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Towards an evidence-based assessment of early motor performance in the child health services: Psychometric properties and clinical utility of the Structured Observation of Motor Performance in Infants
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The Swedish child health services (CHS) have a unique position in that they reach almost all children 0-6 years of age. The child health nurse has the main responsibility for developmental surveillance. Twelve scheduled visits with the nurse during the child’s first year of life make this an ideal setting to systematically identify infants with motor problems, ranging from asymmetric head positioning that may lead to plagiocephaly to more severe forms such as cerebral palsy (CP). However, the CHS lack evidence-based methods to assess motor development.

The Structured Observation of Motor Performance in Infants (SOMP-I) assesses motor performance in two domains, i.e. level of motor development and quality of motor performance. SOMP-I is quick, non-invasive, requires minimal handling, and is suitable for a busy clinical setting when applied by physiotherapists. Given the importance of early detection, the increased likelihood of detecting motor problems when using evidence-based assessment methods and the key role of nurses within the CHS, the overall aim of this thesis was investigate the psychometric properties and clinical utility of SOMP-I when used by child health nurses. Furthermore, we aimed to establish the ability of SOMP-I to detect CP.

Our results show that child health nurses can reliably assess the level of motor development in infants using SOMP-I. More variability was found when they assessed the infants’ quality of motor performance. Although the nurses expressed concern about introducing a more time-consuming assessment in an already tight schedule, they were able to integrate the SOMP-I assessment in routine care. The nurses reported that barriers to using SOMP-I were mostly logistic and practical in nature, and they pointed out the necessity of education and practice in order to become proficient assessors. Using SOMP-I appears to have supported the nurses in the decision-making process regarding motor performance in routine care. SOMP-I detected CP during the first months of life in neonatal intensive care recipients.

To our knowledge, these studies are the first to evaluate child health nurses’ assessment of early motor performance using an evidence-based assessment method in routine care. The results are promising, but further research is warranted.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , p. 95
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1317
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-317985ISBN: 978-91-554-9861-0 (print)OAI: oai:DiVA.org:uu-317985DiVA, id: diva2:1083913
Public defence
2017-05-12, Gunnesalen, Ing 10, Akademiska sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2017-04-21 Created: 2017-03-22 Last updated: 2017-05-05
List of papers
1. The Structured Observation of Motor Performance in Infants can detect cerebral palsy early in neonatal intensive care recipients
Open this publication in new window or tab >>The Structured Observation of Motor Performance in Infants can detect cerebral palsy early in neonatal intensive care recipients
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2017 (English)In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 113, p. 31-39Article in journal (Refereed) Published
Abstract [en]

Background

The detection of motor problems in infancy requires a detailed assessment method that measures both the infants' level of motor development and movement quality.

Aim

To evaluate the ability of the Structured Observation of Motor Performance in Infants (SOMP-I) to detect cerebral palsy (CP) in neonatal intensive care recipients.

Study design

Prospective cohort study analyzed retrospectively.

Subjects

212 (girls: 96) neonatal intensive care recipients (mean gestational age 34 weeks, range: 23–43). Twenty infants were diagnosed with CP.

Outcome measures

The infants were assessed using SOMP-I at 2, 4, 6 and 10 months' corrected age. Accuracy measures were calculated for level of motor development, quality of motor performance and a combination of the two to detect CP at single and repeated assessments.

Results

At 2 months, 17 of 20 infants with CP were detected, giving a sensitivity of 85% (95% CI 62–97%) and a specificity of 48% (95% CI 40–55%), while the negative likelihood ratio was 0.3 (95% CI 0.1–0.9) and the positive likelihood ratio was 1.6 (95% CI 1.3–2.0). At 6 months all infants with CP were detected using SOMP-I, and all infants had repeatedly been assessed outside the cut-offs. Specificity was generally lower for all assessment ages, however, for repeated assessments sensitivity reached 90% (95% CI 68–99%) and specificity 85% (95% CI 79–90%).

Conclusions

SOMP-I is sensitive for detecting CP early, but using the chosen cut-off can lead to false positives for CP. Assessing level and quality in combination and at repeated assessments improved predictive ability.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-316405 (URN)10.1016/j.earlhumdev.2017.07.009 (DOI)000415776000006 ()28728014 (PubMedID)
Note

Cecilia Montgomery and Kine Johansen share first authorship

Available from: 2017-03-01 Created: 2017-03-01 Last updated: 2018-02-26Bibliographically approved
2. Can nurses be key players in assessing early motor development using a structured method in the child health setting?
Open this publication in new window or tab >>Can nurses be key players in assessing early motor development using a structured method in the child health setting?
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2015 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 4, p. 681-687Article in journal (Refereed) Published
Abstract [en]

Rational, aims and objectivesIncreasing evidence highlights the importance of early interventions for motor disorders in children. Given the key medical role of the nurse within the Swedish Child Health Service (CHS), we aimed to examine if nurses could apply a structured assessment of early motor development at the child health centre to enable early identification of children at risk. MethodsStructured Observation of Motor Performance in Infants (SOMP-I) assesses infant's level of motor development and quality of motor performance using subscales converted to total scores. The total score for both level and quality can then be plotted within the SOMP-I percentile distribution at the child's age for comparison with a reference population. Fifty-five infants (girls: 30) were assessed according to SOMP-I at three child health centres. Assessments were performed by nurses (n=10) in a clinical setting; one nurse performed the assessment while another nurse and a physiotherapist observed. ResultsAgreement for the assessment of level as a continuous variable was excellent [intraclass correlation coefficient (ICC) 0.97-0.98], but was lower for quality (ICC 0.02-0.46). When the children were categorized according to the percentile range categories, the assessors were in agreement for the majority of the children, with respect to both level (78-82%) and quality (78-87%). ConclusionDespite brief experience with SOMP-I, the agreement was excellent when assessing the level of motor development, but was less satisfactory for the assessment of quality of motor performance. More extensive education and training may be necessary to improve the nurses' ability to assess quality, as this domain was an entirely new concept to the nurses. Further research is warranted to determine the applicability of SOMP-I as a standardized method for nurses to assess motor development within the CHS.

Keywords
child public health, development, early assessment, infant, motor performance
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-260819 (URN)10.1111/jep.12366 (DOI)000358693200019 ()25958886 (PubMedID)
Available from: 2015-08-28 Created: 2015-08-25 Last updated: 2017-12-04Bibliographically approved
3. 'Now I use words like asymmetry and unstable': nurses' experiences in using a standardized assessment for motor performance within routine child health care
Open this publication in new window or tab >>'Now I use words like asymmetry and unstable': nurses' experiences in using a standardized assessment for motor performance within routine child health care
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2016 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, no 2, p. 227-234Article in journal (Refereed) Published
Abstract [en]

RATIONALE, AIMS AND OBJECTIVES:

There is an increasing recognition that early intervention is important for children with motor disorders. The use of standardized assessment methods within the Swedish Child Health Services (CHS) may improve early identification of these children and thereby their development and quality of care. Given the key role of nurses within the CHS, we explored their experiences of using a structured assessment of motor performance (SOMP-I) in a clinical setting, and investigated possible barriers and facilitators for implementation of the method within the CHS.

METHODS:

The study was conducted in 2013 in Uppsala County, Sweden. Ten child health nurses participated in two focus group interviews, which were analysed using systematic text condensation.

RESULTS:

The analysis yielded three themes: (1) increased knowledge and professional pride - nurses described their desire to provide high-quality care for which SOMP-I was a useful tool; (2) improved parent-provider relationship - nurses felt that using SOMP-I involved both the parents and their infant to a greater extent than routine care; and (3) conditions for further implementation - nurses described that the time and effort needed to master new skills must be considered and practical barriers, such as lack of examination space, resource constraints and difficulties in documenting the assessment must be addressed before implementing the SOMP-I method in routine care.

CONCLUSION:

Child health nurses felt that the SOMP-I method fitted well with their professional role and increased the quality of care provided. However, significant barriers to implementing SOMP-I into routine child health care were described.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-269209 (URN)10.1111/jep.12459 (DOI)000373135400012 ()26489378 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-68
Available from: 2015-12-14 Created: 2015-12-14 Last updated: 2017-12-01Bibliographically approved
4. Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services
Open this publication in new window or tab >>Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 7, article id e0181398Article in journal (Refereed) Published
Abstract [en]

Aim: This study aimed to evaluate the clinical utility of the Structured Observation of Motor Performance in Infants (SOMP-I) when used by nurses in routine child healthcare by analyzing the nurses' SOMP-I assessments and the actions taken when motor problems were suspected.

Method: Infants from three child health centers in Uppsala County, Sweden, were consecutively enrolled in a longitudinal study. The 242 infants were assessed using SOMP-I by the nurse responsible for the infant as part of the regular well-child visits at as close to 2, 4, 6 and 10 months of age as possible. The nurses noted actions taken such as giving advice, scheduling an extra follow-up or referring the infant to specialized care. The infants' motor development was reassessed at 18 months of age through review of medical records or parental report.

Results: The assessments of level of motor development at 2 and 10 months showed a distribution corresponding to the percentile distribution of the SOMP-I method. Fewer infants than expected were assessed as delayed at 4 and 6 months or deficient in quality at all assessment ages. When an infant was assessed as delayed in level or deficient in quality, the likelihood of the nurse taking actions increased. This increased further if both delay and quality deficit were found at the same assessment or if one or both were found at repeated assessments. The reassessment of the motor development at 18 months did not reveal any missed infants with major motor impairments.

Interpretation: The use of SOMP-I appears to demonstrate favorable clinical utility in routine child healthcare as tested here. Child health nurses can assess early motor performance using this standardized assessment method, and using the method appears to support them the clinical decision-making.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-316404 (URN)10.1371/journal.pone.0181398 (DOI)000406067800048 ()28723929 (PubMedID)
Available from: 2017-03-01 Created: 2017-03-01 Last updated: 2017-11-29Bibliographically approved

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