Reliability of the Motor Learning Strategies Rating Instrument in physiotherapy intervention for children with cerebral palsy.
Jennifer L Ryan, Danielle E Levac, F Virginia Wright
PMID 30740648WHAT IT FOUND
Trained physiotherapists could rate the total Motor Learning Strategies score for children with cerebral palsy with moderate agreement, but individual items were less reliable.
Do not use the instrument to judge single therapist behaviours.
Key findings
01Different physiotherapist raters agreed on the total score at 0.78, and the same rater agreed with themselves at 0.89.
02Individual items were less reliable, with poor between-rater agreement for six of 10 items in 'What the therapist says' and three of five items in 'How the practice is organized'.
03Raters spent a mean 77.1 minutes to rate one video.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The test was only done on 30 videos from 18 children in one hospital, so it may not apply to other settings. Total score agreement between different raters was acceptable but not strong, because the lower bound of the agreement range and the between-rater variation were outside the study's own targets. Individual item scores were unstable, especially for what the therapist says and how practice is organised. The total score has no clinical value, so it cannot be interpreted as a patient outcome score. Video problems, such as background noise and difficulty telling who spoke, made some ratings harder. The MLSRI-20 was tested with trained external raters, not for self-reflection by treating therapists.
Declared interests
The article is listed as supported by U.S. National Institutes of Health and non-U.S. government research funding. No author conflicts of interest are stated.
The easy way to misread this
Do not conclude the MLSRI-20 reliably identifies individual motor learning strategies. Many item scores had poor agreement, and the total score has no clinical value.