Does a Structured Clinical Training Focused on Range of Motion and Spasticity Assessment Improve Therapist Reliability When Assessing Children with Neuromuscular Diagnoses?

Abstract

<h3>Research Objectives</h3> 1) To investigate inter-rater agreement of lower extremity (LE) range of motion (ROM) and spasticity assessment in children with neuromuscular disorders among physical therapists (PT) before and after training, 2) investigate whether training improves ROM documentation consistency, and 3) investigate PT perceptions of clinical assessment of ROM and spasticity. <h3>Design</h3> Correlational. <h3>Setting</h3> Hospital-based outpatient PT department. <h3>Participants</h3> 12 PTs with at least one year pediatric experience, two highly experienced PTs, and 13 children, 5-18 years old with known neuromuscular diagnoses. <h3>Interventions</h3> PTs completed a clinical practice/perceptions questionnaire and assessed the children's LE ROM and spasticity before and after participating in training. Training included standardized evidence-based online and hands-on assessment of LE ROM and spasticity. A test was given before and after online training. <h3>Main Outcome Measures</h3> LE ROM was assessed using a standard goniometer (9 measurements, one predetermined LE) and spasticity was assessed using the Modified Modified Ashworth Scale (MMAS). The questionnaire included 15 10-point Likert scale items covering PT confidence, frequency, and perceived need for LE ROM and spasticity assessment training. The online test included 20 questions covering the assessment of LE ROM and spasticity. <h3>Results</h3> There was no difference in average ROM between PTs and expert before (10.74°) and after training (10.76°). PT documentation consistency improved after training. Spasticity assessment agreement between PTs and expert did not significantly improve before (47%) to after training (50%). Inter-rater agreement did not significantly improve, 53% pre and post. Inter-rater agreement kappa values with expert were .35 (pre-training), and .39 (post-training). Test scores demonstrated evidence of improvement after online training, 24% average increase. Pre-questionnaire average score for confidence was 5.29, need for training 8.31, training would be beneficial 9.14. <h3>Conclusions</h3> Experienced PTs indicated a need for additional LE ROM and spasticity assessment training. After training, issues with reliability and agreement of measures continued. Post-online training test score improvement indicated increased didactic knowledge; however, this didn't translate into improved performance. Training program modifications are need to address inconsistencies found. Further assessment with a larger cohort of PTs is needed. <h3>Author(s) Disclosures</h3> The authors declare no conflict of interest.