title: A new scale for the assessment of performance and capacity of hand function in children with hemiplegic cerebral palsy: reliability and validity studies.
abstract: BACKGROUND
  In hemiplegic children, the recognition of the activity limitation pattern and the possibility of grading its severity are relevant for clinicians while planning interventions, monitoring results, predicting outcomes.
  
  
  OBJECTIVE
  Aim of the study is to examine the reliability and validity of Besta Scale, an instrument used to measure in hemiplegic children from 18 months to 12 years of age both grasp on request (capacity) and spontaneous use of upper limb (performance) in bimanual play activities and in ADL.
  
  
  METHODS
  Psychometric analysis of reliability and of validity of the Besta scale was performed.
  
  
  METHODS
  Outpatient study sample
  
  
  METHODS
  Reliability study: A sample of 39 patients was enrolled. The administration of Besta scale was video-recorded in a standardized manner. All videos were scored by 20 independent raters on subsequent viewing. 3 raters randomly selected from the 20-raters group rescored the same video two years later for intra-rater reliability. Intra and inter-rater reliability were calculated using Intraclass Correlation Coefficient (ICC) and Kendall's coefficient (K), respectively. Internal consistency reliability was assessed using Alpha's Chronbach coefficient. Validity study: a sample of 105 children was assessed 5 times (at t0 and 2, 3, 6 and 12 months later) by 20 independent raters. Each patient underwent at the same time to QUEST and Besta scale administration and assessment. Criterion validity was calculated using rho-Pearson coefficient.
  
  
  RESULTS
  Reliability study: The inter-rater reliability calculated with Kendall's coefficient resulted moderate K=0.47. The intra-rater (or test-retest) reliability for 3 raters was excellent (ICC=0.927). The Cronbach's alpha for internal consistency was 0.972. Validity study: Besta scale showed a good criterion validity compared to QUEST increasing by age and severity of impairment. Rho Pearson's correlation coefficient r was 0.81 (P<0.0001). Limitations. Besta scales in infants finds hard to distinguish between mild to moderately impaired hand function.
  
  
  CONCLUSIONS
  Besta scale scoring system is a valid and reliable tool, utilizable in a clinical setting to monitor evolution of unimanual and bimanual manipulation and to distinguish hand's capacity from performance.
authors.affiliation: Epidemiology and Community Medicine Unit Department of Pediatrics, University of Padua, Padua, Italy - melissa.rosarizzotto@unipd.it.
authors.forename: M
authors.initials: M
authors.lastname: Rosa-Rizzotto
authors.forename: L
authors.initials: L
authors.lastname: Visonà Dalla Pozza
authors.forename: A
authors.initials: A
authors.lastname: Corlatti
authors.forename: A
authors.initials: A
authors.lastname: Luparia
authors.forename: A
authors.initials: A
authors.lastname: Marchi
authors.forename: F
authors.initials: F
authors.lastname: Molteni
authors.forename: P
authors.initials: P
authors.lastname: Facchin
authors.forename: E
authors.initials: E
authors.lastname: Pagliano
authors.forename: E
authors.initials: E
authors.lastname: Fedrizzi
mesh_terms: D000203:Activities of Daily Living; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006225:Hand; D018737:Hand Strength / Q000502:physiology*; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D015588:Observer Variation; D010988:Play and Playthings; D015203:Reproducibility of Results; D013647:Task Performance and Analysis