Valores de referência e propriedades psicométricas do Lower Extremity Motor Coordination Test

Abstract

The Lower Extremity Motor Coordination Test (LEMOCOT) was developed to assess lower limb motor coordination and has shown good construct validity and clinical utility. However, the reference values for the LEMOCOT were not previously provided and its psychometric properties were not thoroughly investigated. Thus, the aims of this study were: (1) to establish the reference values and the predictive equations forthe LEMOCOT; 2) to investigate the inter- and intra-rater reliabilities of theLEMOCOT and to assess whether various means of obtaining the scores affect the test results, as well as its reliability; (3) to assess the agreement levels between two methods of scoring the test (direct and video observations); (4) to investigate the test-retest reliability, standard errors of the measurement (SEM), and the smallest real differences (SRD). Therefore, both lower limbs of 320 healthy individuals 20years of age were assessed with the LEMOCOT. For the inter-rater reliability investigation, the first 30 participants performed three trials of the LEMOCOT and two trained examiners scored the test simultaneously. For the intra-rater reliability, the performances of the same participants were recorded by video and the recorded images were analyzed twice by the same examiner, 30 days apart. The first trial, means of the first two and the last two trials, means of three trials, and the highest scores of three trials. In addition, the scores obtained by direct observations andvideos were compared by the same examiner. The test-retest reliability was assessed and the obtained intra-class correlation coefficients (ICCs) were used to calculate the SEM and SRD. The following analyses were performed: descriptive statistics; multiple linear regression, for the creation of the predictive equations; repeated measure ANOVAs, to compare the test results according to the various means of obtaining the scores; ICCs, to assess the test-retest, intra-, and inter-rater reliabilities; Bland and Altman limits of agreement, to investigate the levels ofagreement between the scores obtained by direct and video observations. The findings indicated that higher LEMOCOT scores were found for men, younger participants, and the dominant lower limb. Age and gender were able to explain 48% and 44% of the variance in the LEMOCOT scores for the dominant and nondominant lower limbs, respectively. No significant differences were found regarding the various means of obtaining the scores (0.12<F<1.02; 0.10<p<0.92) and all of them demonstrated adequate reliability values (0.91<ICC<0.99; p<0.05). The agreement between the scores obtained by direct and video observations was adequate (limits of agreement: -1.99 a 1.85; -1.55 e 1.62). In addition, appropriate values of SEM (1.97-1.54) and SRD (5.48-4.26) were found. In conclusion, the established reference values could be used to estimate the severity of lower limb motor coordination impairments in individual aged 20 years. Only one trial, after familiarization, was enough to generate reliable scores. Both direct and video observations could be used to score the test, since these methods demonstrated adequate levels of agreement. In addition, the established SEM and SRD could be used to interpret the LEMOCOT results, when applying the test to measure changes over time.