title: INCLEN Diagnostic Tool for Neuromotor Impairments (INDT-NMI) for primary care physician: development and validation.
abstract: OBJECTIVE
  To develop and validate a diagnostic tool for use by primary care physicians for diagnosing neuro-motor impairment among 2-9 year old children in primary care settings.
  
  
  METHODS
  Modified Delphi technique involving national (n=49) and international (n=6) experts was used for development of INDT-NMI. The tool was then validated through a cross sectional study.
  
  
  METHODS
  Neurology specialty clinics of three tertiary care pediatric centers in New Delhi, India.
  
  
  METHODS
  454 children aged 2-9 years [mean (SD) age: 60.4 (23.7) mo], selected through systematic random sampling, underwent assessment for identification and classification of neuromotor impairments (NMI).
  
  
  METHODS
  All study subjects were first administered INDT-NMI (candidate test) by a trained physician followed by expert assessment for NMI and other neurodevelopment disorders (NDD) by team of two pediatric neurologists (Gold standard).
  
  
  RESULTS
  According to expert evaluation, 171 (37.8%) children had neuromotor impairments. There were four categories of subjects: NMI alone (n=66); NMI+other NDDs (n=105); Other NDDs without NMI (n=225) and 'Normal' group (n=58). Using expert evaluation as gold standard, overall sensitivity of the INDT-NMI was 75.4% and specificity was 86.8%. INDT-NMI helped graduate physicians to correctly classify 86.6% (112/129) children with NMI into different types (cerebral palsy, neuromotor diseases and other NMI). Graduate physicians assigned 40 children (8.8%) as 'indeterminate', 38 (95%) of whom had either NDD and/or NMI and thus merited referral. Misclassification of NMI occurred in those with mild changes in muscle tone, dystonia, or ataxia and associated NDDs.
  
  
  CONCLUSIONS
  Graduate primary care physicians with a structured short training can administer the new tool and diagnose NMI in 2-9 year old children with high validity. INDT-NMI requires further evaluation in actual primary care settings.
authors.affiliation: INCLEN TRUST International, New Delhi, India Correspondence to: Dr Narendra K Arora, Executive Director, The INCLEN Trust International, F1/5, Okhla Industrial Area Phase 1, New Delhi, India. nkarora@inclentrust.org.
authors.forename: Sheffali
authors.initials: S
authors.lastname: Gulati
authors.forename: Satinder
authors.initials: S
authors.lastname: Aneja
authors.forename: Monica
authors.initials: M
authors.lastname: Juneja
authors.forename: Sharmila
authors.initials: S
authors.lastname: Mukherjee
authors.forename: Vaishali
authors.initials: V
authors.lastname: Deshmukh
authors.forename: Donald
authors.initials: D
authors.lastname: Silberberg
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Bhutani
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Pinto
authors.forename: Maureen
authors.initials: M
authors.lastname: Durkin
authors.forename: Poma
authors.initials: P
authors.lastname: Tudu
authors.forename: Ravindra M
authors.initials: RM
authors.lastname: Pandey
authors.forename: M K C
authors.initials: MK
authors.lastname: Nair
authors.forename: Narendra K
authors.initials: NK
authors.lastname: Arora
mesh_terms: D000465:Algorithms; D002547:Cerebral Palsy / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D009468:Neuromuscular Diseases / Q000175:diagnosis*; D010372:Pediatrics / Q000379:methods*; D058007:Physicians, Primary Care; D012680:Sensitivity and Specificity