title: Development and Reliability Evaluation of the Movement Rating Instrument for Virtual Reality Video Game Play.
abstract: BACKGROUND
  Virtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation.
  
  
  OBJECTIVE
  The objectives of this study were to develop and evaluate the feasibility and reliability of the Movement Rating Instrument for Virtual Reality Game Play (MRI-VRGP).
  
  
  METHODS
  Item generation occurred through an iterative process of literature review and sample videotape viewing. The MRI-VRGP includes 25 items quantifying upper extremity, lower extremity, and total body movements. A total of 176 videotaped 90-second game play sessions involving 7 typically developing children and 4 children with cerebral palsy were rated by 3 raters trained in MRI-VRGP use. Children played 8 games on 2 virtual reality and active video game systems. Intraclass correlation coefficients (ICCs) determined intra-rater and interrater reliability.
  
  
  RESULTS
  Excellent intrarater reliability was evidenced by ICCs of >0.75 for 17 of the 25 items across the 3 raters. Interrater reliability estimates were less precise. Excellent interrater reliability was achieved for far reach upper extremity movements (ICC=0.92 [for right and ICC=0.90 for left) and for squat (ICC=0.80) and jump items (ICC=0.99), with 9 items achieving ICCs of >0.70, 12 items achieving ICCs of between 0.40 and 0.70, and 4 items achieving poor reliability (close-reach upper extremity-ICC=0.14 for right and ICC=0.07 for left) and single-leg stance (ICC=0.55 for right and ICC=0.27 for left).
  
  
  CONCLUSIONS
  Poor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements.
authors.affiliation: Northeastern University, Department of Physical Therapy, Movement and Rehabilitation Sciences, Boston, MA, United States. d.levac@neu.edu.
authors.forename: Danielle
authors.identifier: http://orcid.org/0000-0001-7356-9335
authors.initials: D
authors.lastname: Levac
authors.forename: Joanna
authors.identifier: http://orcid.org/0000-0001-7566-3720
authors.initials: J
authors.lastname: Nawrotek
authors.forename: Emilie
authors.identifier: http://orcid.org/0000-0003-3727-6812
authors.initials: E
authors.lastname: Deschenes
authors.forename: Tia
authors.identifier: http://orcid.org/0000-0001-5053-9846
authors.initials: T
authors.lastname: Giguere
authors.forename: Julie
authors.identifier: http://orcid.org/0000-0002-5723-8840
authors.initials: J
authors.lastname: Serafin
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0002-8464-8837
authors.initials: M
authors.lastname: Bilodeau
authors.forename: Heidi
authors.identifier: http://orcid.org/0000-0002-7335-8121
authors.initials: H
authors.lastname: Sveistrup
keywords: active video games, virtual reality, physical therapy, movement, reliability