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Checks and balances: a meta-analysis on the known-groups validity of functional postural control tests in children
Jorn Ockerman1, Silke Velghe2, Anke VAN Bladel1
1Unit of Pediatric Rehabilitation Research of Ghent, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
Insights
Pediatric functional postural control tests show varying validity in identifying deficits in children with disorders. Test batteries appear more effective than single-task tests, with pathology influencing results more than age.
Area of Science:
- Pediatric physical therapy
- Clinical assessment
- Motor control research
Background:
- Pediatric physical therapists frequently encounter children with postural control deficits.
- Effective functional postural control tests are crucial for identifying these deficits across various pediatric disorders.
- Existing evidence for the validity, particularly known-groups validity, of these tests is limited.
Purpose of the Study:
- To systematically review and determine the known-groups validity of functional postural control tests in children.
- To assess the ability of these tests to differentiate between pediatric pathological groups and typically developing peers.
- To analyze the influence of pathology and age on test validity.
Main Methods:
- A systematic search of PubMed, Web of Science, and Scopus databases was conducted (up to February 2023).
- Forty case-control studies involving 1331 children with pathologies and 1889 typically developing peers were included.
- Random-effect meta-analyses were performed to estimate pooled standardized mean differences (SMD), with risk of bias and level of evidence assessed.
Main Results:
- Children with pathologies performed significantly worse on test batteries (SMD=-2.21), Timed Up and Go variants (SMD=2.30), and One Leg Stance variants (SMD=-2.14) compared to typically developing peers.
- Reach tests showed a smaller difference (SMD=-1.19).
- Pathology significantly influenced test batteries and One Leg Stance tests, while age influenced Reach tests. All tests had a low level of evidence.
Conclusions:
- Functional postural control test batteries demonstrate higher known-groups validity than single-task tests for pediatric populations.
- The type of underlying pathology is a more significant factor in test validity than the child's age.
- A low level of evidence necessitates further research with homogenous groups and norm-referenced data to improve the validity of pediatric functional postural control tests.
Introduction:
Pediatric physical therapists commonly treat children with postural control deficits. Ideally, pediatric functional postural control tests should therefore be able to identify postural control deficits in children with various disorders. Despite a plethora of available tests, evidence for their validity - especially known-groups - remains scarce. This review aims to determine the known-group validity of available functional postural control tests to differentiate various pediatric pathological groups of different ages from their typically developing (TD) peers.
Evidence Acquisition:
PubMed, Web of Science and Scopus were systematically searched (last update: February 2023; PROSPERO: CRD42023408982). Forty case-control studies with a pathological pediatric sample (N.=1331) and TD peers (N.=1889) were included and selected for data-extraction and -analysis. Risk of bias was assessed using the SIGN checklist and level of evidence was scored using GRADE. Random-effect meta-analyses were performed to estimate pooled standardized mean differences (SMD) for the various test types and subclassified based on pathology and/or age.
Evidence Synthesis:
When compared with TD peers, children with underlying pathologies performed significantly worse on pediatric functional postural control test batteries (SMD=-2.21), the Timed Up and Go Test and variants (SMD=2.30), the One Leg Stance test and variants (SMD=-2.14), while the Reach tests showed a smaller difference (SMD=-1.19). Subclassification within the meta-analyses showed that pathology was an influencing factor for the test batteries and the one leg stance test and variants. Age was an influencing factor for the reach tests. None of the included functional postural control tests exceeded a low level of evidence.
Conclusions:
Pediatric functional postural control tests that assess multiple aspects of postural control (such as test batteries) seem to offer higher known-groups validity than single-task tests (e.g. reach tests). The underlying pathology has a larger impact on the validity of these tests than age. There remains an overall low level of evidence for the known-groups validity of pediatric functional postural control tests indicating the need for research with more homogenous groups and norm reference data.
