The predictive validity of Hammersmith Infant Neurological Examination versus prechtl’s general movement assessment with the Motor optimality score on gross motor outcomes in high-risk infants at 12-15 months corrected age : a descriptive study

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dc.contributor.advisorBurger, Marletteen_ZA
dc.contributor.advisorUnger, Marianneen_ZA
dc.contributor.authorJansen van Rensburg, Emma Anitaen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.en_ZA
dc.date.accessioned2022-02-24T14:39:54Z
dc.date.accessioned2022-04-29T09:23:00Z
dc.date.available2022-02-24T14:39:54Z
dc.date.available2022-04-29T09:23:00Z
dc.date.issued2022-04
dc.descriptionThesis (MScPhysio)--Stellenbosch University, 2022.en_ZA
dc.description.abstractENGLISH SUMMARY: BACKGROUND: Advances in neonatal and maternal care have caused an increase in survival rate of high-risk infants, however with increased risk for developing adverse neurodevelopmental outcomes such as cerebral palsy (CP). Evidence supports the predictive value of Prechtl’s General Movement Assessment (GMA) with Motor Optimality Score (MOS), and the Hammersmith Infant Neurological Examination (HINE) for CP outcome before 5 months corrected age. Exploring usefulness of these measures and understanding how these two compare in predicting gross motor outcome in high-risk infants may enable earlier referrals for all and not just those at risk for developing CP. OBJECTIVE: To compare the predictive validity of the HINE versus Prechtl’s GMA with MOS (measured at 11-16 weeks corrected age) for determining the gross motor outcomes in high-risk infants at 12-15 months corrected age as measured by the Alberta Infant Motor Scale (AIMS). METHODOLOGY: A longitudinal descriptive study was conducted at Tygerberg Children’s Hospital (TCH). All high-risk infants assessed at 11-16 weeks corrected age using Prechtl’s GMA with MOS and HINE and whose parents consented to participation were re-evaluated using the AIMS to determine their gross motor outcome at 12-15 months corrected age. Data was analysed using STATA version 16 and IBS SPSS software. HINE and Prechtl’s GMA with MOS cut-off scores were determined and ROC curve analysis utilised to determine sensitivity and specificity values for both measures. RESULTS: The study enrolled 100 infants with a mean birthweight of 1525.6g and a mean gestational age of 31.1 weeks. Fifteen infants scored <5th percentile on the AIMS at 12-15 months corrected age and seven infants were suspected to have CP. The HINE with a sample specific cut-off score of 62.5 had an area under the curve (AUC) of 0.867 to predict gross motor delay with sensitivity of 87% and specificity of 81%, and positive predictive value (PPV) of 45%, negative predictive value (NPV) of 97%. Prechtl’s GMA with the MOS had AUC=0.713 with sensitivity of 47% and specificity of 100%, and PPV of 100%, NPV of 91%. The reflexes and reactions subcategory on the HINE, and the observed postural patterns and fidgety movements subcategories on the MOS were predictive of gross motor outcome. Both HINE and GMA with MOS total scores were more predictive of gross motor outcome than subcategory scores or single items. CONCLUSION: The results of this study indicate that both the HINE and Prechtl’s GMA with MOS are valid measures for predicting gross motor delay as determined by the AIMS in high-risk infants. The HINE, however, is more sensitive to predict gross motor delay than the GMA with MOS. The HINE showed lower PPV to predict gross motor delay compared to the GMA with MOS, however NPV values for both were similar. For both measures total scores were more predictive of gross motor outcome than subcategory or single item scores. The results of our study suggest either HINE or GMA with MOS total scores be used to predict gross motor outcome. However due to small sample size and recruitment from one site this topic warrants further research.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: AGTERGROND: Vooruitgang in neonatale en moederlike sorg het gelei tot ‘n hoër oorlewingskoers van hoë-risiko babas, maar hierdie babas het steeds ‘n verhoogde risiko vir ongewensde neuro-ontwikkelings uitkoste soos serebrale gestremdheid (SG). Literatuur ondersteun die voorspellende geldigheid van Prechtl se Algemene Bewegings Assessering (GMA) met die Motor Optimaliteit Telling (MOS) en die Hammersmith Baba Neurologiese Assessering (HINE) vir die uitkoms van SG voor 5 maande gekorrigeerde ouderdom. Dit is belangrik om die gebruiklikheid van hierdie twee assesserings te ondersoek en te verstaan hoe dit vergelyk om grof motoriese uitkomste te voorspel. UITKOMSTE: Om die voorspellende geldigheid van die HINE teen Prechtl se GMA met die MOS (gemeet by 11-16 weke gekorrigeerde ouderdome) om grof motoriese uitkomste van hoë-risiko babas by 12-15 maande gekorrigeerde ouderdom volgens die Alberta Baba Motor Skaal (AIMS) te bepaal. METODOLOGIE: ‘n Longitudinale beskrywende studie is uitgevoer by Tygerberg Kinder Hospitaal (TCH). Alle hoë-risiko babas geasseseer met Prechtl se GMA met die MOS en die HINE by 11-16 weke gekorrigeerde ouderdom, en wie se ouers toestemming gegee het tot deelname in die studie, is her-evalueer deur die AIMS om hulle grof motoriese vaardigheid by 12-15 maande gekorrigeerde ouderdom te bepaal. Data is geanaliseer deur STATA weergawe 16 en IBS SPSS sagteware te gebruik. HINE en Prechtl se GMA met die MOS afsny-punte is bepaal en ROC kurwe analise is gebruik om sensitiwiteit en spesifisiteit waardes te genereer. RESULTATE: Een honderd babas met ‘n gemiddelde geboortegewig en gestationele ouderdom van onderskeidelik 1525.55g en 31.14 weke is ingesluit in die studie. Vytien babas het by 12-15 maande gekorrigeerde ouderdom <5de persentiel op die AIMS behaal, en sewe babas is voorwaardelik met SG gediagnoseer. Die HINE, met ‘n afsny-punt van 62.5 het ‘n area onder die kurwe (AUC) van 0.867, sensitiwiteit van 87%, spesifisiteit van 81%, positive voorspellende waarde (PPV) van 45% en negatiewe voorspellende waarde (NPV) van 97% gehad om grof motoriese uItkomste te voorspel. Prechtl se GMA met die MOS het ‘n AUC=0.713, sensitiwiteit van 47%, spesifisiteit van 100%, en PPV en NPV van 100% en 91% gehad. Die reflekse en reaksies subkatagorie van die HINE en die geobserveerde postural patrone en woelige bewegings subkatagorieë van Prechtl se GMA met die MOS was die mees voorspellend van motoriese uitkoms, Beide die HINE en die MOS totale puntetellings was meer voorspellend van grof motoriese uitkoms as subkatagorieë of enkele items. GEVOLGTREKKING: Die resultate van hierdie studie wys dat beide die HINE en Prechtl se GMA met die MOS geldige assesserings is om grof motoriese uitkomste volgens die AIMS te voorspel in hoë-risko babas. Die HINE is egter meer sensitief as die GMA met die MOS. Die HINE het laer PPV gehad om grof motoriese uitkomste bepaal as die MOS, maar NPV vir beide assesserings was eenders. Vir albei asseserings was die totale puntetellings meer voorspellend van grof motoriese agterstand as subkatagorieë of enkele items. Die resultate dui daarop dat beide die HINE en GMA met MOS assesserings gebruik kan word om grof motoriese uitkomste te bepaal. As gevolg van die klein steekproefgrootte, en beperkte werwings ligging, verg hierdie onderwerp verdere navorsing.af_ZA
dc.description.versionMasters
dc.format.extentxix, 132 pages : illustrations, includes annexures
dc.identifier.urihttp://hdl.handle.net/10019.1/124626
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch University
dc.rights.holderStellenbosch University
dc.subjectChild development -- South Africaen_ZA
dc.subjectInfants -- Development -- South Africaen_ZA
dc.subjectMotor ability in children -- South Africaen_ZA
dc.subjectMotor ability in infants -- South Africaen_ZA
dc.subjectCerebral palsied children -- Rehabilitation -- South Africaen_ZA
dc.subjectUCTD
dc.titleThe predictive validity of Hammersmith Infant Neurological Examination versus prechtl’s general movement assessment with the Motor optimality score on gross motor outcomes in high-risk infants at 12-15 months corrected age : a descriptive studyen_ZA
dc.typeThesisen_ZA
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