Abstract
Objective
Evaluate the validity of the Kids-Balance Evaluation Systems Test (Kids-BESTest) clinical
criteria for the Functional Reach Test (FRT) forward and lateral with laboratory measures
of postural control in children with cerebral palsy (CP).
Design
Psychometric study of face, concurrent, and content validity.
Setting
Clinical laboratory.
Participants
Children (N=58) aged 7-18 years (ambulant CP n=17, typically developing [TD] n=41).
Intervention
Not applicable.
Main Outcome Measures
Stability limits in standing were assessed using the Kids-BESTest items for FRT forwards
(FRTFORWARD), FRT lateral preferred (FRTLATERAL(P)), and FRT lateral nonpreferred (FRTLATERAL(NP)). Force platforms and kinematic markers were used to collect information on center
of pressure (CoP) and joint movement during reach. Analyses included face validity
(Kids-BESTest scores compared between CP and TD groups), concurrent validity (agreement
between Kids-BESTest scores and digitally derived scores), and content validity (relations
between Kids-BESTest scores with kinematic and CoP data).
Results
Face validity of Kids-BESTest criteria was demonstrated with lower scores for CP compared
to TD groups for FRTFORWARD (P<.001) and FRTLATERAL(NP) (P=.03) and equal scores for FRTLATERAL(P) (P=.12). For concurrent validity, agreement between Kids-BESTest scores and digitally
derived scores was good to excellent for FRTLATERAL(both P/NP) (88%-100%) and good for FRTFORWARD (86%-88%) for both groups. For content validity, the CP group Kids-BESTest scores
were correlated with CoP-RangeFORWARD during FRTFORWARD (ρ=0.68) and CoP-RangeLATERAL during FRTLATERAL(NP) (ρ=0.57). For kinematic data, correlations were moderate-high between Kids-BESTest
scores and range of hip flexion (ρ=0.51) and ankle plantar flexion (ρ=0.75) during
FRTFORWARD, and trunk lateral flexion (ρ=0.66) during FRTLATERAL(NP).
Conclusion
The FRTFORWARD demonstrated face, concurrent, and content validity. The FRTLATERAL(P/NP) demonstrated concurrent validity, but partial face and content validity. To improve
validity of Kids-BESTest FRT criteria, additional descriptors have been added under
the scoring criteria to enable clinicians to quantify observed reach strategies.
Keywords
List of abbreviations:
BoS (base of support), CoM (center of mass), CoP (center of pressure), CP (cerebral palsy), FRT (Functional Reach Test), Kids-BESTest (Kids-Balance Evaluation Systems Test), NP (nonpreferred), P (Preferred), TD (typically developing)To read this article in full you will need to make a payment
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References
- The balance evaluation systems test (BESTest) to differentiate balance deficits.Phys Ther. 2009; 89: 484-498
- Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review.Dev Med Child Neurol. 2013; 55: 988-999
- Functional reach as a measurement of balance for children with lower extremity spasticity.Phys Occup Ther Pediatr. 1996; 15: 1-16
- Reproducibility of the Balance Evaluation Systems Test (BESTest) and the Mini-BESTest in school-aged children.Gait Posture. 2017; 55: 68-74
- Reproducibility of the Kids-BESTest and the Kids-Mini-BESTest for children with cerebral palsy.Arch Phys Med Rehabil. 2019; 100: 695-702
- Exercise interventions improve postural control in children with cerebral palsy: a systematic review.Dev Med Child Neurol. 2015; 57: 504-520
- Reliability and comparison of electromyographic and kinetic measurements during a standing reach task in children with and without cerebral palsy.Gait Posture. 2008; 27: 128-137
- Anticipatory postural adjustments in children with cerebral palsy and children with typical development.Pediatr Phys Ther. 2007; 19: 188-195
- Postural control during reaching in preterm children with cerebral palsy.Dev Med Child Neurol. 2004; 46: 253-266
- Postural muscle dyscoordination in children with cerebral palsy.Neural Plast. 2005; 12: 197-203
- Development of postural adjustments during reaching in infants with CP.Dev Med Child Neurol. 1999; 41: 766-776
- Review of the Bruininks-Oseretsky Test of motor proficiency, (BOT-2).Phys Occup Ther Pediatr. 2007; 27: 87-102
- Content validity of the expanded and revised Gross Motor Function Classification System.Dev Med Child Neurol. 2008; 50: 744-750
- A guide to appropriate use of correlation coefficient in medical research.Malawi Med J. 2012; 24: 69-71
- Selective motor control in spastic cerebral palsy.Dev Med Child Neurol. 2009; 51: 578-579
- Gross muscle morphology and structure in spastic cerebral palsy: a systematic review.Dev Med Child Neurol. 2010; 52: 794-804
- Validity and reliability of a pediatric reach test.Pediatr Phys Ther. 2003; 15: 84-92
- Test-retest reliability of balance tests in children with cerebral palsy.Dev Med Child Neurol. 2001; 43: 180-186
- Balance training with visual feedback in children with hemiplegic cerebral palsy: effect on stance and gait.Motor Control. 2005; 9: 459
- Clinical characteristics of impaired trunk control in children with spastic cerebral palsy.Res Dev Disabil. 2013; 34: 327-334
- Perspectives on postural control dysfunction to inform future research: a Delphi study for children with cerebral palsy.Arch Phys Med Rehabil. 2017; 98: 463-479
Article Info
Publication History
Published online: January 25, 2021
Footnotes
Supported by the Research Foundation of Cerebral Palsy Alliance, New South Wales, Australia (grant no. PG4114) through the Children’s Motor Control Research Collaboration.
Disclosures: none.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine
