Tests & Measures: A Resource for Pediatric Physical Therapy Practitioners

ACTIVLIM-CP

Guidelines for Critical Review of Tests & Measures

 

I.               Descriptive Information

A.   Title, Edition, Dates of Publication and Revision*: ACTIVLIM-CP a new Rasch-built measure of global activity performance for children with cerebral palsy, 2016

B.    Author (s): Yannick Bleyenheuft, Julie Paradis, Anne Renders, Jean-Louis Thonnard, Carlyne Arnould

C.    Source (publisher or distributor, address): Research in Developmental Disabilities 60 (2017) 285-294

D.   Costs (booklets, forms, kit)*: free

E.    Purpose*: to assess the global activity performance of children with CP that incorporates LE, UE, and trunk abilities. The scale is able to follow the changes the child makes overtime.

F.    Type of Test (eg, screening, evaluative; interview, observation,

checklist or inventory)*: questionnaire completed by caregiver

G.   Target Population and Ages*: children with CP ages 2-20

H.   Time Requirements  – Administration and Scoring*

II.             Test Administration

A.   Administration

B.    Scoring (include MCD/MCID when available)

C.    Type of information, resulting from testing

(e.g. standard scores, percentile ranks)

D.   Environment for Testing

E.    Equipment and Materials Needed

Instruction sheet, test forms with response scales
F.    Examiner Qualifications

Self-report measure, health care provider administers to child’s parents
G.   Psychometric Characteristics* → not available

H.   Standardization/normative data → not available

I.      Evidence of Reliability

Inter-rater reliability: ICC:0.99; 95% CI: 0.97–0.99; p < 0.001
Test-retest reliability: ICC:0.96; 95% CI: 0.94–0.97; p < 0.001
J.     Evidence of Validity

Divergent validity: No significant effects of age (Pearson correlation r = 0.07; p = 0.326) or gender (t-test; p = 0.762)
Convergent validity: able to detect significant difference between children with diplegia, quadriplegia, and hemiplegia (p< 0.001)
Significant correlations between the ACTIVLIM-CP and the PEDI (r = 0.87, p < 0.001); the ABILOCO-Kids (r = 0.80, p < 0.001) and the ABILHAND-Kids (r = 0.95, p < 0.001)
Demonstrated less ceiling effect than other currently used measures (PEDI, ABILOCO-Kids, ABILHAND-Kids)
Less floor effect than ABILOCO-Kids and ABILHAND-Kids but not compared to PEDI
K.   Discriminative → not available

L.    Predictive → not available

III.           Summary Comments*

A.   Strengths

Excellent test-retest reliability and reproducible results
Consistent results over time, did not significantly vary based on age/gender
Incorporates both LE and UE functional activities
B.    Weaknesses

Unable to compare child’s scores to that of typical developing children
Newer measure with limited data regarding responsiveness, sensitivity, and specificity
C.    Clinical Applications

Reliable, self-report measure to be used to assess and track changes in global activity performance related to neurorehabilitation in children with cerebral palsy
 

Bleyenheuft et al., developed the ACTIVLIM-CP in order to provide an outcome measure to assess global motor skills while including upper extremities, lower extremities, trunk control, and the changes that children with CP go through as time goes on. The authors described other outcome measures that were specific to only UE, LE, and motor skills that involved only these components. There was no test that assessed children with CP and their global activity. For example, there was no way to track the progression or regression for a child’s ability to get in and out of a car, or standing and reaching.
The sample population included 226 children with CP ages 2-20 years old. Children from Centers dedicated to CP in Belgium and France were referred to this study. The questionnaire was developed through a process of combining items in previous questionnaires that focused either on UE or LE activities. A group of physicians, physiotherapists, and occupational therapists were consulted to determine which items were appropriate and what items should be added to the final experimental questionnaire. These items were presented to the care takers of the children in random order. The Rasch model with the Rasch Unidimensional Measurement models computer program 2020 was used to analyze the responses. Responses could be chosen on a linear scale addressing patient performance level, item difficulty, and item thresholds. Based on the responses from the caregivers, the items were once again analyzed to determine which ones were relevant to the daily realities of children with CP so that the final questionnaire could be determined. The parents response rate was 38%, which is close to the acceptable response rate (40%). 43 items were determined to most accurately describe and measure the global abilities of children with CP.
This study demonstrated excellent reliability in the precision of the questionnaire to accurately asses children and excellent test-retest reliability. A limitation to this study was that the responsiveness of the scale was not addressed, which is necessary to detect floor and ceiling effects if it is to be used in clinical practice. It also would have been good if the scale was able to compare results to those of typically developing children.
The ACTIVLIM-CP was created out of necessity to accurately document and measure children with CP’s global activity abilities incorporating UE, LE, and trunk stability. Now, this simple questionnaire can be given to caregivers and analyzed to accurately measure changes as the child progresses with CP. Overall, this study was very well done, demonstrating excellent reliability and will contribute to a clearer overall picture of the function of children with CP.