Clinical Tools for Assessing One-Handed Skills in Children With Cerebral Palsy: An Umbrella Review.

More than half of the 13 systematic reviews included did not evaluate the quality of the primary trials they drew on, so the psychometric evidence for some tools rests on studies that may not have met basic methodological standards. The original PMAL lacked reliability evidence in the cerebral palsy population, and its two revised versions (Wallen and Uswatte) differ in item count, scoring, and who completes them, so results are not comparable across versions. Several commonly used tools (Purdue Pegboard, Wolf Motor Function Test, Grooved Pegboard, and others) were excluded because they had no psychometric data in the cerebral palsy population, so the review does not address them. The umbrella review is only as strong as the systematic reviews it includes, and the authors themselves note that the quality of those reviews was often poor.

Do not read the 'excellent' ratings as proof that using these tools will improve a child's outcomes. This paper rates the measurement quality of the instruments themselves, not the effectiveness of any treatment. Also, more than half of the systematic reviews it drew on did not check the quality of the trials they included, so the evidence base behind some of these ratings is thinner than the scores suggest.