Measurement

An essential component of all pediatric physical therapy practice is measurement and data collection in an ongoing, valid, reliable, and unbiased way. My experience suggests that we regularly miss out on one or more of these components, and the effectiveness of the services we provide to children and families is subsequently diminished.

Ongoing: why is it important to collect data regularly? We all know that children have good days and bad days- don’t we all! When we’re measuring regularly (every session? weekly?), those ups and downs tend to even out and we get a truer picture of the child’s capabilities than when the measurements are few and far between.

Valid: selecting the correct tests/measures that connect directly with the goals of the child and family is a difficult challenge. There are many test/measures available, and identifying the most appropriate for each individual child and family is absolutely necessary to optimize our impact. The ICF framework and the age of the child help to narrow our options here and ensure that we are measuring what is meaningful and important for that child.

Reliable: following the same testing procedures consistently with each child helps to reduce the error in testing as much as possible and therefore improve the reliability of the data we’re collecting. Also the “art” of pediatric physical therapy is a consideration here- motivating children to put forth their best effort during testing is where we earn our money!

Unbiased: be careful to avoid “confirmation bias”- seeing what we expect to see. Also be willing to acknowledge when the child is not making as much progress as we would like, which then should lead to some thoughtful change in the intervention strategies.

A couple last thoughts: multi item tests (like the Peabody, the Bruinicks, the Bayley, etc) are an important aspect of this area of practice, but for the most part should only be administered in specific circumstances. There are many other tests/measures that provide much more relevant data and are much more feasible to administer frequently (eg gait (or mobility) velocity, TUG, Timed Up and Down Stairs, RPE (for the child and in some instances for the caregiver), etc). Sharing data with children and families is almost always a good idea. I also would suggest that physical therapists tend to focus on developing high-level skill in intervention techniques, but probably not as much learning is focused on developing high level skill in measurement. One way to address that is to take this upcoming course at Widener University in Chester, PA on May 20 that is aimed at improving knowledge and skills in measurement. This course will include some asynchronous online pre-work that is mainly connected to Chapter 3 in the Campbell’s Physical Therapy for Children, 6th Edition, textbook. Hopefully you can join us for this great learning opportunity.

Reference; Dole RL & Schreiber J. Chapter 3 Measurement. In Campbell’s Physical Therapy for Children, 6th Edition. Palisano, Orlin & Schreiber Eds. Elsevier. St Louis. 2023