The Neurological Hand Deformity Classification : Construct validity, test-retest, and inter-rater reliability

Journal article

Garbellini, Simon, Randall, Melinda, Steele, Michael, Elliott, Catherine and Imms, Christine. (2022). The Neurological Hand Deformity Classification : Construct validity, test-retest, and inter-rater reliability. Journal of Hand Therapy. 35, pp. 581-589. https://doi.org/10.1016/j.jht.2021.03.005

Publication dates
Authors	Garbellini, Simon, Randall, Melinda, Steele, Michael, Elliott, Catherine and Imms, Christine
Abstract	Background The Neurological Hand Deformity Classification (NHDC) is an impairment-based tool that classifies hand deformity into one of two ordinal scales: flexion or extension deformities. Classification is made from live observation or from recorded video footage. Differentiation between the levels is determined by wrist position and wrist and finger movement. Purpose To examine aspects of validity and reliability of the NHDC. Study design A measurement study design. Methods Data from a convenience sample of 127 children with cerebral palsy, 66 males: 61 females, ranging in age from 8 months to 15 years, across all Manual Ability Classification System levels I to V, were analyzed. Construct validity was assessed by testing predetermined hypotheses of relationships between the NHDC and measures of body function and activity measures with observed performance using the Chi Squared Test of Independence and Spearman Correlation Coefficient. Test-retest and inter-rater reliability were assessed by calculating agreement between repeated measures and paired raters using weighted kappa and Cohen's kappa with 95% confidence intervals. Results Predicted hypotheses for the NHDC were met in nine of 10 Spearman's rho correlations with body structure measures and in 2 of 7 correlations with activity measures. Test-retest for flexion deformities: κw = 0.84; 95% CI 0.70-0.98; and extension deformities: κ = 1.0; 95% CI 1.0-1.0 was good to excellent; inter-rater reliability for flexion deformities: κw = 0.76; 95% CI 0.67-0.85; and extension deformities κ = 0.75; 95% CI 0.43-1.0 was moderate to excellent. Conclusion Expected relationships between the NHDC and other measures, stability between repeated measures and acceptable between-rater agreement supports confidence classifying hand deformity in children with cerebral palsy with the NHDC.
Keywords	hand deformities; classification; cerebral palsy; psychometrics
Year	2022
Journal	Journal of Hand Therapy
Journal citation	35, pp. 581-589
Publisher	Elsevier Inc.
ISSN	0894-1130
Digital Object Identifier (DOI)	https://doi.org/10.1016/j.jht.2021.03.005
PubMed ID	34011469
Scopus EID	2-s2.0-85106246445
Page range	581-589
Funder	Channel Seven Perth Telethon
	Australian Catholic University (ACU)
	National Health and Medical Research Council (NHMRC)
	Percy and Ruby Haddy Foundation
	Perth Children’s Hospital Foundation
	Monash Health
Publisher's version	License All rights reserved File Access Level Controlled
Output status	Published
Online	29 Mar 2021
Publication process dates
Accepted	21 Mar 2021
Deposited	28 Apr 2023
Grant ID	APP201300413
	APP1057997

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