Intra-And Inter-Rater Reliability of the Assessment of Children's Hand Skills Based on Video Recordings

By Chien, Chi-Wen; Scanlon, Clare et al. | British Journal of Occupational Therapy, February 2014 | Go to article overview

Intra-And Inter-Rater Reliability of the Assessment of Children's Hand Skills Based on Video Recordings


Chien, Chi-Wen, Scanlon, Clare, Rodger, Sylvia, Copley, Jodie, British Journal of Occupational Therapy


Introduction

Hand use is essential for the occupational performance of a person completing a meaningful occupation within particular contexts/environments in order to satisfy his or her life needs and participation (American Occupational Therapy Association [AOTA] 2008, Kimmerle et al 2003, Rand and Eng 2010). Hand use is particularly vital for children as they are learning and developing fundamental skills/abilities required for manipulating toys, objects, and tools with their hands (Chien et al 2009, Rodger and Ziviani 2006). This occupational performance related to hand use, in turn, facilitates children's development in various life areas such as physical, adaptive, social-emotional, cognitive, or communication (Henderson and Pehoski 2006). A large number of children with disabilities are referred to occupational therapy services as a result of occupational performance difficulties. Ineffective hand skills may account for some of these difficulties in daily life activities which arise in childhood (Chien et al 2009, Jackman and Stagnitti 2007). Using an appropriate and psychometrically sound hand-skill assessment can assist occupational therapists in identifying those children's underlying hand-skill problems that may cause occupational performance difficulties (Henderson and Pehoski 2006, Pendleton et al 2006).

Most available hand-skill assessments focus on body structures, functions, or capacity (that is, what children can do in standardized testing settings), rather than on actual performance in daily life situations (Klingels et al 2010, Lemmens et al 2012). For example, according to the International Classification of Functioning Disability and Health (ICF, World Health Organization 2001), measurement of range of motion and grasp strength is considered as an assessment of body structure and function. At the ICF activity level, the Bruininks-Oseretsky Test of Motor Proficiency (Bruininks and Bruininks 2005) and the Peabody Developmental Motor Scales (Folio and Fewell 2000) assess children's hand-skill capacity to perform standardized tasks (for example, stacking blocks or stringing beads) in specified circumstances. This type of the capacity assessment, however, indicates a construct different from actual performance, such as what children would actually do with their hands in real-life, unstipulated situations (Lemmens et al 2012). Therefore, there is a need for a tool that assesses children's actual hand-skill performance in a way that reflects their occupational performance and provides true connection with their participation in daily life situations.

The Assessment of Children's Hand Skills (ACHS, Chien et al 2010) is an instrument recently developed to capture how children actually use their hands to perform meaningful activities in their relevant contexts (for example, engaging in drawing, eating, or writing activities at home or school) through naturalistic observations. In contrast to the aforementioned assessments, the ACHS measures actual hand-skill performance as an indication of occupational performance. The ACHS can be used to observe children aged 2-12 years and with a range of conditions while engaging in various childhood activities (Chien et al 2010).

The psychometric properties of the ACHS have been studied previously and the results indicated satisfactory internal and external construct validity (Chien et al 2010, Chien et al 2011). However, its reliability findings exhibited only a modest level of inter-rater reliability (Spearman's rho coefficient = 0.63) and an acceptable, rather than high, level of intra-rater reliability (rho = 0.78) (Chien et al 2010). In the previous reliability study, hand skills of 54 children were assessed by the ACHS developer and one newly trained rater via naturalistic observations in schools, kindergartens and homes. Due to the in-vivo observations, children's hand-skill performance might be varied between the first and second evaluations, affecting the intra-rater reliability of the ACHS. …

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