“How Well” and “How Often” questions for birth brachial plexus injury: a validity and reliability of the pediatric upper extremity motor activity log-revised

Abstract

Purpose The pediatric upper extremity motor activity log-revised (PMAL-R) is a structured interview that measures use of the affected arm in daily life in children with unilateral pathologies like hemiparetic cerebral palsy (CP) or birth brachial plexus injury (BBPI). This study investigated validity and test–retest reliability of the PMAL-R in children with BBPI. Materials and methods The PMAL-R was administered to parents of 132 children with BBPI between 5 and 9 years for validity, also 98 parents were re-interviewed after 3 weeks to establish test–retest reliability. Its concurrent validity was examined by correlating scores on the PMAL-R How Well (HW) and How Often (HO) scales with Brachial Plexus Outcome Measure (BPOM) and Pediatric Outcomes Data Collection Instrument (PODCI) scores. Results PMAL-R scores were strongly correlated with BPOM scores (HW, r = 0.943, p < 0.001; HO, r = 0.897, p < 0.001), also strongly correlated with PODCI (HW, r = 0.799, p < 0.001; HO, r = 0.797, p < 0.001). PMAL-R test–retest reliability (intraclass correlation; HO = 0.997, HW = 0.998) and internal consistency (Cronbach’s a; HO = 0.99, HW = 0.99) were high. Conclusions The PMAL-R has good reliability and validity for measuring everyday use of the affected arm with “how often” and “how well” questions in children with BBPI. Implications for rehabilitation The pediatric upper extremity motor activity log-revised (PMAL-R) is the first tool to assess both “how often” and “how well” the affected arm is used in unimanual activities in children with BBPI. PMAL-R is a real-world measure providing valuable information about “how often” and “how well” the affected arm is used to guide treatment. PMAL-R is valid in both concurrent and discriminative validity in children with BBPI. PMAL-R is reliable in children with BBPI.