INCLEN Diagnostic Tool for Neuromotor Impairments (INDT-NMI) for Primary Care Physician: Development and Validation.
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Date
2014-08
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Abstract
Objectives: 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.
Study design: 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.
Setting: Neurology specialty clinics of three tertiary care pediatric
centers in New Delhi, India.
Participants: 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).
Intervention: All study subjects were first administered INDTNMI
(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 INDTNMI
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.
Conclusion: 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.
Description
Keywords
Cerebral palsy, Disability, Diagnosis, Neuromuscular disorders, Resource constrained environments
Citation
Gulati Sheffali, Aneja Satinder, Juneja Monica, Mukherjee Sharmila, Deshmukh Vaishali, Silberberg Donald, Bhutani Vinod K, Pinto Jennifer M, Durkin Maureen, Tudu Poma, Pandey Ravindra M, Nair M K C, Arora Narendra K. INCLEN Diagnostic Tool for Neuromotor Impairments (INDT-NMI) for Primary Care Physician: Development and Validation. Indian Pediatrics. 2014 Aug; 51(8): 613-619.