Both Hands Assessment for children and adolescents with bilateral cerebral palsy: Content and construct validity.
Gøril Okkenhaug Johansen, Annoek Louwers, Melanie Hessenauer and 3 others
PMID 41548110WHAT IT FOUND
The Both Hands Assessment could measure bimanual hand use in children and adolescents with bilateral cerebral palsy, but it needed separate scoring for symmetric and asymmetric hand use.
One item was revised to count stabilizing objects.
Key findings
01After revising the 'orients objects' item, all 16 BoHA items were judged suitable for assessing bimanual performance in adolescents.
02The BoHA required separate analyses for symmetric and asymmetric hand use, and the split scales showed acceptable fit.
03BoHA units were converted to a 0 to 100 scale, showed a strong correlation with MACS levels, and showed no correlation with sex or age.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study did not establish test-retest reliability, full interrater reliability, or responsiveness to change. The total sample did not show unidimensionality, so the BoHA had to be split into separate symmetry and asymmetry analyses. One item, 'reaches' for the non-dominant hand, misfit in the asymmetry group. Local dependency between item pairs slightly lowered reliability and ability strata. Most participants were recruited through rehabilitation services or hospitals, so they may not represent all children and adolescents with bilateral cerebral palsy. The sample had fewer participants at MACS level I (27%) and more at MACS level III (37%) than population-based studies. Age distribution was uneven, with nearly twice as many younger participants as older participants. The asymmetry group was relatively small, which limited age-related comparisons within symmetry and asymmetry groups. The original data set did not include information on cerebral palsy subtypes.
Declared interests
The authors declared no conflicts of interest. The study was funded by Norges Teknisk Naturvitenskapelige Universitet.
The easy way to misread this
Do not treat the BoHA as a measure that has been shown to detect change after therapy. This study tested content and construct validity, but responsiveness and full reliability were not established, and the scale needed separate symmetry and asymmetry analyses.
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