Article Review for AIMS (2017-Concurrent Validity Between Live and Home Video Observations Using the Alberta Infant Motor Scale.)
Title: Concurrent Validity Between Live and Home Video Observations Using the Alberta Infant Motor Scale.
Purpose: The purpose of this study was to compare the validity of an Alberta Infant Motor Scale (AIMS) assessment via video recorded observation versus live, in-person observation.
Study Population: 48 infants and parents were included in this study (ages 1.5 – 19 months). They were recruited to volunteer via a convenience sample at local clinics birth centers. Infants with known or observed abnormal movement patterns were excluded from the study. Parents that were physical therapists were also excluded due to their background and understanding of motor development.
Prior to Testing: An instructional video and checklist developed by pediatric physical therapists and researches, was provided to parents to inform the parents on how to record a video in which their infant’s motor performance can more easily be assessed by the testers. A different set of instructions and checklists were provided to parents based on the infants age group (group 1: 0 to 5.5 months, group 2: 5.5 to 8.5 months, and group 3: 8.5 to 19 months). All parents were instructed to have their infant only wearing a onesie and diaper. Twelve pediatric physical therapists that were familiar with the AIMS, underwent two, three-hour training sessions on AIMS scoring and administration guidelines. To qualify as a tester for this study, they also had to score two video-recorded AIMS assessments and score within two points of the consensus score for those respective videos.
Testing Itself: One tester would schedule an appointment with the parents. While one parent (or a family friend) held the video camera, mobile phone, or tablet, the other parent would be responsible for handling the child, introducing toys to the child, or interacting with the child. The tester simply sat to the side and scored the AIMS based on their observations, without any prompting of the child or parent. Recording was completed when the child had the opportunity to perform movements in each of the four positions (prone, supine, sitting, standing). Following the recorded session, another tester (that was blinded to the first tester’s AIMS score) watched the recorded video and also scored the AIMS based on their observations. Throughout the course of the study, testers would be randomized as to which role they played (in person observation or video observation).
Comparing Test Scores: Interclass correlation coefficients (ICCs) for a 3-way mixed effect model was used to analyze concurrent validity. A value of 0.90 was considered the accepted level of agreement. Limits of Agreement was also used to visualize differences of the two measurements. The SEM was then used to measure the error between the two scores and calculate the smallest detectable change. Lastly, the mean difference was analyzed by a 1-tailed t-test.
Results: Out of 48 cases, twelve of the AIMS scores were in absolute agreement. In twenty-three of the cases, the video recorded scores were higher, while the other thirteen cases had higher scores in the live observations. The mean difference between live observation scores and video recorded scores was 0.46 (standard deviation = 1.98), but this value was not considered significant (P = .115; 95% confidence interval [CI] = −0.116 to +1.033). The ICC between the two testing groups (live and recorded) was 0.99. These results show that whether AIMS assessments are made in person or from a video recording, the assessment scores are likely to be similar.
Strengths: I think the strength of this study is the results. The fact that similar AIMS scores are able to be assessed both in person and over a video could potentially change the way initial assessments or follow up assessments are able to be done. The fact that motor skills can adequately be assessed over video could be very influential for telehealth treatments and evaluations.
Limitations: I think the limitation of this study is the fact that in a typical clinical setting, not every parent is going to receive a checklist of instructions for what type of video needs to be captured for proper physical therapy assessment. Without this strict protocol of instructions, it is possible that the assessment scores may not be as similar.
My Overall conclusion: This study shows that it is possible to get similar AIMS assessments of a child’s motor skills via video recording when compared to an in-person assessment. Although the study followed a certain protocol that may not be as replicable in a clinical setting (such as providing the parents with a step by step instruction video and checklist), these results are still promising for potential use of the AIMS in areas such as telehealth PT.
Citation: Boonzaaijer M, van Dam E, van Haastert IC, Nuysink J. Concurrent Validity Between Live and Home Video Observations Using the Alberta Infant Motor Scale. Pediatr Phys Ther. 2017;29(2): 146-151. doi: 10.1097/PEP.0000000000000363.