Clinimetric properties of lower limb neurological impairment tests for children and young people with a neurological condition: A systematic review

Abstract

BackgroundClinicians and researchers require sound neurological tests to measure changes in neurological impairments necessary for clinical decision-making. Little evidence-based guidance exists for selecting and interpreting an appropriate, paediatric-specific lower limb neurological test aimed at the impairment level.ObjectiveTo determine the clinimetric evidence underpinning neurological impairment tests currently used in paediatric rehabilitation to evaluate muscle strength, tactile sensitivity, and deep tendon reflexes of the lower limb in children and young people with a neurological condition.MethodsThirteen databases were systematically searched in two phases, from the date of database inception to 16 February 2017. Lower limb neurological impairment tests were first identified which evaluated muscle strength, tactile sensitivity or deep tendon reflexes in children or young people under 18 years of age with a neurological condition. Papers containing clinimetric evidence of these tests were then identified. The methodological quality of each paper was critically appraised using standardised tools and clinimetric evidence synthesised for each test.ResultsThirteen papers were identified, which provided clinimetric evidence on six neurological tests. Muscle strength tests had the greatest volume of clinimetric evidence, however this evidence focused on reliability. Studies were variable in quality with inconsistent results. Clinimetric evidence for tactile sensitivity impairment tests was conflicting and difficult to extrapolate. No clinimetric evidence was found for impairment tests of deep tendon reflexes.ConclusionsLimited high-quality clinimetric evidence exists for lower limb neurological impairment tests in children and young people with a neurological condition. Results of currently used neurological tests, therefore, should be interpreted with caution. Robust clinimetric evidence on these tests is required for clinicians and researchers to effectively select and evaluate rehabilitation interventions.

Tools to Assess the External Validity of Randomized Controlled Trials in Systematic Reviews: a Systematic Review of Measurement Properties

“…Literature search and selection process Figure 1 shows the selection process. The "PRISMA ow diagram of systematic search strategy used to identify clinimetric papers" was adapted from Clark et al [29] In the phase 1 search, from 4670 non-duplicate records, 4330 irrelevant records were excluded. 345 full-text articles were screened, and 71 potential tools were extracted.…”

“…Figure 1 Flow diagram "of systematic search strategy used to identify clinimetric papers" [29] Supplementary Files This is a list of supplementary les associated with this preprint. Click to download.…”

“…validity and reliability) [28]. The four key elements were divided in two main searches (as performed by others [29]): the phase 1 search contained the rst three key elements to identify measurement tools to assess the external validity of RCTs. The phase 2 search aimed to identify studies evaluating the measurement properties of each tool, which was identi ed and included during phase 1 search, using the fourth key element.…”

Perceived Barriers, Enablers, and Modifications to Tests Assessing Pediatric Lower Limb Neurological Impairment: An International Delphi Survey

“…2 Neurological conditions in this population present with similar impairments in lower limb muscle strength, tactile sensitivity and/or reflexes when compared to adults. 3,4 However, neurological development and growth occurs from birth into the early twenties irrespective of a neurological diagnosis. [5][6][7][8] Outcome measures in children and young people, must therefore be responsive to clinical change independent of growth.…”

“…1,3,9 Current tests of neurological impairment lack adequate evidence of clinimetric properties when used on children and young people with a neurological condition. 4 Evidence of reliability was predominantly limited by small sample sizes and inconsistent reporting of protocols. 4,11 Most available tests have not been validated for use in children with a neurological condition.…”