Modifications of lower limb neurological impairment testing for paediatric clients: An international Delphi survey

Abstract

Background and Objective: To obtain consensus on appropriate modifications of adult lower limb neurological testing of strength, tactile sensitivity and reflexes for paediatric clients.

Study Design: A modified Delphi technique with two electronic survey rounds.

Methods: An expert panel of experienced paediatric neurological physiotherapy clinicians and academics (n=34) were invited to complete surveys. Survey 1 consisted of open‐ended questions and statements generated by review of the literature. Experts were required to rate their level of agreement with statements using a 1–6 Likert scale (strongly agree, agree, somewhat agree, somewhat disagree, disagree, strongly disagree). Survey 2 consisted of statements generated from thematic analysis of responses to open‐ended questions and statements that did not reach consensus in Survey 1. A‐priori criteria for item consensus was set at 65% strongly agree, agree, or somewhat agree or 65% strongly disagree, disagree, or somewhat disagree. The median and interquartile range of Likert scores was calculated to estimate perceived importance for each item.

Results: Twenty‐four experts from nine countries completed both surveys. Consensus was reached on 92% of total items (n=292/316). Consensus agreement was reached on 92% of items (n=34/39) relating to modifications of adult neurological tests for paediatric clients. Consensus was also reached on 96% of items (n=27/28) relating to tests required for interpretation of results, 88% of items (n=15/17) on equipment use, and 61% of items (n=11/18) relating to measurement scales utilised to grade impairments. Experts perceived with strong agreement (>85%) and strong importance (strongly agree) that paediatric tests should be developmentally appropriate (96%, IQR: 5,6), include functional observation (96%, IQR: 5,6) and incorporate fun and play (92%, IQR: 5,6) to maintain a child's motivation (100%, IQR: 6,6). Experts also perceived with strong agreement and importance that instructions could be modified by using a child's own words (96%, IQR: 5,6) or non‐verbal communication (96%, IQR: 4.75,6) and that children should be familiarised with test equipment (100%, IQR: 5,6) and have tests demonstrated (92–96%, IQR: 5,6) prior to testing.

Conclusions: This is the first study to report on modifications of adult lower limb neurological tests for paediatric clients. Expert consensus was reached regarding several modifications, however there was variability in the type of modifications which may impact the interpretation and reporting of results. The appropriateness of suggested modifications of adult tests will need to be verified through clinimetric analysis of these properties in paediatric clients of different ages and diagnoses.