Robby Sacher1, Dana Loudovici-Krug2,3, Marc Wuttke1, Holger Spittank1, Michael Ammermann4, Ulrich C Smolenski2. 1. Practice for Manual Medicine, Freistuhl, Dortmund, Germany. 2. Insitute for Physiotherapy, University Hospital Jena, Am Klinikum 1, Jena, Germany. 3. Practice for Manual Medicine and Orthopaedics, Düsseldorf, Germany. 4. Research Consulting Office of Manual Medicine (FBS MM), Jena, Germany.
Abstract
OBJECTIVE: The purpose of this study was to develop and verify a quantifiable symmetry score for infantile postural and movement asymmetries. METHODS: Three studies were conducted. For reliability, 6 test items examining postural and movement asymmetries, which came under consideration, were investigated in 24 infants with postural abnormality (range: 14-24 weeks). The inter-rater reliability was chosen as the primary endpoint. Furthermore, intrarater reliability and test-retest reliability were determined. Analysis and weighting of the items were performed by calculating the intraclass correlation coefficient. The validity was reviewed by expert opinion and by using a study with 26 infants (range: 12-28 weeks) of a cross-section population. The pilot study involved 38 infants, aged 14 to 24 weeks, who were examined using video. Their autonomic symptoms were recorded, and subsequently, they were treated once by means of manual medicine. The parents were instructed to a daily home program that focused on "tummy time." RESULTS: The reliability tests led to a 4-item symmetry score with a point value between 4 points (very symmetrical) and 17 points (very asymmetrical). The chosen items achieved an intraclass correlation coefficient >0.8 and Cohen's κ >0.6, respectively. The experts' opinions matched mainly to a majority agreement (>50%). Furthermore, a comparison between the outcome of clinical testing and the symmetry score applied to 26 children without diagnosed abnormalities displayed an agreement of 84.6%. The pilot study showed a good reduction of the postural and movement abnormalities because 63% of the manual treated children were assessed as being symmetric afterward. CONCLUSION: The reliable and valid 4-item symmetry score served for the diagnosis, evaluation, and follow-up of infants aged 3 to 6 months with infantile postural and movement asymmetries. The results of a pilot study showed the positive effect of a single manual medical treatment session along with a home program focusing on "tummy time."
OBJECTIVE: The purpose of this study was to develop and verify a quantifiable symmetry score for infantile postural and movement asymmetries. METHODS: Three studies were conducted. For reliability, 6 test items examining postural and movement asymmetries, which came under consideration, were investigated in 24 infants with postural abnormality (range: 14-24 weeks). The inter-rater reliability was chosen as the primary endpoint. Furthermore, intrarater reliability and test-retest reliability were determined. Analysis and weighting of the items were performed by calculating the intraclass correlation coefficient. The validity was reviewed by expert opinion and by using a study with 26 infants (range: 12-28 weeks) of a cross-section population. The pilot study involved 38 infants, aged 14 to 24 weeks, who were examined using video. Their autonomic symptoms were recorded, and subsequently, they were treated once by means of manual medicine. The parents were instructed to a daily home program that focused on "tummy time." RESULTS: The reliability tests led to a 4-item symmetry score with a point value between 4 points (very symmetrical) and 17 points (very asymmetrical). The chosen items achieved an intraclass correlation coefficient >0.8 and Cohen's κ >0.6, respectively. The experts' opinions matched mainly to a majority agreement (>50%). Furthermore, a comparison between the outcome of clinical testing and the symmetry score applied to 26 children without diagnosed abnormalities displayed an agreement of 84.6%. The pilot study showed a good reduction of the postural and movement abnormalities because 63% of the manual treated children were assessed as being symmetric afterward. CONCLUSION: The reliable and valid 4-item symmetry score served for the diagnosis, evaluation, and follow-up of infants aged 3 to 6 months with infantile postural and movement asymmetries. The results of a pilot study showed the positive effect of a single manual medical treatment session along with a home program focusing on "tummy time."