Towards an evidence-based assessment of early motor performance in the child health services : Psychometric properties and clinical utility of the Structured Observation of Motor Performance in Infants

Abstract: The Swedish child health services (CHS) have a unique position in that they reach almost all children 0-6 years of age. The child health nurse has the main responsibility for developmental surveillance. Twelve scheduled visits with the nurse during the child’s first year of life make this an ideal setting to systematically identify infants with motor problems, ranging from asymmetric head positioning that may lead to plagiocephaly to more severe forms such as cerebral palsy (CP). However, the CHS lack evidence-based methods to assess motor development.The Structured Observation of Motor Performance in Infants (SOMP-I) assesses motor performance in two domains, i.e. level of motor development and quality of motor performance. SOMP-I is quick, non-invasive, requires minimal handling, and is suitable for a busy clinical setting when applied by physiotherapists. Given the importance of early detection, the increased likelihood of detecting motor problems when using evidence-based assessment methods and the key role of nurses within the CHS, the overall aim of this thesis was investigate the psychometric properties and clinical utility of SOMP-I when used by child health nurses. Furthermore, we aimed to establish the ability of SOMP-I to detect CP.Our results show that child health nurses can reliably assess the level of motor development in infants using SOMP-I. More variability was found when they assessed the infants’ quality of motor performance. Although the nurses expressed concern about introducing a more time-consuming assessment in an already tight schedule, they were able to integrate the SOMP-I assessment in routine care. The nurses reported that barriers to using SOMP-I were mostly logistic and practical in nature, and they pointed out the necessity of education and practice in order to become proficient assessors. Using SOMP-I appears to have supported the nurses in the decision-making process regarding motor performance in routine care. SOMP-I detected CP during the first months of life in neonatal intensive care recipients.To our knowledge, these studies are the first to evaluate child health nurses’ assessment of early motor performance using an evidence-based assessment method in routine care. The results are promising, but further research is warranted.