Development of hierarchical model on lifespan motor function assessment uisng field survey and indep

1
Development of Hierarchical Model on Lifespan
Motor Function Assessment Using Field Survey and
In-Depth Expert Interview
Edward Wang1, Richard Gershon1, Jin-Shei Lai1,
Cindy Nowinski1, Inga Wang2 1CORE, Evanston
Northwestern Healthcare Research Institute
(ENHRI), Evanston, IL,USA 2Rehabilitation
Institute of Chicago, Chicago, IL, USA
Objective The National Institutes of Health (NIH)
Toolbox is a five-year initiative aiming to
assemble brief, comprehensive measures for the
assessment of neurological and behavioral
function across diverse study designs and
populations. The purpose of this study was to
validate the functional constructs of the motor
function domain that were most relevant to
assessment across the lifespan.

• Results Field Survey
• 147 respondents (63 response rate) participated
  in the field survey. The majority were male (58)
  and stated that their area of expertise was with
  adult populations (57 adult only 18 pediatric
  only 25 adult and pediatric).
• The respondents reported an average of 25 years
  of research experience (SD 8) and an average of
  17 years of clinical experience (SD 13). Most
  respondents reported conducting clinical (86) or
  longitudinal/epidemiological research (87), and
  have been the Principal Investigator on a
  clinical trial (mean 2 SD 5) or a
  longitudinal/ epidemiological study (M 4 SD
  6). On average, they reported enrolling hundreds
  of patients into clinical trials (M425 SD
  1001).
• Forty-five percent (45) of respondents reported
  sufficient familiarity with motor function to
  make recommendations for specific domains of
  importance. The four most relevant areas were
  locomotion (23), strength (14), coordination
  (14) and non-vestibular balance (13).
  Locomotion was most highly rated as best if
  assessed objectively and via self report the
  other three areas were most highly rated as best
  if assessed objectively.

Methods We conducted field survey and in-depth
interviews with lifespan-approach scientists
engaged in large cohort, pre-clinical and
clinical studies. Since it is important to
include representatives from all interested
groups, we recruited respondents from a variety
of sources. We derived a sample from our clinical
testing sites, our panel of investigators and
consultants, the NIA and its nominees, NIH-funded
investigators in neurological and behavioral
research and professional societies. We also
received the names of several key opinion leaders
from NIA research program staff. Participating
experts were asked to provide functional
constructs that they thought to be most relevant
for assessment of the motor functional domain.
They were further asked to rank these constructs
based on conceptual and clinical relevance.
Figure 1 Field Survey Participant by Areas of
Specialization
Table 1 Most Relevant Areas of Motor Functioning

• Results In-depth Interview
• Twelve motor experts participated in in-depth
  interview. The majority were male (58) and
  reported an average of 24 (SD3) and 21 (SD9)
  years of research and clinical experiences.
• Locomotion (92) and hand upper extremity (92)
  were highly endorsed by the motor experts,
  followed by strength (67), endurance (58),
  balance (50), dexterity (45), coordination
  (36), and flexibility (8).

Conclusions Motor functioning can be conceptually
fit into a hierarchical model. The model
illustrated that motor function is constructed by
upper and lower extremity function, which in turn
are characterized by the 8 sub-domains. Both
upper and lower extremity function involve
coordination, strength and endurance hand and
upper extremity function and dexterity are
primarily related to upper extremity function
and balance, flexibility and locomotion are more
related to lower extremity function. These
subdomains are essential to daily functioning and
need to be carefully monitored across the
lifespan.
Sample A link to the on-line survey was emailed
to 232 experts between November 2006 and January
2007. A total of 147 clinical and epidemiological
researchers responded to the filed survey. In
addition, twelve motor experts specialized in
pediatric, young adults, and geriatric agreed to
participate in the in-depth interview.
Figure 3 - Motor Function Conceptual Model
Motor Function
Upper Extremity Function
Lower Extremity Function
Coordination
Strength
Endurance
Locomotion
Hand upper extremity
Balance/ non-vestibular
Dexterity
Flexibility

• Sub-domain under upper extremity function only
  Hand Upper Extremity and Dexterity
• Sub-domains under lower extremity function
  only Locomotion, Balance, and Flexibility
• Sub-domains shared by both upper and lower
  extremities Coordination, Strength and Endurance

Acknowledgement This project has been funded in
whole or in part with Federal funds from the
National Institute on Aging, National Institutes
of Health, under Contract No. HHS-N-260-2006-0000
7-C.