Interrater Reliability of Activity Questionnaires After an Intensive Motor-Skill Learning Intervention for Children With Cerebral Palsy

Published:February 18, 2019DOI:


      • Activity questionnaires seem reliable in the usual rehabilitation context.
      • Activity questionnaires seem less reliable after motor-skill learning therapy.
      • A goal-directed process seems to influence the parent’s perception of activity changes.
      • Home-videotaped items are recommended after motor-skill learning therapy.



      To investigate the reliability of parents-reported activity questionnaires after a motor-skill learning intervention for children with cerebral palsy (CP). We hypothesize that the intervention process might influence parental judgment.


      Double-blind randomized trial.


      Conventional therapy was delivered in the usual context while intensive intervention was provided at the Catholic University of Louvain.


      Children with CP (N=41; age range 5-18y, Gross Motor Function Classification System I-IV) were randomized to a control group (CG) (n=21, 2 dropouts) receiving conventional therapy or an intervention group (IG) (n=20) receiving hand-arm bimanual intensive therapy—including lower extremities (HABIT-ILE).


      Conventional therapy (mostly neurodevelopmental) was delivered as ongoing treatment (1-5 times/wk). HABIT-ILE, based on motor-skill learning, was delivered over 2 weeks. All children were assessed at T1 (baseline), T2 (3wk after baseline) and T3 (4mo after baseline).

      Main Outcomes Measures

      ABILHAND-Kids and ACTIVLIM-CP questionnaires rated by parents (perception) and 2 examiners (videotapes).


      Agreement (level/range) between examiners was systematically almost perfect (P≤.001). At baseline, moderate to almost perfect agreement (level/range) was observed between parents and examiners (P≤.001). At T2 and T3, a similar agreement (level/range) was observed for the CG. For the IG, a similar level of agreement was observed, but the range of agreement varied from poor to almost perfect (P≤.001), with parents estimating higher performance measures compared to examiners after intervention. Higher performance was associated with higher satisfaction scores of the child’s functional goals at T3.


      Parents and examiners have a similar perception of the child’s performance at baseline and during conventional therapy. Their perceptions are less congruent after a motor-skill learning intervention, probably due to the goal-oriented process of the intervention. Therefore, our results favor the use of blind observations of home-videotaped items after intensive motor-skill learning interventions.


      List of abbreviations:

      CG (control group), CI (confidence interval), COPM (Canadian Occupational Performance Measure), CP (cerebral palsy), E1 (examiner 1), E2 (examiner 2), GMFCS (Gross Motor Function Classification System), HABIT-ILE (hand-arm bimanual intensive therapy—including lower extremities), ICC (intraclass correlation coefficient), IG (intervention group), MACS (Manual Ability Classification System)
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