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USE OF STANDARDIZED TESTS FOR ASSESSING MOTOR
DEVELOPMENT IN PHYSICAL THERAPY CLINICAL PRACTICE

By

Sherry Lynn Herman-Hilker

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE
Department of Kinesiology
1998

ABSTRACT

USE OF STANDARDIZED TESTS FOR ASSESSING MOTOR
DEVELOPMENT IN PHYSICAL THERAPY CLINICAL PRACTICE

By

Sherry L. Herman-Hilker

Physical therapists provide treatment for children with disabilities
in order to optimize their level of motor functioning. How pediatric
physical therapists evaluate, interpret, and report clinical findings is
essential to the practice of physical therapy. The importance of using
standardized tests in pediatric clinical practice is clear but the actual
assessment practices of pediatric physical therapists have not been
thoroughly studied and therefore cannot be understood. The purpose of
the present study was to collect empirical data on the clinical use of
standardized assessment tools by pediatric physical therapists in order
to develop a basis for understanding their assessment practices.

A national survey of members of the Section on Pediatrics of the
American Physical Therapy Association (APTA) was conducted. The
response rate was 61%. The results of the study suggest that a large
variety of standardized tests are used clinically, however, the frequency
of use and the consistency of use of any particular test are quite low.
Only two tests, the Peabody Developmental Motor Scales and the
Bruininks-Oseretsky Test of Motor Proficiency, were identified as
frequently used tests. Results indicate that therapists are not highly
satisfied with available tests, do not believe themselves to be highly
informed about the availability, administration, and scoring of such
tests, and report many disadvantages and reasons for choosing not to

use standardized tests.

Copyright by
Sherry Lynn Herman-Hilker
1998

To my husband, from whom I've learned to be realistic.
To my family, from whom I've learned to be optimistic.
To my children, from Whom I've learned to priorize.
To Allison Hatchar Dybdahl who, in living and in dying, gave me
perspective.

iv

ACKNOWLEDGMENTS

I received assistance from so many individuals during the
completion of this project —- I regret that it is impossible for me to list
everyone. Thank you all, you know who you are.

In particular I would like to acknowledge those in the physical
therapy community who assisted me: The pediatric physical therapy
staff at Mott Children's Hospital who participated in the development of
the questionnaire and gave me ongoing professional and personal
support; the pediatric physical therapy staff at Sparrow Hospital and
Meyer Institute who participated in a pilot study; and Dr. Wayne
Stuberg, Dr. Paulette Cebulski, Dr. Elizabeth Marcoux, and Dr. Barbara
Connolly who assisted in the development of the proposal for this study
and in the development of the questionnaire.

I would also like to thank Brian Silver for his assistance in the
development of the questionnaire.

I would like to thank the Pediatric Section of the APTA for partially
funding this study.

I would like to thank my committee members, Dr. Gail Dummer
and Dr. Anne Soderman, for their recommendations and feedback
throughout the completion of this project.

I would like to thank my friends--especially Marlo Rojeck and
Janet Cook--who assisted in too many ways to list. I especially thank
you for the impromptu babysitting, dinners delivered to the door and

donated clerical supportl!

I would like to thank my Advisor, Dr. John Haubenstricker, who
gave ongoing support and guidance throughout the course of this
project. His belief in me gave me the perseverance to complete it despite
many obstacles. Thank you, Dr. H., for sharing your knowledge, advice,
and sense of humor.

I would like to thank my family--Dan and Nan Herman, Dannan
Herman, Kimberley Herman Mitchell, Gilbert and Genevieve Herman,
Dorothy Wilder, Vivian and Emerson Hilker, and all the rest--who helped
in too many ways to list. Thank you all for the love, support, and
encouragement. I could not have done this without you.

Finally, I thank my husband, Donn Hilker, and my children Trevor
and Kaiya, who have lived with me day in and day out during my life as a
graduate student. They have given technical support --some of the time,
undying patience --most of the time, and never ending support --all of
the time. I love you all--thank you for letting me do this for me. I have
learned so many "lessons of life" having worked on this project during
these years. I appreciate your commitment to me and to my goals

despite the sacrifices that it meant for you.

vi

TABLE OF CONTENTS

LIST OF TABLES ................................................................................... ix
LIST OF FIGURES ................................................................................. xi
CHAPTER I
THE PROBLEM ...................................................................................... 1
Need For the Study ....................................................................... 2
Purpose of the Study ..................................................................... 3
Research Questions ...................................................................... 3
Research Plan ............................................................................... 4
Assumptions Related to the Research Plan .................................... 4
Limitations of the Research Plan ................................................... 4
CHAPTER II
RELATED LITERATURE .......................................................................... 6
Introduction .................................................................................. 6
Clinical Measurement in Pediatric Physical Therapy ...................... 6
Background .................................................................................. 8
Clinical Use of Standardized Assessment Tools ........................... 11
Summary .................................................................................... 12
CHAPTER III
METHODS ........................................................................................... 18
Research Design ......................................................................... 18
Internal Validity .......................................................................... 18
External Validity ......................................................................... 2O
Participants ................................................................................ 2 1
The Questionnaire ...................................................................... 22
Reliability .................................................................................... 24
Data Collection Procedures ......................................................... 26
Data Analysis .............................................................................. 27
CHAPTER IV
RESULTS ............................................................................................. 29
Respondents Demographics ........................................................ 30
Regional Representation .................................................... 30
Level of Education ............................................................. 31
Employment Experience and Current Employment
Situation ........................................................................... 33

vii

Evaluation Habits ....................................................................... 36

Number of Evaluations Performed ...................................... 36
Ages of Children Evaluated ................................................ 36
Diagnoses of Children Evaluated ....................................... 37
Training and Knowledge of Standardized Tests ............................ 45
Opinions Regarding Use of Standardized Tests ............................ 47
Reasons for Using and Perceived Advantages of
Standardized Tests ...................................................................... 47
Reasons for Not Using and Perceived Disadvantages of
Standardized Tests ............................................................ 48
CHAPTER V
DISCUSSION ........................................................................................ 49
Clinical Developmental Assessment Practices Of Pediatric
Physical Therapists ..................................................................... 50
Specific Standardized Tests of Motor Development Used By
Pediatric Physical Therapists ....................................................... 53
Frequency of Use of Specific Standardized Tests In Pediatric
Clinical Practice .......................................................................... 55
Purposes For Which Pediatric Physical Therapists Are Using
Standardized Assessment Tools .................................................. 56
CHAPTER VI
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS ...................... 58
Conclusions ................................................................................ 58
Recommendations ....................................................................... 6O
APPENDICES
APPENDIX A ............................................................................... 62
APPENDIX B ............................................................................... 69
APPENDIX C ............................................................................... 86
APPENDIX D ............................................................................... 87
APPENDIX E ............................................................................... 88
APPENDIX F ............................................................................... 89
APPENDIX G ............................................................................... 90
LIST OF REFERENCES ........................................................................ 94

viii

LIST OF TABLES

Table 1 - Time Table for Data Collection and Analysis ........................... 27
Table 2 - Years of General and Pediatric Physical Therapy Practice ........ 33
Table 3 - Other Work Environments Reported by Respondents .............. 35

Table 4 - Percentage of Physical Therapists Who Perform Evaluations
on Children in Each Age Group .............................................. 36

Table 5 - Average Percentage of Evaluations Performed by Therapists
by Age Group ......................................................................... 37

Table 6 - Percentage of Children Evaluated and Re-Evaluated Using
Standard Tests of Motor Development by Medical Diagnosis
Category ................................................................................. 38

Table 7 - Diagnoses of Children Evaluated by a Majority of Physical
Therapists Using Standardized Tests of Motor Development
and Most Frequently Used Test .............................................. 39

Table 8 - Frequency of Use of Specific Standardized Assessment
Tools Indicated on Checklist/Used by More Than 1% of

Respondents .......................................................................... 4 1
Table 9 - Frequency of Use of Specific Standardized Assessment

Tools Written in by More Than 1% of Respondents ................. 43
Table 10 -Five Most Frequently Used Standardized Tests of Motor

Development and Reasons for Use .......................................... 44
Table 11 -State of Current Practice-Reliability Study .............................. 74

Table 12- Educational Degree in Physical Therapy-Reliability Study ....... 74

Table 13- Highest Educational Degree in Field Other Than Physical
Therapy - Reliability Study ..................................................... 74

Table 14- Mean Response of Years of Experience - Reliability Study ....... 75
Table 15- Location of Pediatric Practice - Reliability Study ..................... 75

Table 16- Primary Location of Pediatric Practice - Reliability Study ........ 75

ix

Table 17 - Ages of Children Evaluated - Reliability Study ...................... 76

Table 18 - Diagnoses of Children Being Evaluated by Respondents -
Reliability Study .................................................................. 76

Table 19 - Methods of Developmental Assessment Clinically Used by
Respondents - Reliability Study ............................................ 77

Table 20 - Frequency of Use and Reasons For Use of Specific
Standardized Assessment Tools ........................................... 78

Table 21 - Frequency of Use of Specific Standardized Assessment
Tools .................................................................................... 90

Table 22 - Frequency of Use of Assessment Tools Written In By
Respondents ........................................................................ 92

LIST OF FIGURES

Figure 1 -Regional Response and Regional Membership
Representation ...................................................................... 30

Figure 2 -Highest Level of Education in Physical Therapy ..................... 31

Figure 3 -Other Certifications and Credentials Held by Pediatric
Physical Therapists ............................................................... 32

Figure 4 ~Primary Locations of Pediatric Physical Therapy Practice ....... 34

Figure 5 ~Average Percentage of Time Spent by Pediatric Physical
Therapists in Various Professional Responsibilities ................ 35

Figure 6 -Methods of Developmental Assessment Used by Pediatric
Physical Therapists in Clinical Practice ................................. 39

Figure 7 -Methods of Training in the Use of Standardized Tests of
Motor Development as Reported by Therapists in the
Pediatric Section ................................................................... 45

Figure 8 ~How Informed Pediatric Physical Therapists Believe
Themselves to Be Regarding the Availability and
Administration / Scoring of Standardized Tests of Motor
Development ......................................................................... 46

Figure 9 -Degree of Satisfaction of Pediatric Physical Therapists
Regarding Currently Available Standardized Tests of

Motor Development ............................................................... 47
Figure 10- Record of Returns ................................................................. 87
Figure 11- Post Card Reminder .............................................................. 88

xi

CHAPTER I
INTRODUCTION

Pediatric physical therapists evaluate and treat children with
disabilities in order to optimize their level of motor functioning and
ultimately to impact the quality of their lives. A vast number of factors
contribute to motor dysfunction, thus therapists find it difficult to
objectively and quantitatively report clinically important changes that
occur as the result of therapeutic intervention (Campbell, 1989).
Consequently, many therapists resort to qualitative descriptions to
document changes in motor abilities. This approach is criticized by some
members of the scientific community because of its subjective basis
(Campbell, 1987). Unfortunately, subjective reporting often is
inconsistent and makes communication with other professionals
difficult. In order to justify treatment, communicate effectively, and
document change in ability, particularly in this era of health care reform,
therapists must utilize an objective method of reporting (Jette, 1993).

The growing need for therapists to develop and use standardized
assessment tools that measure outcomes specific to therapeutic
intervention has been documented in the literature (Boyce, Gowland 85
Hardy, 1991; Campbell, 1989). Standardized tests are assessment tools
for which a manual exists which outlines procedures for test
administration, scoring and interpretation (Law, 1993). A number of
such standardized tests exist and more are continuing to be developed
and reported (Boyce et al., 1991).

Physical therapists are recognizing the need for formal measures in

order to ensure the credibility of the profession. This is clearly evidenced

by the development of The Standards for Tests and Measurements in
Physical Therapy Practice that were adopted by the House of Delegates of
the American Physical Therapy Association (Rothstein et al., 199 1). The
intent of "The Standards" is to assist therapists in "ensuring the quality
of physical therapy evaluations" (Gaynor, 1991, p.591). How therapists
evaluate, interpret, and report their clinical findings is critical to the
credibility of their profession. It is essential that attention be given to the
development of guidelines and tests, and to the preparation of
publications that emphasize the need for standardized tests as a
component of the assessment process. It is also essential that clinicians
use this information and actually implement the use of such tests in
clinical practice--with clients in the treatment environment. Little is
reported in the literature, however, about the use of standardized
assessment tools by pediatric physical therapists in the clinical setting
(Crowe, 1989; Lewko, 1976).

Need For the Study

The surge of attention toward the development and use of
standardized assessment tools in physical therapy is clearly evident in
the literature (Campbell, 1989, 1990; Gaynor, 1991). More studies are
reporting the use of these assessment tools as components of research.
Little is reported in the literature, however, about the use of standardized
assessment instruments by pediatric physical therapists in the clinical
setting.

It is imperative that pediatric therapists in clinical practice
communicate with each other and with those involved in test

development on how standardized assessment tools are actually being

used. This knowledge can help those advocating for the use of
standardized tests to better understand current practices in assessment
and ultimately to improve their advocacy for the use of standardized
assessment tools or other methods of assessment. Such knowledge also
can provide insight and support to clinicians who are making decisions
about the use of assessment tools or about the avoidance of measures
that they feel are inappropriate or inadequate. Moreover, the information
can educate them about how other clinicians like themselves are using
assessment tools. This is only the beginning of obtaining the knowledge
necessary to adequately meet the needs of pediatric therapists in clinical

practice.

Purpose of the Study
The purpose of this study is to determine the clinical use of

standardized assessment tools by pediatric physical therapists in order
to enhance the body of knowledge regarding the behaviors and views of
pediatric therapists toward standardized tools for the assessment of
motor development. Such information is relevant to researchers in test
development, to educators who teach test use, and to clinicians who
struggle with issues related to the use of standardized assessment tools

in the clinical setting.

Research Questions

The following research questions were addressed in this study:

1. What types of developmental assessment tools are pediatric physical
therapists using in clinical practice?

2. What specific standardized tests of motor development are being
used clinically by pediatric physical therapists?

3. How frequently do physical therapists use standardized tests in
clinical practice?

4. For what purposes are pediatric physical therapists using
standardized tests of motor development?

5. What are the general opinions of pediatric physical therapists about
standardized assessment tools?
Research Plan
A national survey of 1000 practicing pediatric physical therapists

was conducted. The questionnaire, developed by the researcher (see
Appendix A), consists of questions about the attributes and
demographics of the respondents and their behaviors regarding the use
of assessment instruments with their clients. The pool of potential
respondents was derived from the population of pediatric physical
therapists who are members of the Section on Pediatrics of the American

Physical Therapy Association (APTA).

Assumptions Related to the Research Plan
It is assumed that the subjects were truthful and accurate in their
responses to the questionnaire. It is also assumed that the responses of

the APTA members are representative of pediatric clinicians who are not

members of the APTA.

Limitations of the Research Plan
Despite careful planning of this study, a number of limitations
remain which may have impacted the outcome. The sample was

essentially one of convenience. It was not economically feasible to obtain

a sample representing the entire population of practicing pediatric
physical therapists. Membership in the APTA or Pediatric Section is not
mandatory for licensed therapists, therefore, selecting the sample from
the population of therapist members excludes therapists who are not
members of this organization. Thus, the sample of APTA therapists may
not be representative of all pediatric therapists. The sample obtained
from the APTA was not truly random. It was provided by the
Management Information Systems (MIS) and Direct Mail Services
Department of the APTA. The selection was made by member
identification number and is not guaranteed by the MIS to be truly
random. The information obtained from this sample is valuable in its
own right though it may represent only a subset of the population of
interest.

The response rate to the survey could not be anticipated. The
response rate obtained (61%, n= 610) represents approximately 15% of
the total population of Pediatric Section members. Financial constraints
prevented the use of a larger sample.

To make the survey of reasonable length for respondents to
complete in a timely manner, some lines of questioning were abbreviated.
Thus, not all of the information that might be desired about the
assessment practices of pediatric physical therapists could be obtained
and the impact of such information on the questions posed in this study

will remain unknown pending further investigation.

CHAPTER II
RELATED LITERATURE

Introduction

Literature pertaining to standardized assessment ranges from
abundant to obscure depending upon the specific topic area. This
chapter is a summary of the literature that is specifically relevant to this
study. The first section consists of a discussion of clinical measurement
in pediatric physical therapy. This is followed by a brief historical review
of the development of standardized assessment in pediatric physical
therapy including a review of four currently used standardized tests. The
next section consists of a review of the literature pertaining to
assessment practices of pediatric therapists. Finally, a summary is

presented in light of the literature reviewed.

Clinical Measurement in Pediatric Physical Therapy

"The physical therapy evaluation is the foundation for the
measurement of the outcome of our therapeutic intervention. And we
must measure these outcomes." (Gaynor, 1991, p. 591). Without clinical
measurement physical therapists simply could not practice (Rothstein et
al., 1991). According to Smith (1990), clinical measurement is "the
process of quantifying characteristics of individuals". Physical therapists
attempt to quantify in numerous ways in order to communicate with
each other, to document the efficacy of their treatments and to achieve
credibility in the scientific community (Rothstein, 1985; Rothstein et al.,
1991). The clinical importance of measurement may include the desire

to classify or describe a particular characteristic of a client, to predict

outcomes, to evaluate change as a result of an intervention, or to
document the results of a treatment intervention (Gowland et al., 1991;
Kirschner 8r Guyatt, 1985; Rothstein et al., 1991). The extent of
measurement in physical therapy is astounding ranging from
observational assessments to complex "hands-on" assessments
(Rothstein et al., 1991). As vital to the success of the profession as
measurement is, even more vital is the quality of the measurements that
are used. Standardization of measurement is "the process of
systemization of the methods used to obtain a measurement" (Rothstein
et al., 1991, p. 597). It is one factor that helps to insure quality of
measurement.

Despite the theoretical quality afforded by using good standardized
assessment instruments, a number of apparent reasons exist for
pediatric physical therapists choosing not to use standardized tests in
the clinical setting. These include lack of tests that meet the needs of the
clinical therapists (Campbell, 1990), lack of knowledge of available tests
(Lewko, 1976), lack of formal training regarding the use of standardized
tests, and lack of time in the clinic for conducting such tests (Campbell,
1990). Campbell (1989) identified six primary factors which may account
for these problems: (a) the complexity of developmental disabilities, (b)
the isolation of academics from the clinical environment which limits
feasibility of joint research with clinicians, (c) the difficulty with obtaining
funding for the development of appropriate tools, ((1) the service
orientation of the profession of physical therapy, (e) the anti-scientific
and anti-quantification characteristics of two respected treatment
philosophies, and (f) the lack of available faculty with appropriate

training, experience, and time. She suggests that these reasons explain

why no universally agreed upon standardized tests of motor development

exist.

Background

"Physical Therapists historically have been slow to develop and
standardize tests for use in studying motor development, control and
learning and for diagnosing problems or measuring progress in clients"
(Campbell, 1989, p. 4). The importance of objective assessment of motor
development was first addressed in the 1960's (Zausmer, 1964; Zausmer
8!. Tower, 1966). At this time only a handful of tests of motor
development were available for use and had not been adequately
validated on large populations (Campbell, 1981). In 1976 a survey of
individuals assessing motor behavior of children (the majority of which
were occupational and physical therapists) revealed that those assessing
motor behavior of children were using a large number of assessments,
however, many were unpublished and unstandardized (Lewko, 1976).
The respondents to this survey indicated a lack of knowledge of
standardized assessments.

In the 1980's, a surge occurred in the development of instruments
for assessing motor development, particularly by physical therapists
themselves (Campbell, 1985). Previously most available assessments
had been developed by professionals in other fields such as psychology
(Campbell, 1989). Despite this surge in development it appeared that
physical therapists in the clinic were still reluctant to use the tools that
were being developed (Campbell, 1990).

In 1991, the American Physical Therapy Association Task Force on

Standards for Measurement in Physical Therapy produced guidelines for

determining the quality of tests and measurements used by physical
therapists. The ultimate goal of these standards was to ensure the
quality of the physical therapy evaluation (Rothstein et al., 1991). The
development of tests by and for physical therapists has continued into
the 1990's with more emphasis placed on meeting the needs of the
clinical therapists. Two newer tests, developed in the 1990's, have been
specifically designed for evaluating change over time; the Pediatric
Evaluation of Disability Inventory (Haley, Coster, Ludlow, Haltiwanger,
and Andrellos, 1992) and the Gross Motor Function Measure (Russell et
al., 1993).

Currently, a large number of assessment instruments exist for
screening and evaluating motor development. The Handbook of Pediatric
Physical Therapy (Long 85 Cintas, 1995) contains a table of 47 tests
available for use by pediatric physical therapists. Many of the tests
pertain to motor development. The name of each test, the source for
obtaining it, the purpose and areas assessed, the appropriate age range,
the psychometric qualities, and the clinical implications are presented in
the table. It is not possible to discuss each of these tests within the
context of this paper. Four tests, that are particularly visible in the
literature currently, will be reviewed. These tests include; the Bayley
Scales of Infant Development II (Bayley, 1993), the Peabody
Developmental Motor Scales (Folio 85 Fewel, 1983), the Gross Motor
Function Measure (Russell et al., 1990), and the Pediatric Evaluation of
Disability Inventory (Haley et al., 1993).

The Bayley Scales of Infant Development II were designed by
Bayley (1993) for the evaluation of children from birth to 42 months of

age. Components of this test include items which assess cognitive

development, motor development, and behavior. According to Long and
Cintas (1995) this is the most widely used infant assessment in research.
It is an updated version of the original Bayley Scales of Infant
Development published in the late 1960's (Bayley, 1969).

The Peabody Developmental Motor Scales (PDMS) were developed
by Folio and Fewel (1983) for the purpose of evaluating children from
birth through 83 months of age. The test consists of both gross motor
and fine motor scales and takes approximately 45-60 minutes to
administer. Scoring of this test is based on a 0-2 point scale and allows
children to receive partial credit for skills which are emerging.

The Gross Motor Function Measure (GMFM) was developed by
Russell, et a1. (1993) for use in evaluating change over time in children
with cerebral palsy of any age. It is a criterion referenced test consisting
of five evaluation domains; lying and rolling, sitting, crawling and
kneeling, standing, and walking, running and jumping. All of the items
on the test are achievable by a 5 year old with typical motor
development. This test takes approximately 45-60 minutes to
administer. Children receive scores based on level of accomplishment of
each item.

The Pediatric Evaluation of Disability Inventory was developed by
Haley, et al. (1992) for the purpose of assessing the functional ability of
children from 6 months to 7 years of age. It is intended to describe the
current status of the child and to allow evaluation of change over time.
The test measures capability and performance in three domains; self
care, mobility, and social function. It can be administered by clinical
observation by a therapist or by in—depth interview with a parent or

caregiver. It takes approximately 45-60 minutes to administer.

10

Clinical Use of Standardized Assessment Tools

A limited number of reports exist in the literature concerning the
assessment practices of pediatric therapists in the clinical setting.
Initially only three studies were identified that specifically examined the
use of standardized assessment tools in clinical practice by physical
therapists and only two studies were identified that addressed the use of
standardized assessment tools by occupational therapists. Following the
completion of the current study, two recent studies were identified
(Messer 85 Blackinton, 1998; Westcott, Murray 85 Pence, 1998) which
address the use of assessment tools by pediatric physical therapists.

Lewko (1976) gathered information regarding practices in
evaluating the motor development of children with disabilities. The study
was based on a survey of 400 facilities throughout the United States and
Canada that reportedly performed motor evaluations on their clients. Of
the 269 questionnaires retumed, 207 provided usable data. The first
section of the questionnaire was devoted to questions regarding
attributes of the respondents and their facility. The second section
consisted of questions regarding particular tests used, the ages of the
clients evaluated using these tests, and the type of motor behavior
evaluated. Results indicated that individuals performing assessments of
motor behavior belonged to 13 occupational categories. A majority (76%)
of the respondents were either occupational therapists, physical
therapists, special education teachers, or physical educators. The 207
respondents reported using 91 published tests and 165 non-published
tests. Only four of the published tests (Denver Developmental Screening

Test, Purdue Perceptual-Motor Survey, 'Southem California Sensory

11

Integration Tests, and the Developmental Test of Visual Perception) were
reported with any frequency.

Cole, Finch, Gowland, and Mayo (1992) surveyed 17 6 physical
therapists in Canada regarding their use of and satisfaction with
standardized outcome measures. The response rate was 81%. The
majority of the respondents worked with a variety of clients including
adults, geriatrics and pediatrics. Less than half (41%) of the respondents
indicated that standardized outcomes measures were used in their
departments, 18% reported that only department developed tests were
used and 76% reported that mechanical devices were used. A list of tests
used was reported by the authors. None of those reported were tests of
motor development.

Only 8% of the therapists indicated that they were completely
satisfied with their current method of reporting the progress of their
patients. The majority of the respondents were moderately satisfied
(60%). The remaining 25% to 30% were either neutral or dissatisfied
with the current method used to report progress. A large percentage
(82%) of the respondents reported that the use of standardized outcome
measures could improve the documentation of the progress of patients
and over 90% reported that the use of standardized outcome measures
would improve the monitoring of progress. Over half (56%) of the
respondents, however, believed that numerous factors (such as time,
limited knowledge, lack of consensus and failure to meet the clients'
needs) prevented the use of such measures. A small percentage (15%) of
the respondents felt that using such measures would have a negative

impact on physical therapy practice in Canada.

12

Heriza, Lunnen, Fischer, and Harris (1983) surveyed all members
of the pediatric section of the APTA and received a total of 390 completed
questionnaires (a 22% response rate). One section of the questionnaire
pertained to the use of neurological and behavioral tests by pediatric
physical therapists. The authors questioned the participants about 20
such tests. Data were reported on the following six tests: (a) Southern
California Sensory Integration Tests, (b) Brazelton Neonatal Behavioral
Assessment, (c) Bayley Scales, (d) Milani-Comparetti, (e) Gesell, and (f)
Denver Developmental Screening Test. Respondents who indicated
"frequent" or "very frequent " use of these six tests ranged from 12% to
44%, while respondents who indicated never using them or using them
only occasionally ranged from 56% to 88%. This study was replicated by
Sweeney, Heriza, 85 Markowitz (1994) but the data regarding use of
standardized tests have not been published.

Crowe (1989) conducted a survey of 338 occupational therapists
working in the school systems in Alaska, Idaho, Montana, Oregon, and
Washington. Completed questionnaires were received from 293
respondents (87% response rate). One section of the questionnaire
pertained to the current use of 27 developmental assessment tools.
Respondents were asked to indicate which of the tests listed they used
frequently or occasionally in the clinical setting. Reportedly, 14 of these
instruments were used by 49% of the respondents. The tests included:
Peabody Developmental Motor Scales, Motor Free Visual Perception Test,
Bruininks-Oseretsky Test of Motor Proficiency, Developmental Test of
Visual-Motor Integration, Ayres' Clinical Observations, Jebsen-Taylor
Hand Function Test, Southern California Sensory Integration Tests,
Southern California Post Rotary Nystagmus Test, Developmental Test of

13

Visual Perception, Denver Developmental Screening Test, Bayley Scales
of Infant Development, Test of Motor Impairment: Henderson Revision,
Test of Visual-Perceptual Skills, and the Miller Assessment for
Preschoolers. The other 13 tests were used by less than 49% of the
respondents. Additionally, 57 developmental assessment tools were
written in as being used by at least one but not more than 12
respondents.

Reid (1987) surveyed 99 occupational therapists in Ontario
regarding their assessment practices with children with disabilities. The
author received 69 completed questionnaires (70% response rate). The
majority of respondents worked with pediatric clients in rehabilitation
centers or hospitals. The authors provided a list of 16 developmental
tests. Respondents were asked to indicate which tests they use, their
familiarity with the test and their satisfaction with the tests. Participants
were also asked to identify reasons considered important for assessment.
A majority (83%) of the respondents reported using standardized tests.
At least 50% of the respondents reported using the Developmental Test of
Visual-Motor Integration, the Southern California Sensory Integration
Tests, the Bruininks—Oseretsky Test of Motor Proficiency, the
Developmental Test of Visual Perception, the Miller Assessment for
Preschoolers and the Motor Free Visual Perception Test. Regarding
reasons respondents consider important for assessment: 97% indicated
"program planning", 94% indicated "to establish level of function", 86%
indicated "monitor progress", 74% indicated "program evaluation", 65%
indicated "screening", 64% indicated "placement", and 54% indicated

"establishing diagnosis".

14

Components of all of the studies above contributed to the
development of the questionnaire for the current study. Of those studies
described, only one reported information specific to the use of
developmental assessment tools by pediatric physical therapists (Heriza
et al., 1983). This study did not include information pertaining to the
reasons why specific standardized tests are administered. A number of
newer tests have been developed since this study was conducted.

Following the completion of the current study, two recent studies
were identified which address issues related to the use of standardized
tests by pediatric physical therapists. Messer 85 Blackinton (1998)
submitted an abstract for presentation at the American Physical Therapy
Association Annual Meeting regarding current trends in initial evaluation
by pediatric physical therapists. A questionnaire was administered to a
sample (n=52) of physical therapists in the southeastern United States.
Questions pertained to use of evaluation tools. Results indicated that
more than seven different assessment tools are used during an initial
evaluation. Only 21% of respondents indicated that published tests are
the primary tool used. The 52 respondents identified 23 different
standardized tests being used, however only the Peabody was used by
more than 8 respondents. The investigators report that a majority of the
respondents are not using tests which reflect current theory in physical
therapy. They also report that 44% of the respondents were unable to
name a test developed in the last five years. Each respondent was
scored by the investigators on appropriate use of standardized tests. Of
those scored, 31 failed and 14 passed. It was concluded that the
respondents are not aware of new tests of motor development and are not

using developmental tests appropriately. Only the abstract of this study

15

was available. It has not been published. Attempts to contact the
primary author to obtain more information were not successful.
Westcott, Murray, and Pence (1998) conducted a survey to
determine the preferences of pediatric physical therapists for assessing
and treating children with balance dysfunction. The sample consisted of
members of the pediatric section of the American Physical Therapy
Association. Respondents (n=566) were provided with two case examples
and asked questions regarding how they would evaluate and treat the
children presented. One section of the questionnaire pertained to the
use of evaluation tools. Respondents indicated that they would be most
likely to use non-standardized methods of evaluating the balance of these
children. At least 40% of the therapists selected at least one
standardized test for use in evaluating these children. The tests
reportedly used include; Bayley Scales of Infant Development,
Bruininks-Oseretsky Test of Motor Proficiency, Duncan Reach Tests,
Fisher Reach Tests, Gross Motor Function Measure, Miller Assessment of
Preschoolers, Peabody Developmental Motor Scales, Pediatric Evaluation

of Disability Inventory, and Sensory Integration and Praxis Tests.

Summary

Clearly the literature is lacking in information regarding current
practices in the assessment of motor development by pediatric physical
therapists. "Each physical therapist should continually strive to become
a more scientific practitioner, using well-designed tests both to measure
patient progress and to examine the success of the therapist's program
planning and implementation" (Campbell, 1990, p. 7). In order to

improve assessment practices collectively, pediatric physical therapists

l6

need to be knowledgeable about current practices in assessing the motor
behavior of children.

The information obtained from this study will provide much needed
information to practicing pediatric physical therapists who struggle with
issues related to the use of standardized assessment tools in the clinical
setting. It will also be valuable to test developers to better understand
the needs of therapists in the clinical setting, and to educators in the
physical therapy curriculum who can then inform students about

current assessment practices.

l7

CHAPTER III
METHODS

This research project was designed to investigate the use of
standardized assessment tools by pediatric physical therapists in the
United States. Of particular interest is which standardized tests are
being used clinically, how frequently specific standardized assessment
tools are being used, and what the reasons are for using particular

standardized assessment tools.

Research Design
This study is a cross-sectional survey (Babbie, 1990). By design it
is subject to threats to both internal and external validity. Every attempt

was made to identify and control these threats.

Internal Validity

Relevant threats to the internal validity of this study include
selection bias, experimental (data) mortality, instrumentation, fraud, and
error. Some threats to internal validity (i.e. history, maturation, testing,
and statistical regression) are minimized inherently in a cross-sectional
descriptive survey design.

The following measures were taken to minimize selection bias and

experimental (data) mortality:

1. A large modified random sample was obtained.
2. A cover letter explaining the intent and benefit of the study and the
importance of the feedback from respondents accompanied each

questionnaire.

18

3. Potential respondents were strongly urged to participate and were
reassured that all responses would be confidential.

4. Participants were reminded to complete all questionnaire items as
accurately as possible and to review the questionnaire for missing
data prior to returning it.

5. A self-addressed, postage paid envelope was enclosed to allow
convenient return of the completed questionnaire.

6. A post card reminder to all potential respondents and a second
mailing of the questionnaire to non-respondents was completed to

improve response rate.

The following measures were taken to minimize threats to validity

due to instrumentation:

1. The survey instrument was pre-tested and modified multiple times
to ensure that virtually all respondents interpreted each question in
the same manner.

2. Questionnaire instructions were written as clearly and concisely as
possible.

3. Forced choice responses were used whenever possible to minimize
the risk of researcher bias in scoring responses.

4. A test/ re-test reliability study was conducted and the questionnaire
was modified as appropriate (see Appendix A).

The following measures were taken to minimize threats to the

validity due to researcher error or fraud:

1. The questionnaire was pre-coded to eliminate the need for a coding

sheet.

19

2. Any necessary post-coding was performed by the researcher and an
assistant concurrently to reduce the potential for error in the
transfer of data.

3. Data were entered by the same person to minimize risk of inaccurate
data entry.

4. Following entry, data were reviewed to identify and correct entry

CI'I‘OI'S.

External Validity

Many threats to external validity are reduced inherently by the
nature of survey research (Agnew 85 Pyke, 1994). Threats to the external
validity of this study include sample restrictions and measurement
restrictions. The sampling restriction and subsequent limitations were
identified. As large a sample as economically feasible was selected in
order to reduce the risks of sampling error. A modified random sample
was provided by the Management Information Systems department of the
APTA according to their protocol. Participants were asked to be truthful
in their responses and were informed that their responses will be kept
confidential. The limitations to the generalizability of the results of the
study were considered. To minimize the threats imposed by
measurement restriction a panel of five experts in the field evaluated the
content of the survey instrument. The recommendations from these
experts were reviewed and incorporated into the final draft of the survey

instrument.

20

Participants

The pool of potential participants consisted of 1000 pediatric
physical therapists practicing in the United States. This pool
represented a subset of approximately 25% of the therapists who are
members of the Pediatric Section of the APTA. The sample was limited to
1000 for economic reasons. However, a relatively large sample size was
necessary because of the historically low response rate in a similar
survey (Heriza et al., 1983). A sample size of 1000 (with an estimated
response rate yielding at least 400 completed surveys) allowed the
researcher to be 95% confident that the findings of the study are
accurate within plus or minus five percentage points of the population
parameters (Babbie, 1992).

The selection criteria for participation in this study were as follows:

1. Participants are physical therapists licensed in the United States.

2. Participants are currently practicing physical therapy.

3. Participants are physical therapists with pediatric clientele currently
or within the last five years.

A mailing list of 1000 pediatric physical therapists who are
members of the Pediatric Section of the APTA was obtained from the
Management Information Service (MIS) Direct Mail Services department
of the APTA. The criteria for selection excluded physical therapist
assistants and non-licensed physical therapy students. The Pediatric
Section is comprised of 3600 physical therapists who are APTA members
and who have voluntarily become members of the Pediatric Section due
to a special interest in pediatrics. The APTA was the chosen population
source because this organization possesses a data base of members who

meet the criteria for this study. The mailing list of potential participants

21

was devised by a random selection of members by member identification
number. This procedure was performed by the MIS department of the
APTA according to their protocol and the ordering request made by this
author. This resulted in 1000 names comprising the potential

participants for this study.

The Questionnaire

The study consisted of a national survey of the pool of participants.
A self-administered questionnaire was selected as the most appropriate
method for obtaining the desired information (Alreck 85 Settle, 1995;
Babbie, 1992). The questionnaire was developed by the primary
investigator (see appendix A). It is a seven-page document. The first
section consists of 13 questions pertaining to demographic information
such as; region of practice, level of education, certifications and other
credentials, years of practice in general and in pediatrics, primary
location of practice, percentage of time spent in various job
responsibilities, and ages and diagnoses of clients served. In the second
section, respondents are asked to indicate with a check mark how
frequently they use a number of specific standardized assessment tools.
Four options were presented: Never, occasionally, fairly frequently, and
frequently. Next, respondents are asked to indicate the reasons why they
use each test. The reasons presented include: to classify or identify a
problem, to plan a treatment, to monitor progress, and to determine the
effect of a treatment. Respondents are also given an opportunity to name
tests other than those identified by the investigator and to respond to
them in the same manner. Next, respondents are asked to indicate how

they became trained to use tests of motor development, how informed

22

they feel about standardized tests, how satisfied they are with
standardized tests, their primary reasons for choosing to use a
standardized test, and the advantages and disadvantages of standardized
tests. Respondents are also given the opportunity to make comments.

During its development the questionnaire was pre-tested several
times. The first draft of the questionnaire was reviewed by six pediatric
physical therapist colleagues of the investigator, an academic physical
therapy program director with significant related experience, the director
of survey research at Michigan State University, and three thesis
committee members. The second draft of the questionnaire resulted from
a compilation of the feedback received. The second version was pre-
tested by ten pediatric physical therapists. These therapists were asked
to complete the questionnaire as if they were participating in the study
while noting unclear questions, incomplete response choices, and the
length of time required to complete the questionnaire. The therapists
were also asked to add any comments which they believe would simplify
the completion of the questionnaire. The survey instrument was revised
based on the feedback provided by these therapists. This process of
review was repeated with the revised draft of the survey instrument.

The survey instrument was reviewed for content by a panel of five
experts in the field. The experts were individuals highly regarded in their
area of expertise as perceived by the researcher and other physical
therapist members of the APTA. Those who reviewed for content
included clinician /educators in pediatric physical therapy with expertise
in assessment, therapists with expertise in education and research, and
therapists with expertise in survey research. A number of other experts

were consulted during the development of the questionnaire, responding

23

to questions from the researcher but not formally reviewing the
questionnaire. The feedback provided by these experts was appreciated
and incorporated into the final survey instrument. The survey
instrument and proposal was submitted to and approved by the
University Committee on Research Involving Human Subjects (UCRIHS)

at Michigan State University.

Reliability

According to Babbie (1992) reliability refers to how likely it is that
the same description of an event will be obtained repeatedly using a
given measurement procedure. In order to optimize the reliability of this

study, the following measures were taken:

1. Instructions were made clear and concise and were pilot tested.

2. A self-administered questionnaire was used.

3. The questionnaire was pre-tested for clarity.

4. A test-re-test study of reliability was conducted prior to the initial
mailing of the questionnaire (see Appendix B). The usable data
consisted of 23 pairs of questionnaires completed by pediatric
physical therapists at two facilities in Michigan and one in
Nebraska. The data were compiled and examined using two
different strategies. First, for the questions which resulted in the
collection of nominal data, frequencies and percentages for both the
first response and the second response were tabulated and reported
in table format (see Appendix B: Tables 1 1—19). The mean, median,
and mode of response were calculated for those questions containing
ratio data. These techniques allowed comparison of the two sets of

responses in terms of the research questions posed. Second, a

24

percentage of agreement for each specific variable was tabulated.
The results of the percentage of agreement are reported on the %
agreement survey form included in this appendix. This proved to be
an interesting method of examining the data but the output was
useful only as a indicator of strong agreement in some
circumstances.

Despite the limitations of this test-retest study of reliability
(small sample size, sample of convenience), it was valuable in that it
revealed numerous areas where improvements to the questionnaire
would be helpful. Most modifications were made to the instructions
in order to facilitate more consistent responses. Several alterations
also were made to the response categories. Many factors including
passage of time, circumstances during completion, mood of the
respondents, and so forth, will affect the outcome, and thus the
reliability, of a self-administered questionnaire. Continued pre-
testing, modifying and reliability testing could be done. The current
survey instrument, however, had been modified appropriately to
yield reliable results. The percent agreement analysis did
demonstrate areas of incongruency. It must be appreciated,
however, that this method requires an exact match in the responses
for agreement to occur. For example, if a respondent responded
" 160" to the question "how many children do you evaluate per year?"
on his first response and "161" on his second response, this would
not be considered agreement. The researcher believes, therefore,
that areas noted to be incongruent are less so than it seems.
Comparison of frequencies and percentages in light of the research

questions was more revealing in terms of true areas of discrepancy.

25

The instrument was modified based on responses to this reliability

study.

Data Collection Procedures

Following approval of UCRIHS, completion of the reliability study,
final modification of the questionnaire, and approval by the thesis
committee, preparation for the initial mailing of the survey instrument
took place. The questionnaire and cover letter (Appendix C) were
reproduced on 20# stock, 8 1 / 2 x 1 1" white paper, printed on both sides.
Mailing labels were obtained from the APTA and were coded with a
unique identifier. Each questionnaire was coded with a unique identifier
corresponding to the coded label. The coding allowed tracking of non—
respondents for second mailings. The questionnaire was accompanied
by an explanatory cover letter (see appendix C) which introduced the
investigator, discussed the purpose of the study, explained the
questionnaire, and requested its completion and return within a three-
week time period. The cover letter included components required by the
UCRIHS (i.e., consent to participate and confidentiality). A self-
addressed, return postage-paid envelope was included in the mailing.
The first mailing took place on January 26, 1998, with a request for
return by February 10th, 1998. A record of returns was kept to track the
pattern of returns and to monitor non-respondents (see Appendix D).
The initial mailing was followed three weeks later by a post card
reminder (see appendix E). Three weeks after the post card mailing a
second mailing of all the materials was made to participants who had not
responded. Nine weeks following the initial mailing was set as the final

date for the return of completed questionnaires. Upon receipt of the

26

completed questionnaires, each one was assigned a consecutive number
indicating the order of receipt. The consecutive number was recorded on
the back of the questionnaire. Non-deliverable pieces were recorded.
Questionnaires were sight-edited for completeness to eliminate unusable
questionnaires. Questionnaires were then organized in order of return
and held in a locked file cabinet to be post-coded and entered into a data
editor. A summary of the original time-line for data collection is

presented in Table 1.

Table 1 - Time Table for Data Collection and Analysis

 

January 26th, 1998 Initial Mailing

 

February 9th, 1998 Mailing of Post Card Reminder

 

March 2nd, 1998 Mailing to non respondents

 

March 26th, 1998 Final date for receipt of completed
questionnaires

 

March 26, 1998 Begin Data Analysis

 

 

 

 

June-August, 1998 Complete Thesis

 

Data Analysis

The survey response rate was determined. The Statistical Package
for the Social Sciences (SPSS) was used to record and prepare the data
for presentation. The demographic information (responses to Questions
1-13) was compiled to describe the characteristics of the respondents
and was presented in the form of tables and graphs. The mathematical
mode of responses was used to report the frequency of use and the

clinical reasons for use of the standardized tests and was presented in

27

tabular form. The data pertaining to training in, knowledge of,
satisfaction with, and primary reasons for using standardized tests also
were reported in table form. Responses to the open ended questions
regarding the advantages and disadvantages of using standardized tests
were grouped, post-coded, and reported in aggregate.

The types of developmental assessment tools being used by
pediatric physical therapists were determined based on responses to
Question #14. The specific standardized tests of motor development
being used clinically were determined by combining all tests that were
reportedly used "occasionally", "fairly frequently", or "frequently" and
were reported as a percentage. The percentage of participants
responding to each category also was reported. The frequency with which
pediatric physical therapists use specific standardized tests was
determined based on the following criteria: Tests indicated to be used by
a majority of respondents were classified as frequently used tests. The
reasons why specific standardized assessment tools are being used was
determined based on the percentage of the sample responding to each
category. All data collected were interpreted in light of the research

questions posed in Chapter I.

28

CHAPTER IV
RESULTS

Data received from the participants in this study were analyzed
and the results are presented in this chapter in the form of text, tables,
and graphs. Four primary categories of results are included following the
general information; (a) respondent demographics including regional
representation, levels of education, and current employment situation;
(b) evaluation habits including ages and diagnoses of children evaluated
and tests used; (c) training and knowledge of standardized tests; and ((1)
opinions regarding use of standardized tests including advantages and
reasons for use and disadvantages and reasons for choosing not to use
standardized tests.

Of the 1000 questionnaires mailed, 610 were retumed. This
represents a 61% response rate. The first mailing and the post card
reminder resulted in a return of 415 questionnaires. The second mailing
yielded the return of an additional 195 questionnaires. However, of the
610 questionnaires returned only 541 contained usable data. The 69
questionnaires which did not contain usable data consisted of the
following: (a) 46 respondents who indicated that they either do not or
have not treated pediatric clients in the last five years, and therefore were
outside the scope of this study; (b) five incomplete questionnaires; (c)
four duplicate questionnaires (the second questionnaire received was
omitted); (d) three cases in which the respondents did not wish to
participate in the survey; (e) three mailings returned due to incorrect
address; (1) three omissions by the researcher because the therapists are

practicing in foreign countries; and (g) two omissions by the researcher

29

because the potential respondents had participated in the pilot study or
survey preparation. Additionally, three questionnaires were omitted
because they were received after the data analysis had been completed.
Occasionally questionnaires which were essentially complete had some
missing data on selected items. The missing data were coded as such
and analyses were performed appropriately taking this into

consideration.

Respondent Demographics
Regional Representation

Responses were received from all APTA regions of the United States
(see Figure 1). Figure 1 compares the percentage of responses from each

region to the APTA pediatric section membership in each region.

 

4° " 37
35 ~-
30 -- I% Response
[3% Membership
w .
CD
8
3 -
8' 12

10 11

 

 

 

 

 

 

O "I O "I O "I
1 1 l = 1 L

 

 

 

 

 

 

   

 

Western North Great North South Southern South
central Lakes eastern eastern central

Figure 1 - Regional Response and Regional Membership Representation

The highest percentage of returns, 31% and 22%, came from

therapists practicing in the Northeastern and the Great Lakes Regions

3O

respectively. See Appendix F for the list of APTA regions and the states
within each region. However, the distribution of returns is fairly
consistent with the membership distribution of the APTA Section on
Pediatrics. In all cases percentages differ by less than six percentage

points and in most cases they differ by less than three percentage points.

Level of Education

Respondents were asked to indicate their highest level of education
in physical therapy. The highest level of education of the typical
respondent (65%) is a bachelor's degree in physical therapy (see Figure 2).

70 - 65
60 -
5O ‘-

   
  

Percentage
B 8 8

  

I

 

BS MS MPT PhD DPT Other
Highest Degree in PT

 

Figure 2 - Highest Level of Education in Physical Therapy

Master of Science degrees are held by 10% of the therapists, Master of
Physical Therapy degrees by 1 1%, and Ph.D. and Doctor of Physical
Therapy (DPT) each by 0.2%. Other levels of education were reported by
13% of the respondents. The most common "other" educational category
was Certificate in Physical Therapy, an early professional credential.

Respondents were also asked to indicate their highest educational degree

31

in fields other than physical therapy. Data indicate that 50% of the
respondents possess degrees in fields other than physical therapy in
addition to their physical therapy degrees. Of this group, 29% indicated
holding a BA or BS in another field, 15% indicated possessing an MA or
MS in another field, 2% reported having a Ph.D. and 4% listed other
degrees such as MPH, M.Ed., MBA, and Ed.D. Respondents also were
asked to indicate what, if any, additional credentials or certifications they
possess. Slightly less than half of the respondents (47%) indicated that
they possess additional certifications and credentials. Neurodevelop-
mental Training Certification (NDT) was reportedly held by 32% of the
therapists. A variety of other credentials, each reported by less than 1%
of the participants, were listed by 15% of the respondents (See Figure 3).

Percentage
w
o

0.9 o_2
NDT Ped Clinical TAMO Other None
certification Specialist certification

 

 

 

Figure 3 - Other Certifications and Credentials Held by Physical Pediatric
Therapists

32

Respondents were inconsistent in reporting the year in which various
credentials were obtained, therefore this information was not coded or

analyzed.

Employment Experience and Current Employment Situation

The typical respondent has 17 years of general experience in
physical therapy clinical practice [standard deviation (S.D.) of 8.644] with
responses ranging from 2 years to 42 years. Years of pediatric physical
therapy experience ranged from 1 to 40 with the typical respondent
having 13 years of experience. Table 2 indicates the percentage of
therapists falling into each of five categories of experience. The largest
percentage (35%)
of respondents had 21 or more years of general physical therapy
experience while only 10% had 1-5 years of experience. The years of
pediatric practice were more evenly distributed across the categories as

is evident in Table 2.

Table 2 - Years of General and Pediatric Physical Therapy Practice
(% of respondents by category)

 

 

 

 

 

 

 

 

 

 

Years of PT General PT Pediatric PT
Experience Practice Practice
1-5 years 1 0% 2 1%

6- 1 0 years 1 7% 24%
11-15 years 17% 18%
16-20 years 2 1% 19%

2 1 or more years 35% 18%

 

The primary locations in which pediatric practice takes place are

summarized in Figure 4. The largest percentage of respondents (45%)

33

Percentage

0.4

l
I

 

 

-‘ i N N u
O "I O "I O (’I O
r 1 r I l r I

   

School Ped Ped Hosp Ped Day Ped Res Ped Other
Outpt Ctr Trt Ctr Care Ctr Home
Care

Primary Location of Pediatric Practice

Figure 4 - Primary Locations of Pediatric Physical Therapy Practice

indicated that their primary location of pediatric practice is in schools.
Pediatric outpatient centers were indicated as the primary location for
16% of respondents. The remaining 35% of therapists indicated their
primary place of practice was in; (a) pediatric hospitals (1 1%), (b)
pediatric day treatment centers (2%), (c) pediatric residential care
centers (0.4%), (d) private homes (1 1%), or (e) other areas (19%). These
"other" work environments and the number of therapists in each are
summarized in Table 3.

Therapists spend from 1 hour to 60 hours per week at their
primary place of pediatric practice with a mean of 26.66 hours per week
(SD. = 12.39) and a median of 28 hours per week. The most frequently
reported (mode of response) number of hours worked in the primary

place of employment was 40.

34

Table 3 — Other Work Environments Reported by Respondents

 

 

 

 

 

 

 

 

Location Frequency of
Response

Preschool / Early 29

Intervention

Private Practice 23

General Hospital 18

Other Specialty Treatment 16

Environments

Multiple Locations Listed 12

Other Undefined Locations 5

 

 

 

The average percentage of time therapists spend performing each
of six professional responsibilities is depicted in Figure 5. The greatest
amount of time (64%, SD. = 24% ) is spent in direct patient care. Other
activities include program development, supervision, management,
documentation, travel, consultation / education, administrative and

clerical tasks, and meetings.

Percentage

 

g Es 8.? 53‘ g: '=
.60 8E "'0 E6 E0 5
n.'- a Zn on :‘a

on“ 8’2 “2' an. 0”

00 “Q Q. “a O

o n.> 3° :0 D

.-_- a: m “

D D E

Figure 5 — Average Percentage of Time Spent by Pediatric Physical
Therapists in Various Professional Responsibilities

35

Evaluation Habits
Number of Evaluations Performed

Respondents reported that they evaluate from 0-520 new children
per year with a mean of 35 evaluations and a standard deviation of
58.37. The median number of new evaluations performed per year is 20
and the mode is 10. Respondents also indicated that they re-evaluate
from 0-1000 children with a mean of 38 re-evaluations and a standard
deviation of 66.74. The median number of re-evaluations performed per

year is 25 and the mode is 20.

Ages of Children Evaluated
The percentages of therapists evaluating and re-evaluating

children in six age categories are presented in Table 4.

Table 4 - Percentage of Physical Therapists Who Perform Evaluations on
Children in Each Age Group

 

 

 

 

 

 

 

 

 

 

Age Group Average Percentage of

Therapists Performing
Evaluations

0-3 year olds 78%

4-7 year olds 90%

8-11 year olds 75%

12-15 year olds 61%

16-19 year olds 44%

20 years or older 20%

 

The majority of therapists evaluate children under 16 years of age.
The highest percentage of therapists (90%) performed evaluations on

children 4-7 years of age with a much lower percentage evaluating

36

children 16 years of age and older. The percentage of evaluations by age

group is presented in Table 5. There is an inverse relationship between

Table 5 - Average Percentage of Evaluations Performed by Therapists by

 

 

 

 

 

 

 

Age Group
Age Group Average Percentage Standard

of Evaluations Deviation
0-3 year olds 37% 33%
4-7 year olds 32% 23%
8-1 1 year olds 15% 15%
12-15 year olds 8% 10%
16- 19 year olds 5% 10%
20 years or older 3% 10%

 

 

 

 

 

the age of the children and the percentage of children evaluated. In
other words, over 37% of the evaluations involved children under four

years of age while only 3% involved individuals age 20 years or older.

Diagnoses of Children Evaluated

Therapists collectively reported evaluating children representing
more than 14 different medical diagnosis categories. The diagnoses of
the children evaluated are summarized in Table 6. A majority of the
respondents indicated that they evaluate children with the following
diagnoses: (a) cerebral palsy (97% ), (b) developmental delay (96% ), (0)
Down syndrome (81%), (d) neuromuscular disorders (78%), (e) muscular
dystrophy (61%), and (f) mental retardation (63%). Children in the other
diagnosis categories listed in Table 6 were evaluated by less than half of

the therapists. Table 6 also summarizes the percentage of therapists

37

Table 6 - Percentage of Children Evaluated and Re-Evaluated Using
Standard Tests of Motor Development by Medical Diagnosis Category

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagnosis Evaluate Evaluate 85 Evaluate But
With Or Use Do Not Use
Without Standardized Standardized
Standardized Tests Tests
Tests
Cerebral Palsy 97 % 66% 3 1%
Developmental Delay 96% 79% 17%
Down Syndrome 81% 59% 22%
Neuromuscular 7 8% 39% 39%
disorders
Mental Retardation 63% 38% 25%
Muscular Dystrophy 6 1 % 2 1% 40%
High Risk Infants 53% 42% 11%
Myelodysplasia 52% 22% 30%
Congenital Torticollis 47% 12% 35%
Arthrogryposis 40% 13% 27%
Brachial Plexus Injury 40% 11% 29%
Specific Learning 36% 27% 9%
Disability
Burns 13% 3% 10%
Hemophilia 10% 3% 7%

 

who use standardized assessment tools in the evaluation of children in

each diagnosis category. When respondents indicated that they use

standardized tests to evaluate children with a particular diagnosis, they

were asked to indicate the one test they would most often select for use

with evaluating children with this diagnosis. The Peabody

Developmental Motor Scales was used most frequently when evaluating

children with cerebral palsy, developmental delay, and Down Syndrome.

These were the only three diagnostic groups for which 50% or more of

38

 

 

the respondents indicated using standardized assessment tools (see

Table 7).

Table 7 — Diagnoses of Children Evaluated by a Majority of Physical
Therapists Using Standardized Tests of Motor
Development and Most Frequently Used Test

 

 

 

 

 

 

Diagnoses Therapists Most Frequently Used Standardized
Evaluating Test
With
Standardized
Tests (%)
Cerebral Palsy 66% Peabody Developmental Motor Scales
Developmental 79% Peabody Developmental Motor Scales
Delay
Down Syndrome 59% Peabody Developmental Motor Scales

 

 

Methods of Assessment Used
Physical therapist respondents reported using a variety of methods

to perform clinical developmental assessments (see Figure 6).

100 92

Percentage

 

Other

3
O
a
3

Parent Report
Clmlcal Obs
Stand Assess
Interview
Checklists
Home Obs
Video Tape

Self-Made Assess

Figure 6 - Methods of Developmental Assessment Used by Pediatric
Physical Therapists in Clinical Practice

39

Parental report was the most consistently reported method used (92%)
followed by clinical observations (84%) and standardized tests (81%).
When questioned more specifically regarding their use of standardized
tests of motor development, the 541 respondents indicated use of 85
different tests, 29 of which were listed on the questionnaire by the author
and 56 of which were written in by at least one respondent. The
frequency of use of the standardized tests listed on the questionnaire
which were used by at least 1% of the respondents is displayed in
Table 8. Table 9 displays those tests which were written in by at least
1% of the respondents, and their frequency of use. A table of all of the
tests listed and written in by respondents is presented in Appendix G.
The five tests used by the highest percentage of respondents are listed in
Table 10. Only two of the tests, the Peabody Developmental Motor Scales
(PDMS) and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP),
were reportedly used by a majority of respondents and thus are
considered frequently used tests. The PDMS was used by 71% of the
respondents. Of the therapists using the PDMS, frequent use (more than
12 times per year) was reported by 34%, fairly frequent use (7 -12 times
per year) was reported by 16% , and occasional use (6 or fewer times per
year) was reported by 21%. The BOTMP was reportedly used by 52% of
the respondents. Of those respondents using the BOTMP, frequent use
was reported by 8%, fairly frequent use was reported by 10% , and
occasional use was reported by 35% .

For each standardized test used, the respondents were asked to
indicate the reasons why they use it. Table 10 summarizes the reasons

for use of the top five most frequently used tests.

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44

Training and Knowledge of Standardized Tests

Training for use of tests of motor development occurred primarily
through on the job training (74%) and self study (66%). Continuing
education was a method of training for 47 % of the therapists. Graduate
education, certification courses, and undergraduate education each were
reported by less than 15% of the respondents as contributing to their
training in the use of standardized tests. Only 8% of respondents
reported that they had not become trained to use tests of motor

development (see Figure 7). Approximately 30% of the therapists

 

 

On Job Self Study ContEd Grad Ed Cert Undergrad Not

Train Course Ed Trained

Training in Use of Motor Development Tests

Figure 7 - Methods of Training in the Use of Standardized Tests of Motor
Development as Reported by Therapists in the Pediatric Section

reported that they were "informed" or "very informed" about the
availability of standardized tests of motor development (see Figure 8). A
slightly higher percentage (36%) believe themselves to be informed in

administering and scoring standardized tests. Only 2% of respondents

45

are "completely satisfied" with the currently available standardized tests

whereas 34% are "dissatisfied or "completely dissatisfied" (see Figure 9).

60 __ IAvailability
DAdminish‘ation & Scoring

 

 

 

 

 

 

 

 

 

 

 

 

3 5 .
. L4
Very Informed Somewhat Unlnformed Very
Informed Informed Unlnformed

Figure 8 - How Informed Pediatric Physical Therapists Believe
Themselves to Be Regarding the Availability and Administration / Scoring
of Standardized Tests of Motor Development

The majority of therapists were either not familiar with or had not
read the Standards for Tests and Measurements in Physical Therapy
Practice developed by the American Physical Therapy Association. Only
15% reported that they had read it.

46

70-

 

 

60 .
a 50
g 40
§ 30
83 20
10 -
o .
Completely Somewhat Dissatisfied Compleny
Satisfied Satisfied Dice-tidied
Satisfaction With Current Standardized Tests of Motor
Development

Figure 9 - Degree of Satisfaction of Pediatric Physical Therapists
Regarding Currently Available Standardized Tests of Motor Development

Opinions Regarding Use of Standardized Tests
Reasons for Using and Perceived Advantages of Standardized Tests

The therapist respondents were asked to provide reasons why they
use standardized tests of motor development and reasons why they do
not use them. The primary reasons given for using standardized tests of
motor development were; (a) to document need for therapeutic services
(73%), (b) to document effect of therapeutic intervention (51%), (c) to
meet the requirements of the place of employment (39%), and (d) to
obtain reimbursement (1 5%).

The five most frequent responses to the question "Please list
advantages of standardized tests" were; (a) "They allow monitoring or
documentation of progress" (n=121), (b) "They identify need or justify
continuation or discontinuation of services" (n=1 11), (c) "They are
objective" (n=106), ((1) no response (n=82), and (e) "They allow

qualification of clients for services" (n=50).

47

Reasons for Not Using and Perceived Disadvantages of Standardiz_ec_l

Tests
The respondents indicated numerous reasons for choosing not to

use standardized tests. The top five most frequently reported
circumstances when a therapist chooses not to use a standardized test
were; (a) when the test is inappropriate for the child's diagnosis (n =118),
(b) when a child's disability is too severe (n=108), (c) when a child is of an
inappropriate age (n=51), (d) when a child is unable to follow directions

or cooperate due to behavior, cognition, anxiety, etc. (n=71), and (e) when
it is redundant because the child has already been tested elsewhere or

has already qualified for services (n=33).
The five most frequent responses to the question "Please list

disadvantages of standardized tests" were: (a) "They are too time
consuming" (n=124); (b) "They are not applicable to all clients and are not

normed appropriately for our clients" (n=113); (c) "They do not measure
functional change or are not sensitive to change" (n=114); ((1) "They do

not measure quality of movement" (n=112); and (e) "They do not provide a

true picture of the child" (n=83).

48

CHAPTER V
DISCUSSION

How pediatric physical therapists evaluate, interpret, and report
clinical findings is essential to the practice of physical therapy. The
importance of using standardized tests in pediatric clinical practice is
clear (as discussed in Chapter I) but the actual assessment practices of
pediatric physical therapists have not been thoroughly studied and
therefore cannot be understood. The advancement of effective
evaluative / assessment practices depends on a solid understanding of
current practices. The purpose of this investigation was to collect
empirical data on the clinical use of standardized assessment tools by
pediatric physical therapists in order to develop a basis for
understanding their assessment practices. The importance of this topic
to practicing pediatric physical therapists is clearly evidenced by the
response rate of this survey (n=541) and the frequent requests by
respondents for the results of this study. Two current studies, published
following the completion of this study (Messer 85 Blackinton, 1998;
Westcott, 1998) report data related to the assessment practices of
pediatric physical therapists. These contributions to the literature
further indicate the growing interest in understanding this very
important topic.

The following is a discussion of the results of this study. The
regional representation of respondents was fairly consistent with the
general regional membership of the pediatric section of the APTA. The
larger number of respondents from the Great Lakes and Northeastern

region parallels the larger section membership in these regions. The

49

respondents were physical therapists, licensed in the United States who
are treating children currently or have treated children within the last 5
years. The typical physical therapist respondent possesses a Bachelor of
Science Degree in physical therapy, works in a school system or
outpatient practice about 26 hours per week, evaluates children of a
variety of medical diagnoses and uses some standardized assessment
tools. The following discussion will examine the assessment practices of

pediatric physical therapists in light of the research questions which

motivated this study.

Clinical Developmental Assessment Practices Of Pediatric Physical
Therapists

The physical therapist respondents in this study indicated that
they use a combination of methods of developmental assessment which
include, but are not limited to checklists, classroom observations,
clinical observations, home observations, interviews, parental reports,
self-made assessment tools, standardized assessment tools, and
videotape comparisons. The methods used most frequently are parental
reports used by 92% of the respondents, clinical observations used by
84% of the respondents, and standardized assessment tools used by
80% of the respondents. It is not surprising that almost all therapists
indicated using parental reports in their evaluations because in many
cases the parent is with the child during the evaluation and provides
baseline information and medical history on behalf of the child. The
parent or other caregiver is a key participant on the rehabilitation team.
The cases where parental reports were not used may have included cases

in which the parent was not present for the evaluation. The amount of

50

weight to place on parental report of the child's performance is an
individual judgment by the evaluating therapist. It is also not surprising
that a high percentage of therapists indicated using clinical observation
as a component of the evaluation. The term "clinical observation" was
not specifically defined for the purposes of the study but the intent of
this category was to refer to the component of the evaluation taking place
in a clinical environment and based on observation of the child's activity
and other clinical evaluation techniques. It is not possible to know
definitively how the respondents interpreted this category. Many
physical therapy sessions take place in a clinic within a facility, therefore
it is understandable that therapists would frequently report observations
within this setting as a part of the evaluation process. A high frequency
of therapists reported the use of standardized tests. This topic will be
examined later in the discussion on the frequency of use of specific
standardized tests.

A majority of respondents (68%) indicated that they use classroom
observation. This is interesting in light of the fact that a smaller number
(45%) of therapists actually work in schools. Perhaps therapists
employed in other settings have opportunities to conduct observations in
the classrooms. This is advantageous, as are home evaluations, because
it allows the child to be observed in a typical and functional environment.
Self-made assessment tools were reportedly used by 54% of the
respondents. The use of these tools may indicate a dissatisfaction with,
lack of availability of, or lack of knowledge of available standardized
tests, or it may indicate that the standardized tests currently available
are not adequate to meet the needs of the therapist or client or both.

Therapists may develop their own tools because they are unable to

51

identify or obtain published / standardized tests that meet their clinical
needs. Despite the fact that video tape comparison can be a very
valuable tool, it is a method reportedly used by only 29% of respondents.
This may be due to issues of time and efficiency, as well as the
availability of equipment and the comfort of the children in being
videotaped. The fact that eight of nine methods of developmental
assessment were used in clinical practice by a majority of respondents
suggests that therapists need more than one method to effectively
understand and describe a child's motor function. This has been
suggested previously and is supported in the literature (Missiuna 8s
Pollock, 1995). Clearly standardized tests, although essential, cannot
alone provide a complete picture of the child's status.

A number of therapists using standardized tests (39%) reported
that they perform standardized tests of motor development because they
are required to do so by their place of employment or because of other
regulations. Numerous respondents, specifically those working in
schools, commented that the particular tests that they use have been
selected for them by the organizational body in the district in which they
work. This suggests that the decision to use a particular standardized
assessment tool is not necessarily based on the individual client.
Instead, general protocols have been established for evaluating children
in specific age groups with specific diagnoses using specific standardized

assessment tools. This is an area for further study.

52

Specific Standardized Tests of Motor Development Used By Pediatric
Physical Therapists

A large number of tests of motor development (85) are used in
clinical practice, but many are used by less than one percent of
respondents. Only five tests are used by more than 25% of the
respondents. These five tests included the Peabody Developmental Motor
Scales (PDMS) (Folio and Fewel, 1983), the Bruininks-Oseretsky Test of
Motor Proficiency (BOTMP) (Bruininks, 1978), The Gross Motor Function
Measure (GMFM) (Russell, 1993), the Pediatric Evaluation of Disability
Inventory (PEDI) (Haley, 1992), and the Bayley Scales of Infant
Development (BSID) (Bayley, 1993). The Peabody Developmental Motor
Scales are used at least occasionally by 71% of the respondents. This
finding is consistent with a smaller (n=52) regional study which also
identified the PDMS as the most frequently used test (Messer 85
Blackington, 1998). In the current study, the Bruininks-Oseretsky Test
of Motor Proficiency was used at least occasionally by 52% of the
respondents. These were the only two tests used by a majority of the
respondents and therefore, by definition in this study, are the only two
"frequently used" tests. Both are norm-referenced tests which have been
available for many years. The greater consistency in use of these two
particular tests may be a result of their longevity and visibility in the
literature and their perceived applicability to the conditions being
evaluated.

The PEDI and the GMFM are relatively new tests. Both are
criterion referenced (as opposed to norm-referenced) tests. It will be
interesting to see if the frequency of use of these two tests increases in

the future. Comments from some respondents indicated a lack of

53

awareness of the availability of GMFM and the PEDI. This suggests that
perhaps the mechanism for disseminating new information is not
completely successful. A number of factors can contribute to the
decision to use a specific test. These factors were not examined
specifically as part of this study but would likely include: (a) the medical
diagnosis of the child; (b) the age of the child; (c) the reason for the
assessment; (d) the time available for the assessment; (e) the therapist's
familiarity with the test; and (t) the therapist's ability to administer and
score the test.

It is not surprising that so many different tests are used by
physical therapists at least occasionally, because recommendations have
not been clearly stated as to what specific tests to use under what
circumstances. Age, diagnosis, and the availability of equipment and
space must be taken into consideration when selecting a test. In at least
one case, guidelines have been compiled on a computer program which
allows the therapist to identify specific tests that are most appropriate for
particular circumstances. At the time of this writing, no definitive
recommendations regarding the selection of tests of motor development
are known to the author. How therapists identify which specific test or
tests to use was not explored in this study. Comments made by
respondents did indicate that in some cases they are mandated to use
particular tests by their place of employment. In other cases,
respondents indicate that they would never, under any circumstances,
choose to use a standardized test.

The diagnosis groups for which more than half the respondents

report using standardized tests are cerebral palsy, Down syndrome, and

54

developmental delay. The PDMS was the test most often used by

respondents for evaluating each of these three groups.

Frequency of Use of Specific Standardized Tests In Pediatric Clinical
Practice

Of the respondents who use the PDMS, 47 % indicated that they
use it more than 12 times per year. Another 23% use it 7 -12 times per
year and 30% use it six or fewer times per year. Only 15% of the
respondents who use the Bruininks-Oseretsky Test of Motor Proficiency
use it more than 12 times per year. Another 18% report using it 7-12
times and 67% report using it 6 or fewer times per year. Two factors
indicate that the PDMS is the more frequently used test; it is used by a
larger percentage of therapists in general, and more of the therapists who
use it report using it frequently. The frequency of use of the PDMS by
this group of respondents may be reflective of the higher percentage of
evaluations performed on children between birth and seven years of age
as compared to the percentage of evaluations performed on children
between four and fifteen years of age. The PDMS was developed for
the evaluation of children between birth and seven years while the
BOTMP was developed for the evaluation of children 4 1 / 2 to 14 years
of age.

In response to the question regarding frequency of use of the tests
listed on the questionnaire, more therapists indicated "occasional use"
(six or fewer times per year) of any test listed than indicated "frequent
use" (more than 12 times per year) of any test listed. "Fairly frequent" use
(7 -12 times per year) also was reported by relatively few respondents. The

number of responses indicating "frequent use" of any test was 439,

55

the number of responses indicating "fairly frequent use" of any test was
368 and the number of responses indicating "occasional use" of any test
was 1233. These numbers do not include tests written in by
respondents. This suggests that although a large number of therapists
(80%) report that they do use standardized tests and although a large
number of tests are apparently used, the frequency of use of these tests
is not high. A majority of the respondents use a test only occasionally.
Considering the large number of evaluations being performed, the
relative frequency of test use is small. Reasons for not using tests more
frequently may be lack of time, lack of appropriateness of the test or of
the child, lack of availability of tests, lack of knowledge of specific tests,
lack of satisfaction with specific tests, or just a general lack of desire, on
the part of the therapists, to use them. Interestingly, when reporting
reasons for choosing not to use standardized tests, therapists did not, for
the most part, identify lack of knowledge of standardized tests as a
reason. Only 36% of therapists, however, reported that they are
"informed" or "very informed" about the administration and scoring of
standardized tests. In general it seems that the reasons therapists
reported for choosing not to use standardized tests relate specifically to

clinical issues.

Purposes For Which Pediatric Physical Therapists Are Using
Standardized Assessment Tools

The purposes for which pediatric physical therapists use
standardized assessment tools fall into two categories: administrative
reasons, and clinical reasons. Therapists report using standardized

tests of motor development to document the effect and need for

56

therapeutic intervention, to comply with regulations or requirements by
their place of employment, and to obtain reimbursement ( a fair number
of people reported other reasons as well). The only purpose not indicated
by a majority of respondents was "to obtain reimbursement." It is
unclear as to whether this is because standardized tests are truly not
needed in order to obtain reimbursement, if therapists are not aware of
how they affect reimbursement, or if therapists are not concerned about
how they affect reimbursement . This is a topic for further study.
Pediatric physical therapists are using standardized tests of motor
development to classify or identify a problem, to plan a treatment, to
monitor progress, and to determine the effectiveness of a treatment
intervention. Interestingly, not all tests of motor development were
designed to be used for all of these purposes. Neither the Peabody nor
the BOTMP was originally designed to allow monitoring of progress or
determining the effect of treatment--however, both are used in this
manner by some of the therapists. Therapists are, in some cases,

modifying the currently available tests to meet their clinical needs.

57

CHAPTER VI
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

Physical therapists provide treatment for children with disabilities
in order to optimize their level of motor functioning. A solid evaluation is
critical to appreciating the child's functional level. Physical therapists
are recognizing the need for formal evaluative measures in clinical
practice. This is demonstrated by the publication of The Standards for
Tests andr Measurements in Physical Therapy Practice (Rothstein et al.,
1991). Little information is available regarding the actual evaluation
behaviors of pediatric therapists in the clinical setting. The purpose of
the present study was to determine the clinical use of assessment tools
by pediatric physical therapists. The intent was to add to the currently
limited body of knowledge about the use of standardized tests of motor
development by pediatric physical therapists.

The results of this study suggested that a large variety of
standardized tests are used clinically, however the frequency of use and
the consistency of use of a particular test are quite low. Only two tests,
the PDMS and the BOTMP, were identified as frequently used tests.
Results indicated that therapists are not highly satisfied with available
tests, do not feel highly informed about the availability, administration,
and scoring of such tests, and report many disadvantages and reasons

for choosing not to use standardized tests.
Conclusions

A large group of experienced pediatric physical therapists who

evaluate a variety of disorders participated in this study. Based on the

58

ICSU

were

 

 

 

results and within the limitations of this study, the following conclusions

were drawn:

1. A large variety of tests are reportedly used with varying frequencies
and with little consistency. Few tests of motor development are
consistently used by pediatric physical therapists in the clinical
setting and those that are used fairly consistently are not used very
frequently. Only two tests are used by a majority of physical
therapists --PDMS and BOTMP.

2. Currently available standardized assessment tools do not meet all of

the needs of pediatric physical therapists in clinical practice.

3. Few therapists are completely satisfied with the available tests, but
most therapists report using some type of standardized test at least

occasionally with some diagnoses.

4. Although 80% of the respondents indicate using standardized tests,
only 60% feel at least somewhat informed about administering and
scoring them. Few therapists have any formal training preparing them

to administer and score standardized tests.

5. Therapists report many reasons for not using standardized tests
including, but not limited to, lack of time, inappropriate diagnoses of
their clients, and inappropriate age of their clients. It is interesting
that much variability exists between therapists regarding what is
determined to be inappropriate use of standardized tests. For
example, some therapists indicated that a child with cerebral palsy
cannot appropriately be evaluated using a standardized test. Other

therapists indicated that they use standardized tests only to evaluate

59

 

Re

as

re.

children with cerebral palsy. Some therapists indicated that it is not
appropriate to use a standardized test to evaluate a child under the
age of three years. Other therapists indicated that it is only
appropriate to use a standardized test to evaluate children under the
age of three years. Many other diagnoses and age groups were listed
on some occasions as inappropriate and on other occasions as

appropriate.

6. Therapists report many disadvantages to using standardized tests.

7. Therapists report a number of advantages to using standardized tests.

8.

Responses to some questions and comments made by respondents
indicated some lack of understanding and knowledge of available
tests. For example, some therapists indicated that no tests are
available for the evaluation of children with cerebral palsy. This
demonstrates a lack of knowledge of the Gross Motor Function
Measure which was specifically developed for children with cerebral

palsy.

Recommendations

It is clear that further study must be done on the topic of the

assessment practices of pediatric physical therapists. Specific

recommendations for future investigations include:

. Perform an observational study to evaluate the assessment practices

of pediatric physical therapists first hand in the clinical setting.

Perform an observational study to evaluate the appropriateness of test

use and test administration first hand in the clinical setting.

60

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3. Examine the use of standardized tests with one or more specific
diagnostic groups or in one or more specific practice settings.

4. Examine alternatives to the use of standardized testing with the intent
of developing a method of objectively documenting clinical change
which would be more widely acceptable to pediatric physical
therapists.

As a direct result of this study it is recommended that a task force
be developed to address areas of concern identified in this study.
Concerns include lack of consistency of tests used, lack of frequency of
tests used, lack of knowledge and understanding of currently available
tests, and as has been discussed previously, the lack of tests which meet
clinical needs. Clearly these are complex problems that must be
addressed by a group of experts both in test development and clinical
test use.

Evaluation of pediatric clients with various diagnoses and various
presentations of the same diagnosis is a complex task and is difficult to
objectify and quantify. However, it is becoming increasingly evident that
objectification and quantification are essential. In the absence of
another acceptable mechanism for documenting objectively and
quantitatively it appears that standardized testing is a vital part of the
physical therapy evaluation. If it becomes consensus among pediatric
physical therapists that standardized tests are a necessary component of
the pediatric evaluation, much attention must be given to understanding
the current barriers to the use of these tests. This study has only begun
to unravel the complex issues surrounding the evaluation behaviors of

pediatric physical therapists.

61

APPENDIX A

Ple
ob:
in I

(tilt

 

 

APPENDIX A

Survey of Clinical Use of Tests of
Motor Development by Physical Therapists

Please complete this survey as accurately and honestly as possible. Your responses will be used to
obtain information regarding the current use of tests of motor development by physical therapists
in the United States.

If you do not or have not treated pediatric clientele in the last 5 years please check here —— —>CI
and simply return the blank questionnaire.

* Please note the questionnaire is 2-sided.

I. In what state(s) do you currently practice?

 

2. Please indicate your highest educational degree in physicauhempy. (Check only one)
[1] BS

[2] MS (entry level)

[3] MPT

[4] PhD

[5] DPT

[6] other (please explain):

DDDCIDCI

 

3. Please indicate your highest educational degrees in Wm. (Check only
one)

Cl [1] BA [88:
Cl [2] MA/MS:
D [3] PhD:
CI [4] none
Cl [5] other (please explain):

 

 

 

 

4. Please list any certifications or other credentials you may hold and the year in which the
credentialing was obtained

5. How many years have you practiced as a physical therapist ? (If less than one year please
indicate "1 year").

years

6. How many years have you practiced as a MERLE physical therapist ? (If less than one year
please indicate "1 year").

years

62

The following questions pertain to your primary location of pediatric practice

7.

10.

Please indicate your primary location of pediatric practice. (Check only one).
[1] school system

[2] pediatric outpatient center

[3] pediatric hospital

[4] pediatric day treatment center

[5] pediatric residential care center

[6] pediatric home care

[7] other (specify):

UDDCICICICI

 

. Please indicate the number of hours per week you spend at your primary location of pediatric

practice.
hours

Please estimate the percentage of time spent in each area. (The total must equal 100%).
% [1] In direct patient care
% [2] In program development
% [3] In a supervisory capacity (supervising other staff)
% [4] In a management capacity (overseeing department operation/administration)
% [5] Doing documentation
% [6] Other area (specify):

 

100% =TOTAL

Please indicate your primary magic clientele. (Check only one)
[1] outpatients

[2] acute inpatients

[3] rehabilitation inpatients

[4] students

[5] home care

[6] other

DDDDCICI

1 la) Please estimate the number of new children you evaluate per year.

L I I I children

 

1 lb) Please estimate the number of children you reevaluate per year.

| I l I children

 

63

12. What percentage of your evaluations (new and re-evals) fall into each age group? (The total

13.

must equal 100%).

% [1] 0-3 year olds

% [2] 4-7 year olds

% [3] 8-11 year olds

% [4] 12-15 year olds
% [5] 16-19 year olds
% [6] 20 years or older

100% = TOTAL

Please provide information about the diagnoses of the children you evaluate by completing the
table below. Circle your response (Y for "yes", N for "no") in COLUMN I regarding whether
you evaluate children of the given diagnosis. Additionally, circle your response in COLUMN II
regarding whether you use standardized testing for children with this diagnosis. If you do use
standardized testing, then in COLUMN IH please indicate which 9n; test you would use most
often.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

W I W l C(IJJMN III
Standardized Which one test would you

Evaluate? Test? Diagnoses use most often?

Y N Y N [1] Arthrogryposis

Y N Y N [2] Brachial Plexus Injury

Y N Y N [3] Burns

Y N Y N [4] Cerebral Palsy

Y N Y N [S] Congenital Torticollis

Y N Y N [6] Developmental Delay

Y N Y N [7] Down Syndrome

Y N Y N [8] Hemophilia

Y N Y N [9] High Risk Infants

Y N Y N [10] Specific Learning Disability

Y N Y N [11] Mental Retardation

Y N Y N [12] Muscular Dystrophy

Y N Y N [ l3] Myelodysplasia

Y N Y N [14] Neuromuscular disorders

Y N Y N [15] Other (specify):

 

 

 

 

14. Please indicate methods of developmental assessment you use in clinical practice (check all

that apply)

[1] checklists
[2] classroom observations
[3] clinical observations

[4] home observations

[5] interviews

[6] parental report

[7] self-made assessments
[8] standardized assessments
[9] video tape comparison
[10] Other (please list):

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66

17. How have you become trained to use tests of motor development? (check all that apply)
[1] Certification Course

[2] Continuing Education

[3] Graduate education

[4] On the job training

[5] Self Study

[6] Undergraduate education

[7] I have not become trained.

0000000

18a. l-Iow informed do you consider yourself regarding the availability of W tests?
Cl [1] very informed
D [2] informed
l3 [3] somewhat informed
Cl [4] uninformed
Cl [5] very uninformed

18b. How informed do you consider yourself regarding the administration and scoring of 5mm
tests?

CI [1] very informed

Cl [2] informed

Cl [3] somewhat informed
CI [4] uninformed

CI [5] very uninformed

19. How satisfied are you with the currently available W tests of motor development?
Cl [1] completely satisfied
[3 [2] somewhat satisfied
Cl [3] dissatisfied
Cl [4] completely dissatisfied

20. What are your primary reasons for choosing to use a Mad teat of motor development?
(check any/all that apply).

Cl [1] I am required to do so by my place of employment or other regulations
CI [2] In order to obtain reimbursement

Cl [3] In order to document the efLeg of therapeutic intervention

['3 [4] In order to document nggi for therapeutic interventions

Cl [5] Other: (please explain):

 

21. In what cases would you choose not to use a standardized test?

67

22. Please list advantages of using standardized tests.

23. Please list disadvantages of standardized tests.

24. Are you familiar with the Standards for Tests and Measurements in Physical Therapy Practice
developed by the APT A?

D [0] I am not familiar with it.
D [1] I am familiar with it, but have not read it.
C] [2] I have read it.

25. Please use space below to express any comments you may wish to add.

 

* Please review the Questionnaire to be sure you answered each question *

 

Thank you very much for your time and willingness to complete this questionnaire. Your
commitment and contribution to the understanding of clinical assessment by pediatric physical
therapists is very greatly appreciated. Please enclose the completed questionnaire in the self
addressed, postage-paid envelope. It should be returned by March 23, 1998 to:

Sherry L. Herman-Hilker, RT.
134 IM Sports Circle
Michigan State University
East Lansing, Michigan 48824-9904

68

APPENDIX B

APPENDIX B

THE RELIABILITY STUDY

Pugpose

A test-retest study was conducted to establish the reliability of the
survey instrument. The pertinent question was: Will the survey
instrument designed by the researcher produce the same or adequately
similar responses if administered to the same sample on two different
occasions?
The Participants

The potential pilot group consisted of 30 pediatric physical
therapists at three facilities; two in Michigan and one in Nebraska. The
participants were a sample of convenience. The primary investigator
contacted the supervisors of the three physical therapy departments and
requested that the pediatric physical therapy staff participate in a two-
part pre-test of the questionnaire. Each of the three supervisors agreed
to facilitate the participation of their staff members.
Data Collection Procedures

The questionnaires for the reliability study were paired and each of
the pair was coded with a unique identifier. Each supervisor who agreed
to participate was mailed the appropriate number of copies of the cover-
letter and the first questionnaire and explicit instructions regarding
administration of the questionnaire and the use of the unique identifier
to maintain pairs. The completed questionnaires were returned to the
researcher and the date of completion as noted by the supervisor was
noted to allow accurate computation of the amount of time passed

between the first administration and the second administration. Upon

69

receipt of the first set of questionnaires a second set was prepared and
mailed to the supervisors with instructions that it should be completed
no sooner than three weeks following the first date of completion. In all
cases at least 6 weeks passed between completion of the first set and
completion of the second set.

When the questionnaires were received case numbers were
assigned, sight editing was performed to identify incomplete and
unusable questionnaires, and post-coding was performed where
necessary. Data was input into a computerized data editor by the
primary investigator and an assistant.

Data Analysis

The first mailing resulted in the return of 27 questionnaires. This
represents a 90% response rate. The second mailing resulted in the
return of only 23 questionnaires (a 77% response rate). Because pairs of
responses are necessary for a test-retest study the data analysis is based
on data collected from these 23 questionnaires.

The data were compiled and examined using two different
strategies. First, for the questions which resulted in the collection of
nominal data, frequencies and percentages for both the first response
and the second response were tabulated and reported in table format.
Mean, median and mode of response were calculated for those questions
containing ratio data. These techniques allowed comparison of the two
sets of responses in terms of the research questions posed.

Second, a percentage of agreement for each specific variable was
tabulated. The results of the percentage of agreement are reported on
the percent agreement survey form included in this appendix. This

proved to be an interesting method of examining the data but the output

70

was useful only as a indicator of strong agreement in some
circumstances.
Results

As would be expected, the responses to the questions regarding
state of practice and educational degrees resulted in essentially 100%
agreement (see Tables 11, 12, and 13). No differences existed between
the first response and the second response in terms of mean years of
practice or years of pediatric practice (see Table 14).

The frequencies of responses regarding locations of pediatric
practice are summarized in Table 15. The largest areas of discrepancy
pertained to the divisions within the hospital setting where categories
may not have been perceived to be mutually exclusive. The primary
place of employment was more consistent but still subject to some
incongruencies as described above. The number of respondents
indicating each area as "Primary" are displayed in Table 16. The mean
number of children evaluated according to the first response was 143.4
and according to the second response was 131.87. The minimum was 18
both times. The maximum number of children evaluated was 525 the
first time and 500 the second time. In light of the extreme variation in
the numbers of children evaluated these differences seem negligible.

In terms of the ages of children evaluated, the percent agreement
between the two sets of responses ranged from 82.6% to 95.7%. The
ages of children evaluated, by category, are presented in Table 17. The
frequencies of responses to the question about diagnoses of children
evaluated by the respondents are displayed in Table 18.

The methods of deve10pmental assessment clinically used by the

respondents are reported in Table 19. The frequencies and reasons for

71

use of specific tests are shown in Table 20. Respondents were most
consistent regarding the tests which were reportedly used by a larger
number of therapists. A smaller percentage of agreement tended to
occur in the case of tests which were reportedly used by only a couple of
respondents. Those tests that were frequently used tests according to
the first set of responses would also have been determined to be
frequently used tests according to the second set. More discrepancy
existed between the responses regarding the specific frequency of use.
Conclusions

Despite the limitations of this test-retest study of reliability (small
sample size, sample of convenience), it was valuable in that it revealed
numerous areas where improvements to the questionnaire would be
helpful. Most modifications were made to the instructions in order to
facilitate more consistent responses. Several alterations were also made
to the response categories. The researcher appreciates that many factors
including passage of time, circumstances during completion, mood of the
respondent, and so forth may affect the outcome, and thus the reliability,
of a self-administered questionnaire. The researcher also appreciates
that continued pre-testing, modifying and reliability testing could be
done. She believes, however, that the current survey instrument has
been modified appropriately to be adequately reliable for use in the
proposed study. The percent agreement analysis did demonstrate areas
of incongruency. It must be appreciated, however, that this method
considers agreement to reflect exact matches in responses. For example,
if a respondent responded "160" to the question "how many children do
you evaluate per year?" on his first response and "161" on his second

response, this would not be considered agreement. The researcher

72

believes, therefore, that areas noted to be incongruent are less so than it
seems. The comparison of frequencies and percentages in light of the
research questions was more revealing in terms of true areas of
discrepancy. The instrument has been modified based on responses to

this reliability study.

73

Table 11 - State of Current Practice-Reliability Study

 

1st Response

2nd Response

 

Michigan

10

10

 

 

Nebraska

 

13

 

13

 

Table 12 - Educational Degree in Physical Therapy-Reliability Study

 

1st Response

2nd Response

 

BS

 

MS

 

MPT

 

DPT

 

PhD

 

none

 

 

other

 

 

 

Table 13 - Highest Educational Degree in Field Other Than
Physical Therapy-Reliability Study

 

1st Response

2nd Response

 

 

 

 

 

 

 

BA / BS 10 10
MA / MS 5 4
DPT 0 0
PhD 0 0
none 8 9
other 0 0

 

 

 

74

 

 

 

Table 14 - Mean Response of Years of Experience - Reliability Study

 

1st Response

2nd Response

 

years in PT practice

10.65

10.54

 

 

years in pediatric PT
practice

 

7.74

 

7.91

 

Table 15 - Location of Pediatric Practice - Reliability Study

 

1st Response

2nd Response

 

 

 

 

 

 

 

 

 

 

 

 

 

 

school 12 13
outpatient 16 18
acute care 13 12

rehab 4 8

tertiary care 4 5

day treatment 0 0
residential care 0 0
long term 0 0

early intervention 5 6
home care 7 10

other 3 0

 

Table 16 - Primary Location of Pediatric Practice - Reliability Study

 

lst Response

2nd Response

 

 

 

 

 

 

 

 

school 10 12
outpatient 5 5

acute care 4 3
tertiary care 2 3
early intervention 1 0

 

75

 

 

 

Table 17 - Ages of Children Evaluated - Reliability Study

 

 

 

 

 

 

 

 

1st Response 2nd Response
0-3 years 19 21
4-7 years 20 22
8-1 1 years 20 21
12-15 years 19 19
16- 19 years 12 13

 

 

Table 18 - Diagnoses of Children Being Evaluated by Respondents-
Reliability Study

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

lst Response 2nd Response

Arthogryposis 12 1 1

Brachial Plexus 14 11
Injury

Burns 6 4

Cerebral Palsy 23 23

Congenital Torticollis 12 1 1

Developmental Delay 22 23

Down Syndrome 18 19

Hemophilia 4 5

High Risk Infants 9 9

Minimal Brain 11 8
Dysfunction

Mental Retardation 14 13

Muscular Dystrophy 18 18

Myelodysplasia 22 20

N euromuscular 2 1 22
Disorders

Other 1 1 1 1

 

76

 

 

Table 19 - Methods of Developmental Assessment Clinically Used by
Respondents-Reliability Study

 

 

 

 

 

 

 

 

 

 

 

 

1 st Response 2nd Response
checklists 10 1 1
classroom 1 2 12
observations
clinical observations 21 22
home observations 8 8
interviews 1 8 16
parental report 23 22
self-made 1 0 14
assessments
standardized 22 23
assessments
video tape 10 12
comparison
other 4 1

 

 

 

77

 

 

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78

Survey of Clinical Use of Assessments of W
Motor Development by Physical Therapists

Please complete this survey as accurately as possible. Your responses will be used to obtain information
regarding the current use of assessments of motor development by physical therapists in the United

States. If you do not or have not treated pediatric clientele in the last 5 years please check here —— —-)CI
and simply return the blank questionnaire.

1. In what state do you currently practice? 1 00% AGREEMENT

2. Please indicate your educational degree(s) in W- (Check all that apply)

a) BS 100% AGREEMENT
b)MS (entry level)

c) MS (advanced)

(1) PhD

e) none

0 other (please explain):

000000

 

3. Please indicate your educational degrees in MW. (Indicate field of
study)

a) BA lBS: 95.7% AGREEMENT
b) MA / MS:
c) PhD:
d) none
1) other (please explain):

 

 

00000

 

4. Please list any certifications or other credentials you may hold. 91.3% AGREEMENT
but simply based on whether
any were Indicated or not

5. How many years have you practiced as a physical therapist ? (If less than one year please indicate "1
year").

years 87.0% AGREEMENT

6. How many years have you practiced as a flag]; physical therapist ? (If less than one year please
indicate "1 year").

years 78.3% AGREEMENT

79

7. Please indicate your locations of pediatric practice. (check all that apply).

00000000000

8. Of those indicated above, which do you consider primary?
AGREEMENT

3) school system
b) pediatric outpatient center

c) pediatric acute care center

d) pediatric rehabilitation center
e) pediatric tertiary care center

f) pediatric day treatment center
g) pediatric residential care center
h) pediatric long term care facility
i) early intervention center

j) pediatric home care

k) other (specify):

95.7%
87.0%

1 00%
69.6%
82.6%
95.7%
95.7%
95.7%
91.3%
65.2%
82.6%

AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT

(1
(1
(1
(1
(1

missing)
missing)
missing)
missing)
missing)

78.3%

9. Please indicate the number of hours per week you spend at your pm location of pediatric
practice.

hours

56.5%

AGREEMENT

The following questions pertain to the primary location you identified in Question #8.

10. Please estimate the percentage of time spent in each area. (The total must equal 100%).

 

 

100%

a) 0-3
b) 4-7
c) 8-11
(1) 12-15
e) 16-19

00000

82.6%
91 .3%
95.7%
91 .3%
87.0%

% a) In direct patient care

% b) In program development
% c) In a supervisory capacity (supervising other staff)
% d) In a management capacity (department operation/administration)82.6% AGREEMENT
% e) other area (specify):

= TOTAL

l l

AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT

1

l 1. Please estimate the number of children you evaluate per year.

| children

80

34.8%
43.5%
69.6%

43.5%

1 3.0%

12. Please indicate the age ranges of the children you evaluate (check all that apply)

AGREEMENT
AGREEMENT
AGREEMENT

AGREEMENT

AGREEMENT

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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82

13. Please indicate the diagnoses of the children you evaluate (check all that apply)

DDDDDDDDDDDDDDD

14. Please indicate the methods of developmental assessment you use in clinical practice

a) Arthrogryposis

b) Brachial Plexus Injury

c) Burns

d) Cerebral Palsy

e) Congenital Torticollis

0 Developmental Delay

h) Down Syndrome

i) Hemophilia

j) High Risk Infants

k) Minimal Brain Dysfunction
1) Mental Retardation

m) Muscular Dystrophy

n) Myelodysplasia

o) Neuromuscular disorders
p) Other (please list):

95.7%
87.0%
91.3%

100%
95.7%
95.7%
95.7%
69.6%
91.3%
87.0%
69.6%
91.3%
91.3%
87.0%
82.6%

AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT

 

 

 

 

(check all that apply).

DDDDDDDDOD

a) checklists

b) classroom observations
c) clinical observations

d) home observations

e) interviews

0 parental report

g) self-made assessments
h) standardized assessments
i) video tape comparison

j) Other (please list):

78.3%

100%
95.7%
91.3%
73.9%
95.7%
65.2%
95.7%
73.9%
87.0%

AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT
AGREEMENT

 

 

 

 

83

18. How informed do you consider yourself regarding currently available sgndardizgd tests?

a) very informed 60.9% AGREEMENT
b) informed

c) somewhat informed

d) uninformed

e) very uninformed

DODGE]

19. How satisfied are you with the currently available assessments of motor development?

D a) very satisfied 47.8% AGREEMENT
0 b) satisfied

[3 c) somewhat satisfied

D d) unsatisfied

D e) very unsatisfied

20. What are your primary reasons for choosing to use a W W of motor
development? (check any/all that apply).

D a) I am required to do so by my place of employment or other regulations100% AGREEMENT
D b) In order to obtain reimbursement 91 .3% AGREEMENT
D c) In order to document the effect of therapeutic intervention 82.6% AGREEMENT
[3 d) In order to document am for therapeutic interventions 91.3% AGREEMENT
[3 e) Other: (please explain): 82.6% AGREEMENT

21. In what cases would you choose not to use a standardized assessment

22. Please list advantages of using standardized assessments

84

23. Please list disadvantages of standardized assessments

24. Are you familiar with the Standards for Tests and Measurements in Physical Therapy Practice?

CI a) yes 95.7% AGREEMENT
D b) no

25. Please use space below to express any comments you may wish to add.

Thank you very much for your time and willingness to complete this questionnaire. Your
committment and contribution to the understanding of clinical assessment by pediatric physical
therapists is very greatly appreciated. Please enclose the completed questionnaire in the self
addressed stamped envelope. It should be returned by to:

Sherry L. Herman-Hilker, P.T.
11674 Rebecca Lane
Whitmore Lake, Michigan 48189-9782.

85

APPENDIX C

APPENDIX C

January 19, 1998
Dear Colleague,

I am a practicing pediatric physical therapist. I also am currently a graduate student in Motor
Development at Michigan State University studying the assessment practices of pediatric physical
therapists. Despite the recent attention of researchers to the development of assessment tools,
little information is available in the literature about how pediatric therapists are using these tools in
the clinical setting. The purpose of the study is to determine the clinical use of standardized
assessment tools by pediatric physical therapists. In this survey, standardized assessment tools
refer to those tests which have a published manual, a systematic method of administration and
scoring, and have been validated. It is being conducted in partial fulfillment of the requirements of
Masters Degree under the direction of Dr. John Haubenstricker.

You have been randomly selected from a sample of physical therapists with a special interest in
pediatrics. Enclosed you will find a questionnaire which pertains to your experiences and thoughts
about standardized assessment. If you are currently practicing pediatric physical therapy or if you
have done so in the last five years please take the time to complete this questionnaire. It takes
only 15 to 20 minutes to complete. Your feedback is of great importance. (If you are not
treating pediatric clients or have not in the last five years simply indicate that on the questionnaire
and return it in the postage-paid envelope.) Return of the completed questionnaires in the
postage-paid envelope by February 10, 1998 would be greatly appreciated.

The information obtained through this study will benefit you and other therapists by providing
valuable information regarding current assessment practices in pediatric physical therapy. The
results of the study may also help test developers understand the practices of clinicians, and
educators to accurately convey information to students regarding the clinical use of standardized
assessment tools.

All information collected will be strictly confidential. Your name will not be attached to the
questionnaire. Each questionnaire is coded with a unique identifier. The completed
questionnaires will be contained in a locked file cabinet and will be reviewed only by the
researchers and research assistants. The information will be reported in the form of a Masters
Thesis and an article will be submitted for publication in the physical therapy/developmental
literature. Any public presentation of the results of this survey will be made in such a fashion as to
maintain the confidentiality of the respondents.

By completing and returning this questionnaire you indicate your voluntary agreement to
participate. You may choose not to respond to certain questions and may stop answering
questions at any time. However, there are no known risks associated with participating in this
survey.

Thank you very much for your participation in this endeavor. If you have any questions about this
survey or would like information regarding the results of this study do not hesitate to contact the
investigator in writing or by phone.

Sincerely,

Sherry L. Herman-Hilker, P.T. John Haubenstricker. Ph.D., Advisor

11674 Rebecca Lane 128 IM Sports Circle/Michigan State University
Whitmore Lake, MI 48189 East Lansing, Michigan

86

APPENDIX D

Day

APPENDIX D

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87

APPENDIX E

APPENDIX E

 

 

Just a reminder

Dear Colleague:

Recently you should have received a packet containing a
questionnaire pertaining to your use of standardized assessment
tools in pediatric physical therapy. If you have already returned the
completed questionnaire, thank you very much! If you have not
completed and returned the questionnaire, please do so as soon as
possible. Your feedback is essential and greatly appreciated.
Thank you.

Sherry Herman-Hilker, RT.

134 IM Sports Circle

Michigan State University

East Lansing, Michigan 48824-9904

 

Figure 11 - Post Card Reminder

88

 

APPENDIX F

APPENDIX F

APTA REGIONS AND STATES WITHIN EACH REGION

Region I: Western
AK, CA, HI, ID, MT , NV, OR, UT, WA

Region II: Northcentral
CO, IA, KS, MN, MO, NE, ND, SD, WY

Region 111: Great Lakes
IL, IN, MI, OH, WI

Region IV: Northeastern
CT, DE, ME, MA, NH, NJ, NY, PA, RI, VT

Region V: Southeastern
DC, MD, NC, SC, VA, WV

Region VI: Southern
AL, FL, GA, KY, MS, PR, TN

Region VII: Southcentral
AR, AZ, LA, NM, OK, TX

89

APPENDIX G

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91

Table 22 - Frequency of Use of Assessment Tools Written In By

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Respondents
Number of Respondents Indicating
' Frequency of Use
Teee «Meter Development 0:235:32? “Sassy mm
per year) (7-12 peryear) 12 per year)

ABC of Movement 0 l 0
BINS 0 0 1
Carolina 1 1 3
COMPS 1 0 1
Children's Rehab Unit 0 O l
Collier Azuza 1 1 0
Degangi-Beck 1 1 0
Developmental Test of Visual Perception 0 1 0
Developmental Sequence Eval O l 0
EIDP 7 6 15
ELAP 3 5 3
First Step 1 O 0
Functional Assessment Inventory 0 0 1
Functional Mobility O 0 1
F eldenkrais O 0 1
Functional Independence Measure 1 0 2
Gross Motor Reflex Test 0 0 1
Hawaii Early Learning Profile (HELP) 19 18 25
Handwriting Assessment 1 1 0
Infanib l 0 3
IBA 0 O 1
Juvenile Arthritis Functional Assessment 0 1 0
Learning Achievement Profile (D) 5 3 4
Meisells l 0 0
Mullen 1 1 6
MANDT 1 0 0
Meyer 1 1 0
Movement Assessment 1 0 0
MOVE 2 l O

 

 

 

 

92

 

Table 22 (Continued)

 

Number of Respondents Indicating
Frequency of Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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per year) (7-12 peryear) 12 per year)
MEDEK 1 0 0
Morgan 1 2 O
McCarron 1 0 0
Neonatal Neuro Assessment 0 O 1
NICU 1 0 0
NIDCAP O 0 0
Oregon 1 O 0
Playbased Assessment 2 1 1
Portage l O 0
Project Memphis 0 1 0
Quality Checklist O O 1
RIDES 1 O 0
Rockford 1 1 0
School Functional Assessment 3 l 3
Selfmade Assessment 0 O l
Sensorimotor Performance Eval O O 1
Sensory Processing Observation 0 0 l
Sensory Integration & Praxis Test 1 2 O
Sewall l O 0
TIME 4 1 2
TVMS 1 O 1
TVPS 2 0 2
Texarkana Easter Seals Test of Motor 1 O 0
Development
University of Kansas Test 0 O 1
Wisconsin 0
Westhavershaw O

 

 

 

 

93

 

 

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