched (last update: June 2022; PROSPERO: CRD42021246995). Studies were selected using the PICOs-method (pediatric populations (P), functional assessment tools for postural control (I) and psychometric properties (O). The risk of bias was rated with the COSMIN checklist and the level of evidence was determined with GRADE. For each test, the postural control systems were mapped, and the psychometric properties were extracted.
Results:
Seventy studies investigating 26 different postural control tests were included. Most children were healthy or had cerebral palsy. Overall, the evidence for all measurement properties was low to very low. Most tests (95%) showed good reliability (ICC>0.70), but inconsistent validity results. Structural validity, internal consistency and responsiveness were only available for 3 tests. Only the Kids-BESTest and FAB covered all postural control systems.
Conclusion:
Currently, 2 functional tests encompass the entire construct of postural control. Although reliability is overall good, validity results depend on task, age and pathology. Future research should focus on test batteries and should particularly explore structural validity and responsiveness in different populations with methodologically strong study designs.
