Kapil Namarta, Majmudar-Sheth Bittu, Escapita Alexa Celeste, Johnson Tara
Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
Department of Pediatrics, Division of Pediatric Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
NeuroSci. 2024 Jul 23;5(3):244-253. doi: 10.3390/neurosci5030019. eCollection 2024 Sep.
Prechtl's General Movement Assessment (GMA) is a qualitative video assessment that is an early predictor of cerebral palsy (CP) in infants. GMA raters undergo two levels of training: basic and advanced. Using a retrospective study design, we evaluated the impact of the GMA training level on three key measures: inter-rater reliability (IRR), predictability for a later CP diagnosis, and generalizability for both medically trained and non-medically trained raters. As part of a larger study on former level-IV neonatal intensive care unit (NICU) infants, participants had a GMA video at 3-4 months of corrected age with parental consent. Four GMA raters with basic training interpreted the videos. Subsequently, two raters underwent advanced training and reinterpreted the videos. We evaluated IRR with Gwet's AC1 coefficient, CP prediction with logistic regression, and generalizability with Gwet's Linearization method and McNemar's test. Following basic GMA training, all four raters had moderate to almost perfect agreement. The CP predictability of the raters' individual GMA scores ranged from 73% to 81%. Advanced GMA training significantly improved IRR and enhanced CP predictability. GMA rater proficiency was similar regardless of medical training. Advanced GMA training improved readers' capabilities to correctly identify abnormal movement patterns and aid in early CP diagnosis.
普雷赫特尔全身运动评估（GMA）是一种定性视频评估方法，是婴儿脑性瘫痪（CP）的早期预测指标。GMA评估人员要接受两个级别的培训：基础培训和进阶培训。我们采用回顾性研究设计，评估了GMA培训水平对三个关键指标的影响：评分者间信度（IRR）、后期CP诊断的可预测性以及医学专业培训和非医学专业培训评估人员的通用性。作为一项关于原IV级新生儿重症监护病房（NICU）婴儿的更大规模研究的一部分，在获得家长同意后，参与者在矫正年龄3至4个月时进行了GMA视频评估。四名接受过基础培训的GMA评估人员解读了这些视频。随后，两名评估人员接受了进阶培训并重新解读了这些视频。我们用格韦特AC1系数评估IRR，用逻辑回归评估CP预测，并用格韦特线性化方法和麦克尼马尔检验评估通用性。经过基础GMA培训后，所有四名评估人员的一致性为中等至几乎完美。评估人员个人GMA评分对CP的预测性在73%至81%之间。进阶GMA培训显著提高了IRR并增强了CP预测性。无论是否接受过医学培训，GMA评估人员的熟练程度相似。进阶GMA培训提高了评估人员正确识别异常运动模式的能力，并有助于早期CP诊断。
