Validation AIMS home-video method

This study was concerned with the question if it is valid and reliable to assess the motor development of a child by using a video that is made by parents themselves.
If it is possible to detect developmental problems at an early stage, a swift start with targeted interventions is possible. The Alberta Infant Motor Scale (AIMS) is often used to evaluate the motor development of a child. The AIMS is a standardised instrument to observe the gross motor skills of children from birth until they walk independently. The AIMS is often assessed by a pediatric physiotherapist in an outpatient setting. This study examines a new way of administering the AIMS, namely digital assessment of the motor development of a child by using a video that is made by parents themselves at home.

Motivation
For the assessment of the locomotion the pediatric physiotherapist is dependent on the motor performance of the child during the observation time. As a result, there could be a discrepancy between the observed and the actual motor abilities of a child. Facilitated by a society with the increasing use of digital appliances, parents often make additional videos of their child.

In addition to the existing method, the assessment of the AIMS by using a video that is made by parents themselves, could meet a need. This gives parents the opportunity to select a suitable observation moment within their familiar home environment when their child feels at ease.

Besides, this method could be used in future research. To gain more insight into the motor development profiles of the child, longitudinal research is needed. However, longitudinal research is costly and time consuming. This new method could provide opportunities for a more efficient way of data collection. However, a validation study was conditional for further research using the video-method.

Aims

  • Evaluating the agreement of findings in the AIMS assessed on the basis of a video made by parents, compared with a live observation of the child.
  • Making an inventory of the experiences of parents in producing the video and its use for the assessment of their child’s motor development.

Research design
This validation study examined the degree of agreement of the AIMS-scores assessed on the basis of a live observation of the child (1), compared with a video made by parents at the same time.

Population
The study population consisted of 52 infants aged 6 weeks to 19 months, whose parents had a question about the motor development of their child. Both parents gave informed consent for participation of their child in the study. Children with (diagnosed) abnormal motor skills, and children whose parents lack proficiency in Dutch or are physiotherapist themselves, were excluded.

Procedure
Subjects were recruited via an open recruitment (convenience sample). Parents’ attention was drawn to the GODIVA project by using posters in different physiotherapy practices and infant welfare centers in Utrecht and environs. After the informed consent procedure, the research started at home. In front of the tester parents (or one of them and another person) made a video of their child, using the instruction material developed for the research. Parents could use various digital systems, such as a smartphone, iPad or camera. The instructional material includes an instructional video and an accompanying checklist that was adapted to the motor development level of the child. While parents were filming, the tester assessed the child on the AIMS (live observation). Afterwards another tester assessed the child on the AIMS, using the video made by the parents (video observation). Both testers were unaware of each other’s findings (blinding). Thus, the correlation and consistency between scoring in the two different ways (live observation and video observation) could be analysed. The testers switched roles during the research, so testers did both live and video observations.

In this part of the GODIVA project 10 experienced pediatric physiotherapists carried out the observations. The testers were trained and tested by an expert; A good inter-rater reliability was achieved (Intraclass Correlation Coefficient > 0.98).

To gain more insight into the experiences of parents during filming, they were asked to complete a questionnaire after the observation.

Data collection took place from March until September 2014. In October 2014 the data were analysed.

Results
All video’s, but one, were technically useable. Three video’s had to be excluded due to violation of the protocol. The mean difference in raw scores was 0.5 (SD=±2.34). Live-scores were both higher and lower than video-scores. The ICC-agreement on the raw scores was quite high (.99; 95%CI= .983 – .994) with a SEM of 1.6.

Conclusion
Establishment of motor development with the AIMS using standardized home video is well comparable to observation on site. Differences between the two methods could also be allocated to moderate reliability caused by the involvement of a large number of testers. In future, qualitative research on experiences of parents and professionals using this method can provide insight in barriers and facilitators. An optimal technical support must be developed with a user-friendly interface for parents.

Implications
The video-method is a promising application that could be used in longitudinal research and in follow-up clinics of motor development of infants, with fewer burdens for parents and infants. Time and distance are less important barriers. The video is objective evidence of the observation of motor performance of an infant, and could be retested if needed.  

At the end of October 2014 results were presented at the following conferences:

  • 31-10-2014, NVFK, PPT National congress in Zwolle, the Netherlands
  • 3-5-2015, WCPT, PT World congress in Singapore
  • 28-5-2015, EACD, European congress in Copenhagen, Denmark
  • A manuscript is in preparation.

The working group validation consisted of the following persons:

  1. Marike Boonzaaijer MSc, researcher
  2. Ellen van Dam MSC, researcher
  3. Students master pediatric physiotherapy
  4. Trained testers from the field.

Advisory

  1. Jacqueline Nuysink PhD, principal investigator GODIVA
  2. Inge-Lot van Haastert PhD, dep. of Neonatology, WKZ
  3. Cas Kruitwagen MSc, statistician Julius center University Utrecht