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Background and Purpose. The psychometric properties of the Peabody Developmental Motor ScalesSecond Edition (PDMS-2), a revised motor test to
assess both gross motor and fine motor composites in children with cerebral
palsy (CP), are largely unknown. The purpose of this study was to examine the
test-retest reliability and the responsiveness of the PDMS-2 for children with
CP. Subjects. A sample of 32 children who had CP (age27 64 months) and
who received intervention participated in this study. Methods. The PDMS-2
was administered to each child 3 times (at the beginning of the study, at 1
week, and at 3 months later) by a physical therapist. The agreement between
the first 2 measurements was used to examine the reliability. The change
between the first and the third measurements was used to examine the
responsiveness. Results. The composite scores on the PDMS-2 had good
test-retest reliability (intraclass correlation coefficient.88 1.00). The
sensitivity-to-change coefficients ranged from 1.6 to 2.1, and the responsiveness coefficients ranged from 1.7 to 2.3. Discussion and Conclusion. Our
results provide strong evidence that the 3 composites of the PDMS-2 had high
test-retest reliability and acceptable responsiveness. The PDMS-2 can be used
as an evaluative motor measure for children with CP and aged 2 to 5 years.
[Wang HH, Liao HF, Hsieh CL. Reliability, sensitivity to change, and
responsiveness of the Peabody Developmental Motor ScalesSecond Edition
for children with cerebral palsy. Phys Ther. 2006;86:13511359.]
Key Words: Cerebral palsy, Measurement: applied, Measurement: basic theory and science, Reliability of
results.
1351
HH Wang, RPT, MSc, is Pediatric Physical Therapist, Country Hospital, Taipei, Taiwan.
HF Liao, RPT, MPH, is Associate Professor, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University,
No. 17, Syujhou Rd, Taipei City, Taiwan, Republic of China. Address all correspondence to Ms Liao at: hfliao@ntu.edu.tw.
CL Hsieh, OTR, PhD, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University.
All authors provided writing and data analysis. Ms Wang and Ms Liao provided concept/idea/research design and data collection. Ms Wang
provided coordination of institutes and subjects. Ms Liao provided project management and fund procurement. The authors thank the following
rehabilitation departments and the therapists of the institutes for assisting with data collection: National Taiwan University Hospital; Lo-Tung
Pohai Hospital; Kee-Lung General Hospital; Department of Health, Executive Yuan, Taiwan, Republic of China; Buddhist Tzu Chi General
Hospital; Cathay General Hospital; Cardinal Tien Hospital; Country Hospital; and 2 developmental centers, Syin-Lu and Di-Yi. They also thank the
caregivers and children who participated in this study and Dr Jeng-Yi Shien for her valuable help.
This study was reviewed and approved by the Ethics Committee of National Taiwan University Hospital.
This study was supported by the Department of Health, Executive Yuan, Taiwan, Republic of China (DOH 92TD1016).
This article was received August 18, 2005, and was accepted May 2, 2006.
DOI: 10.2522/ptj.20050259
1352 . Wang et al
Wang et al . 1353
Table 1.
Demographic Data for Children With Cerebral Palsy (CP)
XSD
Younger
Older
Parameter
Mild CP
Severe CP
Mild CP
Severe CP
34.05.9
39.82.8
54.57.0
54.66.4
13.110.5
10.64.8
16.410.0
23.09.8
88.85.8
928.1
102.94.8
97.04.0
13.12.4
13.92.9
16.62.7
13.62.1
No. of boys/girls
5/3
7/1
6/2
1354 . Wang et al
5/3
Wang et al . 1355
Table 2.
Test-Retest Reliability and Standard Error of Measurement (SEM) for Developmental
Quotients, Percentile Scores, Raw Scores, and Percentage Scores for the Gross Motor (GM),
Fine Motor (FM), and Total Motor (TM) Composites of the Peabody Developmental
ScalesSecond Edition for Children With Cerebral Palsy
XSD
Intraclass Correlation
Coefficient (95%
Second Test Confidence Interval)a SEM
Sensitivity to Change
The mean percentage scores on the 3
Developmental quotients
composites of the PDMS-2 at the first
GM
54.09.9
54.610.4 .988 (.976.994)
1.1
and second tests are shown in Table 2,
FM
71.717.1
73.218.9 .979 (.958.990)
2.5
TM
57.912.5
58.913.5 .984 (.968.992)
1.6
and those at the third test are shown in
Table 3. The percentage scores were
Percentile scores
GM
1.02.2
1.01.7
.954 (.909.978)
0.5
significantly different between the first
FM
10.715.4
13.521.0 .919 (.840.960)
4.4
and third tests, with t(df31) values of
TM
1.83.3
2.54.9
.878 (.765.939)
1.2
4.98 to 7.35 (P.001). The ES value was
Raw scores
0.2 for all 3 composites; this value met
GM
122.445.3 124.647.2 .996 (.991.998)
3.0
the minimum standard proposed by
FM
129.235.5 130.937.1 .993 (.985.996)
3.0
Cohen for indicating a small change.34
TM
251.673.0 255.576.1 .996 (.992.998)
4.7
The
correlation coefficients of the perPercentage scores
centage
scores on the GM, FM, and TM
GM
49.815.9
50.416.7 .993 (.986.997)
1.3
composites between the first and third
FM
69.417.5
70.218.5 .995 (.989.997)
1.3
TM
56.414.7
57.015.6 .995 (.990.998)
1.1
tests were .978, .976, and .986, respectively. Therefore, the values of the
a
For all values, P.0001, as determined with the ICC(2,1) model.
SRMs were interpreted as trivial (SRM
of 1.0), small (SRM of 1.02.4),
deviation of the score differences between the first and
moderate (SRM of 2.43.8), or large (SRM of 3.8)
third tests.26
for the GM composite; trivial (SRM of 0.9), small (SRM
of 1.02.3), moderate (SRM of 2.33.7), or large
Responsiveness. One of the GRIs,37 which reflects the
(SRM of 3.7) for the FM composite; and trivial (SRM
extent to which change in a measure relates to correof 1.2), small (SRM of 1.23.0), moderate (SRM of
sponding change in a reference measure of clinical or
3.04.8), or large (SRM of 4.8) for the TM composhealth status,35 is referred to as the GRI for responsiveite according to previously described methods.36 The
ness (GRI-R) in this study. The GRI-R is calculated by
SRM values of the percentage scores on the PDMS-2
dividing the change in the group expected to undergo a
were 1.3 for the TM composite, indicating a small
change by the variability in a stable group.26 We calcuchange, 0.9 for the GM composite, indicating a trivial to
lated the GRI-R by dividing the mean change score
small change, and 1.0 for the FM composite, indicating
between the first and third tests for subjects classified as
a small change in children with CP. The GRI-S values
having a clinically important change on the basis of the
ranged from 1.6 to 2.1 (Tab. 3).
caregivers rating scales by the standard deviation of the
score differences between the first and second tests for
Responsiveness
the entire group.26
The GRI-R values for the 3 composites of the PDMS-2
ranged from 1.7 to 2.3 (Tab. 4).
Results
Discussion
The DQs for the 3 composites of the PDMS-2 for the
The results of this study are the first to confirm not only
children with CP at the initial assessment are shown in
good test-retest reliability of various scales of the PDMS-2
Table 2. All children had DQs of less than 85 for the GM
but also acceptable responsiveness of the percentage
composite and the TM composite. The means of the
scores on the 3 composites of the PDMS-2 for children
percentage scores on the GM, FM, and TM composites
with CP. These observations suggest that the PDMS-2 can
were 49.8, 69.4, and 56.4, respectively.
be used as a set of evaluative tools for children with CP.
Test-Retest Reliability
Reliability is particularly important for developmental
The test-retest reliability values and SEMs for the GM,
tests, either as a diagnostic test to evaluate the severity of
FM, and TM composites are shown in Table 2. The
developmental delay in clinics16 or as an evaluative test
test-retest reliability analyses showed ICCs ranging from
.979 to .988 for the DQs, from .878 to .954 for the
to detect the progress of a child after intervention.26
Parameter
1356 . Wang et al
First Test
Table 3.
Sensitivity-to-Change Coefficients for Percentage Scores on the Gross Motor (GM), Fine Motor (FM), and Total Motor (TM) Composites of the
Peabody Developmental Motor ScalesSecond Edition for Children With Cerebral Palsy Over a 3-Month Interval
Composite
XSD Percentage
Score at Third Test
t Value (P)
Effect
Size
Standardized
Response Mean
GRI-Sa
GM
FM
TM
52.815.5
73.317.3
59.614.7
4.98 (.001)
5.68 (.001)
7.35 (.001)
0.2
0.2
0.2
0.9
1.0
1.3
1.6
2.1
2.1
Table 4.
Responsiveness Coefficients for Percentage Scores on the Gross Motor
(GM), Fine Motor (FM), and Total Motor (TM) Composites of the
Peabody Developmental Motor ScalesSecond Edition for Children
With Cerebral Palsy Over a 3-Month Interval
Composite
Mean Change
Scorea
SD of
Differencesb
GRI-Rc
GM
FM
TM
3.2
4.4
3.4
1.9
1.9
1.5
1.7
2.3
2.3
Mean change score between the first and third tests for children rated more
than or equal to somewhat better (percentage score).
b
SD of differencesstandard deviation of score differences between the first
and second tests for the entire group (percentage score).
c
GRI-RGuyatt responsiveness index for responsiveness.
Wang et al . 1357
1358 . Wang et al
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