Feasibility and content validity of the PERF-FIT test battery to assess movement skills, agility and power among children in low-resource settings

Development and content validity of the cognition in daily life scale (CDL)

Cognitive impairment can negatively influence daily functioning. Current cognitive measures are essential for diagnosing cognitive impairment, but findings on these tests do not always represent the level of cognitive functioning in daily life. Therefore, this study aimed to design a structured measurement instrument to observe and rate the impact of cognitive impairment in daily life, named the cognition in daily life scale for persons with cognitive problems (CDL). In this paper we describe the development, expected usability, and psychometric properties (content and face validity) of the instrument. The CDL was established through three consecutive development phases: (1) item selection, (2) item categorization and comparison, and (3) item revision and manual construction. Subsequently, a panel of eleven international experts rated the relevance of the selected items and provided comments on the expected usability and face validity. Content validity was estimated with the content validity index, based on which four items were removed. The experts' comments led to minor adjustments of the manual, domains, and formulation of the maintained items. The final instrument consists of 65 items describing behaviour that relies on cognitive functions within six domains. Future research should focus on evaluating the construct validity and reliability of the CDL.

Activities of daily living, self-efficacy and motor skill related fitness and the interrelation in children with moderate and severe Developmental Coordination Disorder

BACKGROUND

Children with Developmental Coordination Disorder (DCD) are diagnosed based on poor motor skills that impact their daily activities. However, this may also lead to lower predilection and participation in physical activities and a higher risk to develop health problems.

OBJECTIVE

To determine motor skill related levels in children with moderate and severe DCD and compare that to typically developing children (TD). The study also aimed to determine the level of activities of daily living (ADL) as reported by their parent and self-efficacy as reported by the children. Lastly, the relation of motor skill related fitness, ADL, and self-efficacy has been examined.

METHODS

A cross-sectional study has compared TD children (n = 105) and children with DCD (n = 109; 45 moderate DCD and 64 severe DCD) from elementary schools in Tunisia between 7 and 10 years of age. The DCDDaily-Questionnaire and Children's Self-perceptions of Adequacy in and Predilection for Physical Activity Questionnaire have been used to determine ADL and adequacy towards physical activity, respectively. The PERF-FIT has been used to measure motor skill related fitness levels.

RESULTS

Large group differences (p = 0.001) were found for ADL and all domains of self-efficacy between TD and DCD children. However, ADL and self-efficacy were not different between moderate and severe DCD. Motor skill related fitness was significantly lower (p = 0.01) for children with DCD than TD children, and between children with moderate and severe DCD. The relation between self-efficacy and DCDDaily-Q was different in the two DCD groups. Slow motor learning was associated with lower perceived enjoyment in physical education in the moderate DCD group, and with lower perceived adequacy in physical education in the severe DCD group.

CONCLUSIONS

Children with DCD participate and enjoy physical activity less than their peers. This combination of lower participation, lower predilection to physical activity and lowered motor skill-related fitness is a concern for the present and future health status of children with DCD.

The relationship between kinaesthesia, motor performance, physical fitness and joint mobility in children living in Nigeria

PURPOSE

This study aimed to determine the relationship between kinaesthesia, motor performance, fitness, and joint mobility in children.

METHODS

A descriptive cross-sectional study was conducted involving children from two primary schools in the South-Eastern part of Nigeria. The Beighton criteria were used to measure joint mobility. Motor performance, fitness, and kinaesthesia were measured in all the children. Spearman's rank correlation was used to evaluate the relationship between the outcomes.

RESULTS

A total of 91 children (51.6% girls) participated in the study. The mean age of the children was 8.20 ± 1.98 years. Using a Beighton score of ≥ 6, Generalized Joint Hypermobility (GJH) was identified in a total of 35 (38.46%) children and was more prevalent in females (60.0%). Joint mobility had significant correlations with most fitness and motor performance items, but not kinaesthesia. Agility & power, and motor performance seem to be reduced if mobility is larger. Kinaesthesia was correlated with most fitness and motor performance items, indicating that better fitness and better motor performance cooccur with better kinaesthesia or vice versa.

CONCLUSION

Joint mobility may have a significant influence on fitness and motor performance in children. Hence, it may be useful for future studies to investigate how fitness and motor performance modulate the onset and progression of musculoskeletal symptoms in GJH.

Task-specificity and transfer of skills in school-aged children with and without developmental coordination disorder

AIM

To compare the effects of two Active Video Game (AVG) protocols on transfer of learning in children with and without Developmental Coordination Disorder (DCD).

METHODS

Fifty children, aged 6-10 years were randomly allocated to either group A or B. Children in group A participated in a set of Nintendo Wii ball games whereas group B played agility games (8 DCD and 17 typically developing children (TD) per group). Participants in each group practiced Wii games for 20 min twice a week for 10 weeks. All children also practiced ball and agility games in real-world settings, once per week.

RESULTS

Both protocols yielded positive effects with the largest effect sizes shown on agility and balance items of the PERF-FIT and KTK tests. No interaction was found on learning real-world games and the virtual protocol, except for a Ping-Pong game. A significant interaction of time by protocol group indicated that the Ball group improved more on BOT-2-Upper-Limb Coordination than the Agility group. Importantly, children with DCD improved comparably with TD peers in virtual and real-world games.

CONCLUSION

Independent of training protocol, both children with DCD and TD children performed better on trained and non-trained ball, balance and agility tasks after 10 weeks of training.

Type of active video-games training does not impact the effect on balance and agility in children with and without developmental coordination disorder: A randomized comparator-controlled trial

AIM

To compare the effect of the Nintendo Wii-Fit and Xbox Kinect on motor performance and to assess differential effects in children with Developmental Coordination Disorder (DCD) and typical development (TD).

METHOD

In an assessor-blinded randomized comparator-controlled design, 68 participants (34 DCD and 34 TD) aged 7-10 years, were randomly assigned to train on one of two devices (34 Wii-Fit; 34 Xbox Kinect).

RESULTS

Repeated measure ANOVA revealed a significant main effect of time on balance and agility variables (MABC-2, Wii Yoga stance, PERF-FIT side-hop, PERF-FIT ladder-stepping; all p ≤ 0.02), but not on running variables (BOT2-sprint, 10 × 5 m sprint and PERF-FIT ladder running; p > 0.05). No significant interactions were observed, indicating similar changes on both devices. Overall, 35% of the TD children and 76% of the children with DCD improved on one or more of the outcomes beyond the smallest detectable difference. However, at the individual level, larger differences in improvement were found in the Kinect group compared to the Wii between TD and DCD groups.

CONCLUSION

Both Wii-Fit and Kinect devices can be used to train with similar results on motor performance. An important percentage (76%) of children with DCD improved on at least one motor task after training.

Underweight children are agile but lack power

Given the knowledge gap in literature on the impact of undernutrition on muscular power and agility in school-aged children, the aim of this study was to compare physical fitness in such underweight- and normal weight children. In this cross-sectional study, 853 children were included (459 boys; mean age: 9.2 (1.8) years). The children were grouped according to their BMI-for-age-and-sex: normal weight (− 1 ≤ z-score < 2) and underweight (z-score < − 1). Within the underweight group, three thinness subgroups were composed: grade 1 (− 2 ≤ z-score < − 1), grade 2 (− 3 ≤ z-score < − 2) and grade 3 (z-score < − 3). Their agility, muscular endurance and power were assessed with the Performance and Fitness test battery (PERF-FIT). Regardless the country they lived in, the underweight children showed better agility (p = 0.012) and muscular endurance (p = 0.004) than those with normal weight. They presented with lower muscular power than the normal weight group, shown by significantly shorter overhead throwing distances (p = 0.017) and less standing long jump peak power (p < 0.001). The standing long jump peak power decreased further with increasing thinness grade (p = 0.027).

Conclusion: Underweight children are more agile, but have lower muscular power compared to their normal weight peers. Its relationship with motor competence and physical activity, necessitates attention for tackling muscular strength deficiencies in these children, enabling them to meet the basic requirements for a healthy lifestyle later in life.

Do We Drop the Ball When We Measure Ball Skills Using Standardized Motor Performance Tests?

Background: Ball skill performance changes over time during childhood and depends on the child’s physical and psychological characteristics, environmental opportunities, and task constraints. The aim of this study was to examine whether different standardized ball skill-items measure similar constructs and whether results differentiate among age groups. Methods: A total of 250 children (6–10 years) were administered the Movement Assessment Battery for children second edition (MABC-2), the subtest upper-limb coordination of the Bruininks–Oseretsky Test of Motor Proficiency second edition (BOT-2), the tennis ball throw of the Fitness Test Battery (FTB), and the ball skills and overhead throw of the Performance and Fitness test (PERF-FIT). Results: Correlations among scores of BOT-2, FTB, and PERF-FIT ranged from fair to moderate, but correlations were low with the MABC-2. Principal component analysis retrieved three components: the first component contained catch, dribble, bounce, and throw items (MABC-2, BOT-2-SF, and PERF-FIT, respectively); the second contained throwing for distance (PERF-FIT and FTB); the third contained aiming (MABC-2). Most ball skill scores differed significantly between 6–7 and 7–8 years, but less between 8–9 years; the PERF-FIT discriminated best between age groups. Conclusion: Most ball skill items in motor tests belong to a comparable construct containing throw, dribble, bounce, and catch skills. However, aiming tasks belong to a separate category. Additionally, throwing for distance is a task that requires predominantly explosive power.

Ecological validity of the PERF-FIT: correlates of active play, motor performance and motor skill-related physical fitness

Background

Active games are important health enhancing physical activities in children with and without developmental disorders and will help children to develop fundamental motor skills, while inactivity exacerbates coordination difficulties and increases the risk of obesity. Regular engagement in active play promotes physical, social and cognitive development. It is therefore important to know if children have the capabilities for healthy behavior. Motor skills and muscular fitness are both important components to participate in play, sport and leisure. The Performance and Fitness (PERF-FIT) test battery integrates motor skills (running, jumping, hopping, catching, bouncing, throwing, balance) and muscular fitness (explosive power and muscular endurance) needed in many forms of active play.

Aim

To test the ecological validity of the PERF-FIT test battery; a field-based test integrating motor skill proficiency and muscular fitness.

Methods

Seventy-five children were assessed on the PERF-FIT, Movement Assessment Battery for Children (MABC)-2 and performance in 6 active games was scored. Of these children, 52 children scored in the normal range and 23 (or 30.3%) below the 16^th percentile of the MABC-2. Association between the outcomes of the two tests and the 6 games was calculated.

Results

High to moderate associations were found between game scores and PERF-FIT items; moderate to low associations between game scores and MABC-2 items. Principle axes factor analysis with oblique rotation revealed communalities between the explosive power and agility items of the PERF-FIT and the running and ball catching games but not between the games and the balance items.

Conclusions and implications

Scores on the PERF-FIT are significantly related to performance in active play. The tool is able to measure aspects of motor skills, muscle endurance and explosive power needed in children's active games and could be used as an additional tool to measure requirements for participation in everyday physical activity in children with and without developmental disorders.

Pediatric care for children with Developmental Coordination Disorder, can we do better?

This paper adopts a method of narrative critical review based on a non-systematic search of the literature to provide insights into the trends of developmental coordination disorder (DCD) treatment and to point out some future alternative approaches to prevent secondary health implications in children with DCD. The cause of DCD is unknown, but evidence suggests that these children have atypical brain structure and function. Interventions to help children cope with their activity limitations are effective in improving motor competence and motor skill related fitness in the short term. Although activity-orientated interventions can improve motor outcomes in children with DCD, high quality intervention trials and evaluation of long-term effects are urgently needed. Importantly, motor coordination problems associated with DCD extend to exercise-related activities leading to reduced participation in play and sports, which causes secondary problems in muscular fitness and body composition. Hence, treatment goals should not be limited to the improvement of motor skills (in ADL), but should also focus on health-related quality of life. We therefore propose when noticing motor problems in a child, already before enrolling but also during intervention, to explore ways to adapt everyday physical activities to optimally match the child's skill level. Hence, such activities will not only train the skills and improve physical fitness but will lead to positive engagement, thereby preventing the child from opting out of active play and sports. This provides the child with chances for exercise-dependent learning and will also positively impact social-emotional well-being.

High BMI and Low Muscular Fitness Predict Low Motor Competence in School-Aged Children Living in Low-Resourced Areas

Childhood obesity is a relatively new problem for Sub-Saharan developing countries. Especially in children with a low socioeconomic background, the link between motor competence, muscular fitness, and body mass index (BMI) remains poorly investigated. Due to the interrelatedness of BMI and physical fitness, the aim of this study is to determine the predictive value of these factors in relation to low motor competence in school-aged children living in low-resourced areas. Motor competence and physical fitness were assessed in 1037 school-aged Ghanaian and South African children using the Performance and Fitness test battery (PERF-FIT). “Low motor competence” was predicted using odds ratios calculated from backward logistic regression analyses. Low motor competence was less prevalent in Ghanaian children (3.7–11.1%) compared to the South African children (21.9–24.2%). Increased BMI and decreased muscular fitness predicted low motor competence in both Ghanaian and South African children. For example, the chance for a Ghanaian child to have low static balance increased by 22.8% (OR = 1.228, p < 0.001) with a 1-point increase in BMI, whereas this decreased by 30.0% (OR = 0.970, p < 0.001) with a 10-cm increase on the standing long jump. In the case of the South African children, if their BMI increased by 1 point, the chance for those children of having low static balance increased by 7.9%, and if their SLJ performance decreased by 10 cm, their chance of low performance increased by 13%. Clearly, motor competence is associated with both BMI and muscular fitness. Policy makers can use this information to counteract the establishment of childhood obesity by promoting weight control through physical activity and stimulating motor competence at school.

Inter-rater reliability and test-retest reliability of the Performance and Fitness (PERF-FIT) test battery for children: a test for motor skill related fitness

Background

The Performance and Fitness (PERF-FIT) test battery for children is a recently developed, valid assessment tool for measuring motor skill-related physical fitness in 5 to 12-year-old children living in low-income settings. The aim of this study was to determine: (1) inter-rater reliability and (2) test-retest reliability of the PERF-FIT in children from 3 different countries (Ghana, South Africa and the Netherlands).

Method

For inter-rater reliability 29 children, (16 boys and 13 girls, 6–10 years) were scored by 2 raters simultaneously. For test–retest reliability 72 children, (33 boys and 39 girls, 5–12 years) performed the test twice, minimally 1 week and maximally 2 weeks apart. Relative and absolute reliability indices were calculated. ANOVA was used to examine differences between the three assessor teams in the three countries.

Results

The PERF-FIT demonstrated excellent inter-rater reliability (ICC, 0.99) and good test-retest reliability (ICC, ≥ 0.80) for 11 of the 12 tasks, with a poor ICC for the Jumping item, due to low spread in values. A significant difference between first and second test occasion was present on half of the items, but the differences were small (Cohen’s d 0.01–0.17), except for Stepping, Side jump and Bouncing and Catching (Cohen’s d 0.34, 0.41 and 0.33, respectively). Overall, measurement error, Limits of Agreement and Coefficient of Variation had acceptable levels to support clinical use. No systematic dissimilarities in error were found between first and second measurement between the three countries but for one item (Overhead throw).

Conclusions

The PERF-FIT can reliably measure motor skill related fitness in 5 to 12-year-old children in different settings and help clinicians monitor levels of fundamental motor skills (throwing, bouncing, catching, jumping, hopping and balance), power and agility.

Prevalence and predictors of vaccine hesitancy among expectant mothers in Enugu metropolis, South-east Nigeria

Vaccine hesitancy, defined as delay in acceptance or refusal of vaccines despite availability of vaccinations services, constrains control of vaccine-preventable diseases. This study determined the prevalence and correlates of vaccine hesitancy among pregnant women attending a university teaching hospital in Enugu metropolis, South-east Nigeria using cross-sectional survey and parent attitudes about childhood vaccines (PACV) questionnaire. We dichotomised the 256 expectant mother participants into hesitant and non-hesitant categories using median PACV and sub-scale scores. Overall, 31.6% of participants were hesitant. About 17.6%, 14.8%, and 30.9% of mothers were hesitant due to their vaccination behaviour, beliefs about vaccine safety and efficacy, and general attitudes and trust of service providers, respectively. Mothers aged less than 30 years were three times more likely to be vaccine hesitant than older ones. Public health practitioners should target young, expectant mothers by developing and conducting vaccine hesitancy screening, focused health education, and information campaigns. The prevalence of childhood vaccine hesitancy among expectant mothers is high. Younger expectant mothers are more likely to be vaccine hesitant than older ones. Involvement of maternal health service workers to provide vaccine literacy and to support expectant mothers to make informed decision about childhood vaccination might be helpful in reducing vaccine hesitancy.