Faculty of Social and Behavioural Sciences (UvA) Graduate School of Childhood Development and Education
Hogeschool van Amsterdam (HvA) – University of Applied Sciences Faculteit Bewegen, Sport en Voeding
Examining the Validity of the 4-Skills Scan:
A pilot study.
Research Master Child Development and Education
Thesis 2
Name of the student: J.E.A. Brocken
Names of the supervisors: H.M. Toussaint, W.G. van Kernebeek & B. Zijlstra
Date: 22-07-2016
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ABSTRACT
Nowadays, primary school children are not getting enough exercise. A history of less exercise is often seen in children with a motor development delay. Delays in motor development can also influence the social and cognitive development. According to the policy plans of the municipality of Amsterdam, physical education teachers are the professionals who can monitor the motor development of children. The 4-Skills Scan is an often used tool for scanning motor development; however, it has not been validated yet.
The primary aim of the current pilot study is to develop a suitable method to measure the convergent validity of the 4-Skills Scan. Furthermore, a preliminary analysis for the validation was performed.
71 Children were tested using the 4-Skills Scan and an obstacle course. The obstacle course was recorded on video. A short video of each child was shown to 11 experts who filled out a questionnaire after watching each video. Interobserver reliability was determined using intraclass correlation procedures. Scores of the 4-Skills Scan were compared with the opinion of the experts on the questionnaire. Feedback of the experts was taken into account to further improve the obstacle course protocol.
Preliminary results indicated that there was a low to moderate interobserver agreement. Moderate positive significant correlations were found between the scores of the experts and the outcomes of the 4-Skills Scan. Many useful improvements are going to be implemented in the follow-up project. With some improvements, this method could be a suitable and useful tool for assessing the validity of the 4-Skills Scan.
Key words: motor skills, motor development, 4-Skills Scan, obstacle course, video protocol, questionnaire, expert opinion, motor behaviour
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INTRODUCTION
Nowadays, primary school children are not getting enough exercise (Hildebrandt, Bernaards, Chorus, & Hofstetter, 2013). Hildebrandt et al. showed that 80% of Dutch primary school children do not meet the norm of one hour of moderate intense exercise a day (Nederlandse Norm Gezond Bewegen1). The consequence of less physical activity is acquiring less motor skills. Runhaar et al. (2010) examined the motor skills of children in 1980 and 2006 with an extensive motor skill test and concluded that the group of 2006 was less fit and less motor skilled than the group of 1980. A history of less exercise is often seen in children with a motor development delay (Schoffelmeer and
Toussaint, 2013).
Developmental psychology mentions three main areas of development which influence each other: motor development, social development and cognitive development. For instance, having less motor skills can lead to a lower self-confidence. Skinner & Piek (2001) found that children with development coordination disorder (DCD), a motor skill disorder, had lower self-worth than the control groups. Also, Piek, Barrett, Allen, Jones and Louise (2005) found that children with motor problems are more at risk to get a lower self-worth from getting bullied. A lower self-confidence can lead to less sport-participation in leisure time and this leads to a decrease in physical activity
(Poulsen, Ziviani, & Cuskelly, 2008). The Long Term Athlete Development (LTAD) model (Balyi & Hamilton, 2004) also takes into account these main areas of development. This model works with six different stages and each stage takes into account the physical, emotional and cognitive
development of the child. A child cannot optimally develop when the correct area of development is not taken into account.
Physical education is expected to stimulate the motor development of children (Savelsbergh, de Vries, Hoeboer, & Krijger, 2014). In physical education class, all children need to have an optimal chance to develop their (fundamental) movement skills. Gallahue and Ozmun (2006) define
fundamental movements as gross motor skills common to daily living, which are typically mastered during childhood. Fundamental movements include locomotor skills (e.g. running, jumping and hopping), manipulative skills (e.g. throwing, catching and bouncing) and stability skills (e.g. balancing). These fundamental movement skills provide children the basis to grow into physically active individuals (Gallahue & Ozmun, 2006; Stodden et al., 2008). When children have sufficient fundamental movement skills, they are able to participate in various ways of movement activities, such as playing with peers. For example, to participate in a game of soccer, children need basic competence in running and kicking. In other words, fundamental motor skills are a prerequisite to participate in more complex movement activities. Also important is the fact that children with good
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fundamental movement skills, are more likely to become fit adolescents (Stodden, Langendorfer, & Roberton, 2009).
It is expected that physical education teachers are able to signal delays in motor development. According to the policy plans of the municipality of Amsterdam2, every school is required to use a student monitoring system to identify the cognitive and physical development of the children. The law of inclusive education, which is introduced in August 2014 in the Netherlands3, expects that physical education teachers signal physical deficiencies in children and communicate this to youth health care services. To be able to do this, the physical education teachers need a structured and clear measurement instrument to measure and evaluate the motor development of the children within the physical education class. By using such a measurement instrument, it will be possible to investigate the motor development of the children (Savelsbergh et al., 2014). By
connecting the results of these tests to the goals of the physical education class, the teachers receive feedback on the quality and effectiveness of their lessons. However, in a study into student
monitoring systems, many physical education teachers claimed that they do not have the tools to monitor motor skills in the children, or that the tools that they use have too many disadvantages (van den Driessen Mareeuw, Harting, van der Knaap, & Stubbe, 2012).
Objectively assessing general motor skills is very difficult. Motor skill tests that are currently used most often are the Movement Assessment Battery for Children (MABC; Henderson & Sugden, 1992), Test of Gross Motor Development, second edition (TGMD-2; Ulrich, 2000), and the
Körperkoordinations Test Für Kinder (KTK; Kiphard & Schilling, 1974). A disadvantage to these tests is the fact that the tests takes 20 minutes (TGMD-2/KTK) and 40 minutes (M-ABC) per child to conduct, which is too long to use it during the physical education lessons. Also, for the M-ABC, expensive materials are required (Cools, de Martelaer, Samaey, & Andries, 2009). In a school setting the costs need to be as low as possible and the time required as short as possible.
Many physical education teachers in the Netherlands use the “4-Skills Scan”. This is a Dutch motor skills test that was developed to observe and register the motor skills of primary school children during the physical education class (Van Gelder & Stroes, 2011). The four different test items measure (static) balance, jumping force, ball skills and coordination. This corresponds to the fundamental movement skills mentioned before (locomotor skills, object manipulation skills, and balance skills; Gallahue & Ozmun, 2006). Because the scan takes about 6-10 minutes per participant to conduct, it can be used by physical education teachers to determine the development of motor skills of the children in their physical education class. Also, no extra materials specially designed for
2 Gemeente Amsterdam, Amsterdamse Aanpak Gezond Gewicht: Beleids- en uitvoeringsdocument, 2013, Amsterdam: programma Amsterdamse Aanpak Gezond Gewicht.
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the test need to be purchased: the 4-Skills Scan uses materials such as cones and balls that are available in every school.
The 4-Skills Scan is not an assessment to diagnose a disorder, but it could be used to
recognize potential motor developmental problems in time. With the 4-Skills Scan, the overall motor skill level of a class can be assessed, and the physical education teacher is able to come up with a physical education lesson suited for every child. For example, children with a low score on the ball skills test can have difficulties to participate in, for instance, playing soccer on the playground. This might lead to social exclusion. By using the results of the 4-Skills Scan, the physical education teacher can better arrange the physical education classes and for instance place children with a weaker ball skill level together in one group when playing a ball game. This way, children have more successful experiences and they might more enjoy the physical education class. Also, when measured at least once every year, it is possible to determine the development of motor skills of each child (van Gelder & Stroes, 2011).
The project “Gymmermansoog4” tries to identify and monitor the motor development of primary school children in Amsterdam by using the 4-Skills Scan. One important part of this project is the evaluation of the validity of the 4-Skills Scan. To examine a measure’s convergent validity, one must compare the measure of interest to a criterion measure for the factor being investigated (Burton & Miller, 1998). Many studies who investigate the validity of a motor skill test take the M-ABC as “gold standard” when it comes testing motor skills (for instance: Schoemaker, Flapper, Reinders-Messelink, & de Kloet, 2008), although not everybody agrees (Cools et al., 2009,
Venetsanou et al., 2011). One of the disadvantages of comparing the 4-Skills Scan with the M-ABC, is that the validity of the M-ABC is also examined by comparing it with another motor skill test, namely the Bruininks-Oseretsky Test of Motor Proficiency 2 (BOTMP-2; Bruininks & Bruininks, 2005).
Another reason to not use the M-ABC as a criterion measure in this research, is the fact that the goal of the M-ABC is to detect small to moderate impairments in children’s movement skill development. The 4-Skills Scan does not only want to recognize potential motor developmental problems, but also assess the overall motor skill level of a class. Therefore in this research, the criterion measure will be experts on children’s motor development: paediatricians, physical education teachers and paediatric physiotherapists. Experts participate more often in similar studies (Cools et al., 2009; Williams et al., 2009) because they have a lot of expertise with the evaluation of motor skills in children. The study of Williams et al. (2009) showed that the intraobserver reliability was high and positive (R = .56 - .92).
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The research question of this pilot study is: “Is the combination of children performing an obstacle course and video evaluations of experts a suitable method to validate the 4-Skills Scan?”. This study will consist of two parts: the video evaluation method will be examined and a preliminary validation of the 4-Skills Scan will be performed. An obstacle course will be used as a tool to measure motor behaviour. We hypothesize that evaluating video recordings of the motor behaviour of children on an obstacle course by experts is an appropriate method to validate the 4-Skills Scan, because research (Savelsbergh et al., 2014) claims that an obstacle course is a usable and practical test to measure motor skills. Furthermore, with the results of this pilot study, we want to do a preliminary validation analysis of the 4-Skills Scan by comparing the scores of the experts motor evaluation with the outcomes of the 4-Skills Scan. If this method is found to be reliable, then it is possible to use this method to further examine the validity of the 4-Skills Scan.
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METHOD
Data were collected as part of the Gymmermansoog project of the Hogeschool van
Amsterdam. The purpose of this large project is to identify and monitor the motor development of primary school children in Amsterdam by using the 4-Skills Scan. Also, a lot of information about inactivity and overweight is being collected in this major project. In the current part of the project the validity of the 4-Skills Scan is being examined. Therefore, it is required to search for a suitable method to validate the 4-Skills Scan.
Participants
Participants for this pilot included 71 children (41boys, 30 girls) from three primary schools in Amsterdam. These three schools already participated in the Gymmermansoog project. Two schools had a high SES and one had a low SES. Age range of the children was 8.2 to 10.6 years old (M = 9.38, SD = 0.66). Children who were not physically able to join physical education class because of injuries were excluded from this research, because they were not able to participate in the tests and in the obstacle course. Parents had to sign active informed consent. This pilot study was approved by the ethical commission of the VU5.
Eleven experts participated in this project: two paediatricians, eight physical education teachers and one paediatric physiotherapist. Experts were recruited via the network of the Hogeschool of Amsterdam. Eight experts completed the questionnaire (videos of 30 children) and one expert completed half the questionnaire (videos of 15 children). Two experts only watched the videos of four children or less. Therefore, these two experts were left out of the analysis, and nine experts were included.
Instruments
During the physical education lesson, children performed the obstacle course and the 4-Skills Scan. This was conducted by trained research assistants. Children were asked to perform the best they could on every test. Children performed the tests in their regular gymnastics clothing and they got to wear a coloured bib with a number on the front and on the back for the video recordings.
Obstacle Course
The obstacle course was developed in consultation with different experts in motor skill development and/or physical education. The obstacle course (Figure 1) is based on the fundamental
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movement skills (locomotor, manipulative and stability skills). Also, the twelve learning goals of physical education are taken into consideration (Mooij, 2001).
Three cameras recorded the children from different angles (Figure 1). From the video recordings, a movie of approximately two-and-a-half minutes was made of each child. A video method to examine the quality of movement has been used before (Williams et al., 2009) and has been found reliable (R = .56 - .92).
4-Skills Scan
The 4-Skills Scan is developed to signal motor development delays. The 4-Skills Scan is a motor skills scan with four test items (van Gelder & Stroes, 2011). Each test item is divided into different difficulty levels, which represents a skill level that 80% of the children per age group in the range of 2 to 13 years should master. The score sheets and the age ranges can be found in Appendix A. An extended protocol of the 4-Skills Scan can be found in Appendix B.
The first item, balance, is being observed through standing still on one leg. When children score low on this item, it means that they might have a lower sense of balance or that they have less muscle power in their legs. The second item, jumping force, is measured with hopping. Children who score low on this item, have a lower dynamic balance. Their agility is lower, have a lower balance, and often have less muscle power in their legs. This can for instance be seen during playing tag. The third item, coordination, is measured with all sort of different jumps, such as skipping and an
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alternating jump. Children who score low on this item often are called “clumsy”: they stumble more often and have difficulties with complex movements such as skipping rope and cycling. The last item, ball skills, is measured with bouncing a (basket)ball. Children who score low on ball skills, often drop out with playing ball games.
Procedure
The tests for this study will be performed during school hours.
Obstacle Course
The children started with performing the obstacle course. A short standardized explanation about the obstacle course was given to the children before they performed the course (Appendix C). During this explanation, an example was shown by one of the research assistants. All the children practised the obstacle course once from start to finish. After practising the obstacle course, children performed the obstacle course one by one, first from start to finish and then from finish to start. Because time was no criterion for the obstacle course, the children were told that there was no time limit. After performing the complete obstacle course, the children performed the 4-Skills Scan.
4-Skills Scan
The gymnasium was separated in four parts (Figure 2). A general explanation was given to all the children before the tests started. All children were divided in alphabetic order over the different components of the 4-Skills Scan. All experimenters gave a standardized explanation per part of the test to their group. Each child also received standardized individual explanation. Each part of the test took maximally 2 minutes.
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The results were entered in an iPad, in an app specially developed for this project (Filemaker Pro; Figure 3). Using an iPad to collect data has been proven to be a reliable method (Hendriks, 2011).
Data collection
Obstacle Course
The videos of the obstacle course were randomly shown to experts from three different areas of expertise, namely paediatric physiotherapists, paediatricians and physical education teachers. The experts did not know the children, nor did they know the obtained scores from the 4-Skills Scan. The age of the child was shown below the video. The online questionnaire program Qualtrics6 was used to distribute the videos and the questionnaire to the experts (Figure 4). These experts scored the quality of movement of the children based on the videos. Each expert answered questions about 30 children. There was one general question about the general motor skills of the children and four specific questions about balance skills, ball skills, jumping skills and coordination skills (Appendix D). These five questions were answered on a 0 (low) to 10 (high) scale. Also, there was one question where the experts were asked to place each child in a category
(green/orange/red). The green category is the group without any motor problems, the orange category is the group which is at risk for motor problems and the red category is the group that is
6www.qualtrics.com
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considered to have motor problems. The average score was calculated by taking the mean of all the expert scores. The average category score will be between 1 and 3 (1 to 1,66 = green; 1,67 to 2,33 = orange; 2,34 to 3 = red).
Also, because this current study is a pilot study to investigate this method for validating the 4-Skills Scan, there were questions included at the end of the questionnaire about the quality and content of the questionnaire and the obstacle course. This information from the experts will be used in order to improve the method.
4-Skills Scan
The 4-Skills Scan has four items. The raw score from each item can be transformed into an item motor score, before any analysis can be done. From this item motor score, an item motor lead can be calculated as follows: 𝐼𝑡𝑒𝑚 𝑀𝑜𝑡𝑜𝑟 𝐿𝑒𝑎𝑑 = 𝐼𝑡𝑒𝑚 𝑀𝑜𝑡𝑜𝑟 𝑆𝑐𝑜𝑟𝑒 − 𝐶𝑎𝑙𝑒𝑛𝑑𝑎𝑟 𝐴𝑔𝑒.
With the average of the four item motor scores, a total motor score can be calculated. With the total motor score, a general motor lead score can be calculated: 𝐺𝑒𝑛𝑒𝑟𝑎𝑙 𝑀𝑜𝑡𝑜𝑟 𝐿𝑒𝑎𝑑 = (𝑇𝑜𝑡𝑎𝑙 𝑀𝑜𝑡𝑜𝑟 𝑆𝑐𝑜𝑟𝑒/4) − 𝐶𝑎𝑙𝑒𝑛𝑑𝑎𝑟 𝐴𝑔𝑒. If the motor lead is positive, it is indeed a motor lead; if
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the motor lead is negative, it is a motor delay. For instance, a child of 8 years old with a motor score of 9 years old, has a motor lead of +1 year.
Data analysis
For the statistical analysis, the program SPSS (version 23) was used. To answer the main research question (“Is the combination of children performing an obstacle course and video evaluations of experts a suitable method to validate the 4-Skills Scan?”), the inter-rater reliability between the experts was examined. This was done by means of intraclass correlation calculations. If there is a large agreement between the experts, it is likely that the experts are congruent in their answers, indicating the obstacle course to be a reliable assessment. This is important if you want to use the opinion of the experts to validate the 4-Skills Scan. Also, we examined the feedback which was given by the experts in order to improve the obstacle course and the questionnaire for the follow up study.
With the results of this pilot study, we did a preliminary validation analysis of the 4-Skills Scan. The general motor lead score of the 4-Skills Scan was compared with the expert opinion on the general motor questions for the obstacle course, by determining the correlation between the results of the 4-Skills Scan and the obstacle course with the Pearson r. Furthermore, a factor analysis was done to see whether the four items could be transformed into one variable. The separate item scores of the 4-Skills Scan were compared with the expert scores on the specific questions of the obstacle course. Last, a MANOVA and discriminant function analysis were performed to identify significant determinants of cluster membership. An alpha level set at α = .05% was implemented to determine significance.
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RESULTS
Descriptives
71 Children performed the obstacle course. The 4-Skills Scan was performed completely by 63 children. Eight children did not perform all four items of the 4-Skills Scan, for instance because they had an injury to their arm(s) or leg(s), and therefore these data were not taken into analysis for the preliminary validity.
Expert reliability
Because of time limits, each expert watched 30 videos instead of all 71 videos. On average, every child is evaluated by four experts. However, some children are only evaluated by two experts.
Intraclass correlation calculations (ICC) for the question about general motor skills indicated that there was moderate agreement between the experts (ICC = 0.52). The ICC for the questions about specific motor skills were 0.46 for balance (Q3), 0.51 for ball skills (Q4), 0.50 for locomotor skills (Q5) and 0.47 for jumping skills (Q6). There average ICC was 0.49. ICC calculations for the motor skills category question (Q3) indicated that there was low agreement between the experts (ICC = 0.40).
Feedback from experts
The end of the questionnaire included two questions about the obstacle course and one about the questionnaire. The first question was: “Do you think that evaluating the motor skills of children with the current videos and a questionnaire is an appropriate method?”. The second question was: “Do you think that the current obstacle course is suitable for its goal?”. The last question was: “Do you have any feedback for improvement of the questionnaire?”
Table 1
Expert Answers to Feedback Questions in the Questionnaire
Yes No
1. “Do you think that evaluating the motor skills of children with the current videos and a questionnaire is an appropriate method?”
4 5
2. “Do you think that the current obstacle course is suitable for its goal?” 3 6
3. “Do you have any feedback for improvement of the questionnaire?” 9 0
Results indicated that the experts had different opinions (Table 1) about the method, the obstacle course and the questionnaire. The experts gave a lot of feedback for improvement for the questionnaire. The feedback of the experts will be discussed more extensively in the discussion section.
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4-Skills Scan
In Table 2, the results of the 4-Skills Scan can be found. As can be seen, the mean motor lead was negative (-0.7 years). Pearson’s correlations between the items of the 4-Skills Scan were calculated. Table 3 shows that the only significant correlation is between the 4-Skills Scan items bouncing and balance.
Table 2
4-Skills Scan: Total Motor Score and Motor Lead
Note: N = 63; * = significant at the value p < .05 (2-tailed)
Obstacle course
The question: “I put the child in the following group…” had three possible answers (1 = green/good; 2 = orange/risk; 3 = red/problem). For every child, the average opinion of the expert was calculated. In Table 4 can be seen how many children were placed in the red, orange and green category, based on the average opinion of nine experts. This is visualized in Figure 5.
N Mean (in years) SD (in years) Min (in years) Max (in years)
Total motor score (TMS) 63 8.7 1.5 5.8 12.5
Motor Lead 63 -0.7 1.4 -3.7 2.7
Table 3
Pearson Correlations, Means and Standard Deviations Associated with the 4 Items of the 4-Skills Scan
1 2 3 4 M SD
1. Balance Motor Lead 1.00 -0.8 3.0
2. Jumping-Force Motor Lead .22 1.00 -0.7 2.2
3. Jumping-Coordination Motor Lead .15 .24 1.00 0.5 2.2
4. Bouncing Motor Lead .29* .20 .20 1.00 -1.9 1.5
Table 4
Experts Category Scores. Question: “I Put the Child in the Following Group...:”
N %
Problem (Red) 4 6.3%
Risk (Orange) 18 28.6%
Good (Green) 41 65.1%
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Expert opinion on obstacle course questionnaire
Specific questions
The four specific items of the 4-Skills Scan were compared separately with the expert opinions about the motor skills in the obstacle course. For all four questions (Appendix D), the expert scores had a moderate positive significant correlation with the corresponding outcome on the 4-Skills Scan (Table 5). In Figure 6, four graphs of the expert category score versus the item motor leads are shown.
Table 5
Pearson’s Correlations 4-Skills Scan items versus Expert Opinion on Questionnaire
N R p-value
Standing still vs Q4 64 0.410 p < .01
Bouncing (ball) vs Q5 66 0.395 p < .01
Jumping-coordination vs Q6 68 0.371 p < .01
Jumping-force vs Q7 68 0.522 p < .001
Figure 5. Expert Category Score (Questionnaire) Compared With General Motor Lead (4-Skills Scan)
-4 -3 -2 -1 0 1 2 3 4 1 1,67 2,34 Mo to r Lead (in y ear s)
Expert score (average)
Category 1 (No problems) Category 2 (Risk) Category 3 (Problem)
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The Pearson correlations between all of the 4-Skills Scan items were examined in order to test the MANOVA assumption that the variables would be correlated with each other in the
moderate range (i.e. .20 - .60; Meyers, Gampst, & Guarino, 2006). As can be seen from Table 3, most correlations are in de moderate range, suggesting the appropriateness of a MANOVA. Additionally, the Box’s M value of 29.26 was associated with a p value of .003, which was interpreted as non-significant based on Tabachnick and Fidell (2012). Thus, the covariance matrices between the groups were assumed to be equal for the purposes of the MANOVA. Tabachnick & Fidell (2001) recommend to use Pillai’s Trace in the MANOVA because of the unequal sample size.
A one-way MANOVA was conducted to test the hypothesis that there would be one or more mean difference between categories (green, orange, red) and 4-Skills Scan item scores. A statistically significant MANOVA effect was obtained, Pillai’s Trace = .566, F (8, 116) = 2.416, p = .019. The multivariate effect size was estimated at .566, which implies that 56% of the variance in the canonically derived dependent variable was accounted for by group category.
The MANOVA was followed up with discriminant analysis, which revealed two discriminant functions. The first explained 79.9% of the variance, canonical R2 = 0.22, whereas the second explained only 20.1%, canonical R2 = 0.07. In combination these discriminant functions significantly differentiate the motor categories, = 0.73, 2(8) = 18.50, p = .018, but removing the first function indicated that the second function did not significantly differentiate the motor categories, = 0.93, Figure 6. Four Graphs of the Expert Category Scores for the Separate Items Compared with the Separate Item Motor Lead
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2(3) = 4.00, p = .261. The correlations between outcomes and the discriminant functions revealed that the motor lead of Jumping-Force, Jumping-Coordination and Bouncing loaded more highly on the first function (r = .81, r = .56 and r = .52) and that the motor lead of Balance loaded more highly on the second function (r = .57). According to the classification results, 71.4% of the children were correctly classified in the correct category by the experts.
General questions
Scores of the experts on the question: “What do you think of the general motor skills of this child?” were distributed normally. The mean of the experts scores on this question correlated positively with the motor lead score (r = 0.674, p < .001).
Figure 7. Expert General Motor Score Compared With General Motor Lead
-4 -3 -2 -1 0 1 2 3 4 0 1 2 3 4 5 6 7 8 9 10 G en era l Mo to r Lead (in y ear s)
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DISCUSSION
The research question of this pilot study is: “Is the combination of children performing an obstacle course and video evaluations of experts a suitable method to validate the 4-Skills Scan?”. The study consisted of two parts: the video evaluation method was examined and a preliminary validation was performed. Therefore 71 children performed an obstacle course and the 4-Skills Scan, of which 63 completed both. Based on literature, we hypothesize that examining the motor
behaviour of children by video evaluation is an appropriate method to validate the 4-Skills Scan.
Video evaluation method
Expert’s reliability
Results of the intraclass correlation analysis indicated that the interobserver reliability was low to moderate. It is possible that the interobserver reliability is low because of the small group of experts. With more experts, it is expected that a more stable estimation of the interobserver reliability can be given. James Surowiecki (2004) has proven with numerous case studies and anecdotes that aggregation of information in groups will result in decisions that are often better than could have been made by any single member of the group. This phenomenon is called “The Wisdom of the Crowds”.
The interobserver reliability will probably also increase when the experts know what to expect; therefore in the follow-up study an example video will be shown to the experts with which they can practise the questionnaire. Last, a perfect match between the experts is not feasible. In this research, experts from three different professions participated. The experts weigh different criteria when evaluating motor behaviour of a child. In their evaluation experience, expertise and personal considerations will always play a role.
Literature shows that a low to moderate correlation between motor tests and experts is actually common. The study of Schoemaker, Smits-Engelsman, & Jongmans (2003) showed a percentage of agreement between the Movement Assessment Battery for Children and checklists for teachers between 63% an 88%, except for the 7-year-old children, where lower hit rates were obtained (35%). In the two-step screening research of Wright & Sugden (1996), only 26.6% who were identified by a checklist as having motor problems, are also classified as such by a motor test. Likewise, in the research of Piek & Edwards (1997), class teachers were only able to identify 25% of the children with developmental coordination disorder (DCD) and physical education teachers were able to identify 49% of this group with motor problems. Based on these studies, it might be
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concluded that in validation studies of motor behaviour, it is difficult to receive high validation coefficients (Netelenbos, 2005)
The difficulty with the expert evaluation of the motor skills of children is the fact that there is no point of comparison; there is not an example of an average skilled child available. Therefore it is not clear to what the expert compares the children. However, with a large group of experts
participating in this research, the average score of the experts should be a good representation of the true value of the motor skills of the child (Surowiecki, 2004).
In this research, the opinion of the expert is compared with the outcomes of the 4-Skills Scan. Off course the outcome of a motor test can only be seen as an indication of the motor skill level; there could be a deviation from the true value.
Feedback experts
Because this was a pilot study, we have asked the experts who watched the video footage of the children and filled out the questionnaire for some feedback. To evaluate whether an obstacle course and questionnaire is a suitable method to evaluate the motor behaviour of children, the experts were asked to answer three questions at the end of the questionnaire.
- Question 1: “Do you think that evaluating the motor skills of children with the current videos and a questionnaire is an appropriate method?” -
Four experts (B, G, D and I) answered “yes” to this question. They felt that evaluating the motor skills of children with videos and a questionnaire is an appropriate method. Expert D, F, G and I claimed that the current video footage is appropriate to evaluate the (gross) motor skills of the children because the videos provide a lot of information in little time. Expert B added to this that the videos can be used to make a first pre-evaluation. Experts A, C, E, F and H were reserved about the method. Expert C and F were confused by all the different age categories and would like to have the different age categories clustered (Expert I, who was positive about the video footage, gave the same feedback). Experts A and F would like to score more on a quantitative basis, to have a more secure evaluation method. However, this is not what we have in mind: the obstacle course and our questionnaire is not the method to evaluate the motor behaviour of the children, but the opinion of the expert is.
- Question 2: “Do you think that the current obstacle course is suitable for its goal?”. -
Three experts (A, D and H) answered “yes” to this question, although they had some ideas for improvement. Expert A and H found that the obstacle course included a lot of variation of
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movement. However, two experts did claim that the instruction for the children was not always clear, because some children performed the obstacle course different than others. This was confusing according to expert A and B. Experts B, C, E, F, G and I did not find the current obstacle course suitable. According to expert B, C, G and I, the ball skills part was too short and therefore hard to evaluate. The hopping was dangerous (expert F) and also hard to evaluate (expert B and G). Expert I would like to see a longer balance part in the obstacle course. According to expert E, ‘the video footage is too long and the obstacle course could be made a lot shorter’. Last, some experts (F and G) were confused about the (small) differences between the obstacle courses on the three measurement locations.
- Question 3: “Do you have any feedback for improvement of the questionnaire?” -
Three experts (F, H and I) were very positive about the questionnaire. According to them the questionnaire was “clear and everybody is able to answer it”. Also, the amount of questions was good according to expert I. Experts A, B, C, E, F and G had many options for improvement. Expert A and F would like to have some criteria which they had to score. However, as already said for the first question, this is not the purpose of this method. Expert B found it difficult to score motor skills in a grade, and says that ‘she probably gave children with the same motor skills a different grade’. Experts C, F and H wanted the option to put some comments with their answers, especially with the question were the expert was asked to place the child in a category (problem / risk / no problem). Expert G wanted to know during the filling out of the questionnaire how far he was in the process.
Preliminary validation 4-Skills Scan
There was a significant positive correlation between the expert’s opinion about the general motor behaviour in the video recordings and the general motor lead score. So, the higher the score of the expert, the higher the general motor lead in the 4-Skill Scan. This means that the experts broadly agree with the outcomes of the 4-Skills Scan, which is a precondition for using this method to validate the 4-Skills Scan.
As expected, the red category is the smallest and the green category the largest (Table 4 / Figure 5). From the literature (Blank, Smits-Engelsman, Polatajko, & Wilson, 2012; Wright & Sugden, 1994) it appears that the problem group (red) is 5%, the risk group (orange) is 10% and the group without problems (green) is 85%. Our data does not resemble exactly the same percentages and only the red group approaches the numbers from the literature. The orange and green group deviate from the numbers of the literature. The deviation from the numbers from the literature can have several reasons, such as the low amount of participants (71), the specific sample of children from
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urban areas or the method of calculating the average expert category score. According to Hoekman, Breedveld and Kraayman (2016) sport participation is more common in rural than urban areas in the Netherlands.
In Figure 5 can be seen that all the children who are classified as “red” by the experts, have a motor delay of at least 1.7 years (more than 600 days) according to the 4-Skills Scan. The majority of the orange category also has a motor delay. However, there is a large group of green children, so without problems as stated by the opinion of the experts, who have a motor delay according to the 4-Skills Scan. There could be a discrepancy between the four items of the 4-Skills Scan. It is possible that children scored very low on one item of the four items and that this affected their general motor lead score negatively. Perhaps in the video footage, this item was underexposed and therefore the experts scored the children as having no motor problems (green category).
The four items of the 4-Skills Scan were also examined separately. Results of a correlation analysis showed that the four items had positive significant relationships with the opinions of the experts about the specific item questions. This means that the higher the scores of the experts on the four specific item questions, the higher the motor lead of the child according to the 4-Skills Scan.
In Figure 6 some very interesting and remarkable details can be seen. First, it is seen that there are many children who, according to the experts opinion about their general motor skills, are at risk for motor problems (orange group), have a motor lead in balance. Also, there are children in the green category, who have a lower score in balance motor lead than children in the orange and red category (Figure 6A). Furthermore, according to the average general opinion of the experts, there is a child with motor problems who had a motor lead in coordination according to the 4-Skills Scan (Figure 6B). Almost all children have a motor delay in ball skills, according to the 4-Skills Scan (Figure 6C). The jumping-force graph (Figure 6D) looks most similar to the general motor lead graph, but also here there is one child who has motor problems according to the experts, but a small motor lead in jumping-force according to the 4-Skills Scan.
The discriminant analysis showed that the motor lead of force,
jumping-coordination and bouncing loaded on a more discriminant function when it comes to the difference between the green and orange category. The motor lead of balance discriminated more in the difference between the orange and red category. According to the results, 71.4% was correctly classified, which is a high score for a pilot study (Schoemaker et al., 2003; Wright & Sugden, 1996; Piek & Edwards, 1997). However, this number has to go up, if we want to use the 4-Skills Scan as triage method to differentiate between red (motor problems), orange (motor risks) and green (no motor problems).
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Limitations
In the current study, the obstacle course was used as a tool to show the motor behaviour of the children. A disadvantage of video recording children performing an obstacle course while others are waiting is the fact that some children perform worse because others are watching. A solution would be to record the children in a more leisure game environment. However, it would be very difficult for the experts to evaluate the motor skills of individual children. Therefore, we think that recording the children one by one is the best option.
An important limitation was the amount of experts that participated in this study. It was difficult to find more paediatricians and physiotherapists for this pilot study. For the follow-up project it is important to start the search for experts earlier, because a lot of experts took a lot of time to respond to our question whether they wanted to participate.
Another limitations was the fact that the pilot study took place on three different schools. During the measurements, it appeared that the schools had different physical education materials and therefore there were three slightly different obstacle courses.
A last limitation is that editing the videos of all the children takes a lot of time.
Follow-up project
Based on the preliminary analysis, it looks like that this method in itself is suitable for assessing the validity of the 4-Skills Scan. However, based on the feedback of the experts, outcomes of this pilot study indicate that in the current form, the obstacle course and the questionnaire are insufficiently suitable to show the motor behaviour of the children. Some important changes have to be made in the obstacle course and the questionnaire to make them into suitable tools for
evaluating the validity of the 4-Skills Scan.
Another important improvement in this project will be that a lot more experts will be included. The average score of a larger group of experts will give a better result (closer to the “real” value) than a small group (Surowiecki, 2004).
The experts indicated that many parts of the obstacle course should be improved: for instance, the ball skills part was too short to give an adequate evaluation of the ball skills of the child. This part will be extended so that the experts can evaluate the ball skills sufficiently. The hopping part was claimed to be too dangerous: the hoops were made of plastic material and could slip away when the child stepped on it. In the follow-up project, the hoops should be made of some anti-slip material, which is safer. Last, because the measurements were performed on three
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courses, which confused the experts. Therefore, it is important to make sure that in the follow-up project, there are no differences between the obstacles courses. Ideally, the measurements will take place on one location.
In the follow-up project, also the questionnaire will include some important changes. First, an instruction video will be shown to the children before they practise the obstacle course. This video will also be included in the questionnaire so that the experts know what the exact instruction to the child was. Second, an example video with example questions will be shown before the real questionnaire starts: this way the experts can practise with using the online platform Qualtrics and get used to the questionnaire. Third, the children will be clustered per age category: instead of randomising all ages, children from a certain age will be placed in one “block”.
Conclusion
The experts agreed broadly with the outcomes of the 4-Skills Scan, which is a precondition for using this method to validate the 4-Skills Scan (Figure 7). According to the results, 71.4% was correctly classified, which is a high score, especially for a pilot study. It is not yet possible to give a conclusion about the validity of the 4-Skills Scan, because more data is required for the validation.
Results of the intraclass correlation analysis indicated that the interobserver reliability was low to moderate. Literature shows that a low to moderate correlation between motor tests and experts is actually common. However, with the planned improvements, it is expected that the interobserver reliability will increase and therefore this method will be reliable to validate the 4-Skills Scan.
For the follow-up project, some important improvements are required, but there are no insuperable problems found. The aim of the current pilot study was to develop a method to measure the convergent validity of the 4-Skills Scan. When the mentioned changes are applied, this method will be usable and suitable for validating the 4-Skills Scan.
There have been several studies to the relationship between motor development, social development and cognitive development. Sibley and Etnier (2003) found a significant positive relationship between physical activity and cognitive functioning in children. Research of Ekeland, Heian and Hagen (2005) found a positive effect on social development in their systematic review. If is it possible to validate the 4-Skills Scan, physical education teachers have a suitable test to measure the motor development of the child. With this information the physical education teacher is better capable of adjusting the physical education lessons to the individual child; then all children have an optimal chance to develop their motor skills and grow into physically active individuals. The motor development influences the social and cognitive development, so the physical education teachers
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have an important task in optimally improving the area of motor development. The 4-Skills Scan might be a helpful tool for them.
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APPENDIX A: 4-Skills Scan
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Appendix B: Protocol 4-Skills Scan (Dutch)
Doel: Meten van oog-lichaamscoördinatie (STUITEN)
Materiaal: Drie verschillende ballen: basketbal (kleinste maat), volleybal (kleinste maat), molton bal. Pionnen voor 8-baan.
Instructie kind: Het kind krijgt de volgende instructie:
‘Probeer zo vaak als je kunt de bal te stuiten. Kun je het ook met je andere hand?’ ‘Je mag kiezen welke met welke bal je dat wil doen (basketbal/volleybal/molton bal).
Als het kind een fout maakt, dan begint de testafnemer (niet hardop) opnieuw met tellen. Stop hiermee na de tweede fout.
Instructie testleider: Start de test op niveau III: Stuit 15x achter elkaar met de voorkeurshand. Eventueel hardop meetellen.
De volgende niveaus zijn:
IV: stuit 15x met achter elkaar met de niet-voorkeurshand
VI: kan snel dribbelen in 8-baan: 12z rond paal in 30 sec. (Pionnen op 3 m afstand van elkaar)
VIII: kan meer dan 10 sec (of 15x) stuiten zonder naar de bal te kijken (split-vision), zowel links als rechts. Kind kijkt schuin omhoog. Bijv. de korf op 4 m. afstand. Bal mag binnen gezichtsveld komen, maar er mag niet naar gekeken worden. (testafnemer let op oogbewegingen) X: kan snel dribbelen in 8-baan: 12z rond paal in 30 sec. (Pionnen op 3 m. afstand van elkaar) . Kind start naast pion. Pion wordt geteld als er achter de pion langs wordt gedraaid (stapt over denkbeeldige lijn door pionnen, plak tape op grond)
Let erop dat het kind: o De bal goed stuit
o Een bal kiest die past bij het de grootte van de hand o Zo min mogelijk last heeft van omgevingsruis en andere
activiteiten die in de buurt wordt uitgevoerd
o De bril ophoudt tijdens de test als hij/zij een brildrager is o De test uitvoert op blote voeten of sportschoenen.
(afhankelijk van de gebruikelijke outfit tijdens de gymles)
Testuitslag/meetresultaat: Observeer de kinderen 1x voor beide handen, tenzij er overduidelijk
sprake is van een mislukte poging of weinig motivatie, dan wordt een nieuwe poging gestart.
De uitslag (niveau of aantal pionnen) wordt genoteerd in de iPad onder tabblad ‘stuiten’.
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Doel: Meten van balans (statisch evenwicht)
Materiaal: Stopwatch
Instructie kind: Het kind krijgt de volgende instructie:
‘Probeer zo lang als je kunt op 1 been stil te staan. Je mag je voet niet verplaatsen. Je staat niet meer stil als:
- je met je andere voet de grond raakt - je een hupje maakt
- je je voet verschuift’.
Instructie testleider: Neem deze test af met 2 leerlingen tegelijk. Ogen open: gezicht naar muur/afscheiding
Ogen dicht: testafnemer moet beide ogen kunnen zien.
Start de test op niveau IV: Staat 30 sec op 1 been, wiebelen mag (L&R). Leerlingen uit groep 6, 7 & 8 starten op niveau X
Na niveau IV volgen de volgende niveaus: VI: Staat 30 sec stabiel op 1 been (L & R) VIII: Staat 60 sec stabiel op 1 been (L&R)
X: Staat 10 sec met ogen dicht op 1 been, wiebelen mag (L&R) NB Met stabiel wordt bedoeld: stilstaan zonder corrigerende bewegingen van armen, romp en/of hoofd. Een licht correctie is normaal. (wees dus zuinig met de registratie van wiebelen. Let erop dat het kind:
o Zich focust op een muur (afstand tot de muur 2m) o Zo min mogelijk last heeft van omgevingsruis en andere
activiteiten die in de buurt wordt uitgevoerd
o Het startbeen mag gekozen worden. Wissel daarna van been.
o Niet met het andere been ‘klemt’, vraag het kind of hij net zo lang kan staan met de benen ‘los’ van elkaar, die score telt
o De bril ophoudt tijdens de test als hij/zij een brildrager is o De test uitvoert op blote voeten of sportschoenen.
(afhankelijk van de gebruikelijke outfit tijdens de gymles)
Testuitslag/meetresultaat: Observeer de kinderen 1x, tenzij er overduidelijk sprake is van een
mislukte poging of weinig motivatie, dan wordt een nieuwe poging gestart.
De uitslag (niveau of aantal seconden) wordt genoteerd in de iPad onder tabblad ‘stilstaan’.
Opmerkingen: Als er meerdere kinderen tegelijk getest worden, zorg dan voor voldoende afstand van elkaar. Test eerst niveau X (10 sec met ogen dicht op 1 been). De kinderen die het niet halen worden gevraagd zo lang mogelijk op 1 been te staan, waarbij de testleider het aantal seconden noteert en wie de wiebelaars zijn.
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Doel: Meten van balans (dynamisch evenwicht)
Materiaal: Stopwatch, pionnen om een 9 meter parcours te maken (tape een start- en finishlijn als er geen lijnen in de zaal beschikbaar zijn)
Instructie kind: Het kind krijgt de volgende instructie:
‘Ga op 1 been achter de startlijn staan en hinkel in zo weinig mogelijk hinkels /zo groot mogelijke hinkelsprongen, naar de finishlijn’.
Instructie testleider: De test wordt gestart op niveau IV (hinken over 9m). Tel het aantal voetcontacten tussen de lijnen. Als het laatste voetcontact op de finishlijn is, wordt deze meegeteld. Laat het kind 1 keer op beide benen de test uitvoeren.
Niveaus
IV: 11 hinkels sterkste been, 12 hinkels andere been VI: 9 hinkels sterkste been, 10 hinkels andere been VIII: 7 hinkels sterkste been, 8 hinkels andere been X: 6 hinkels sterkste been, 7 hinkels andere been
Let erop dat het kind:
o Start vanuit stilstand op een been (zelf te kiezen) o Een kaatsende beweging maakt (kort contact met de
grond)
o De bril ophoudt tijdens de test als hij/zij een brildrager is o De test uitvoert op blote voeten of sportschoenen.
(afhankelijk van de gebruikelijke outfit tijdens de gymles)
Testuitslag/meetresultaat: Observeer de kinderen 1x, tenzij er overduidelijk sprake is van een
mislukte poging of weinig motivatie, dan wordt een nieuwe poging gestart.
De uitslag (niveau of aantal hinkels) wordt genoteerd in de iPad onder tabblad ‘springen-kracht’.
Opmerkingen: Negen meter is de breedte van het volleybalveld of de helft van de lengte van het veld. De (gele) lijnen van het volleybalveld vormen meestal de buitenlijnen in de gymzaal.
Een (groot) verschil tussen linker- en rechterbeen komt regelmatig voor en is een indicatie voor asymmetrische ontwikkeling en een opvallende looppas.
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Doel: Meten van coördinatie
Materiaal: Lijn (in de zaal)
Instructie kind: Het kind krijgt de volgende instructie:
‘Kun je een wisselsprong maken? Een been voor de lijn en een been erachter, maak een sprongetje en wissel je benen’. Eventueel: ‘Kun je ook op je plaats blijven?’ En: ‘Kun je ook sneller?’
NB Ook vragenderwijs en positief de andere niveaus testen
Instructie testleider: Geef een voorbeeld! Daarna zelfstandig laten uitvoeren. Start de test op het niveau: Groep-1.
Dus groep 7 start op niveau 6, groep 6 start op niveau 5 Maakt snelle wisselsprongen (20 in 10 sec).
De wisselsprong lukt niet als het kind:
a. een stappende en geen springende beweging maakt of een soort loopbeweging (de voeten gaan dan na elkaar over de lijn en weer terug)
b. meedraait (45 graden) met de heupen c. niet op de plaats kan blijven
De volgende /andere niveaus zijn:
VI: kan in ritme huppelen en in de handen klappen (kind mag zelf het klapritme bepalen, eventueel vocale ondersteuning geven)
VIII: kan 10x in ritme kruis-spreid-kruis springen en in de handen klappen: met de klap op ‘kruis’
X: kan 10x in ritme spreid-sluit-spreid springen en in de handen klappen: met de klap op ‘spreid’.
Bij dit testonderdeel wordt na elk niet-gehaald niveau nog één niveau door-getest. Noteer het hoogst gehaald niveau.
Let erop dat het kind:
o De bril ophoudt tijdens de test als hij/zij een brildrager is o De test uitvoert op blote voeten of sportschoenen.
(afhankelijk van de gebruikelijke outfit tijdens de gymles)
Testuitslag/meetresultaat: Observeer of het ‘lukt of niet lukt’. Observeer de kinderen 1x, tenzij
er overduidelijk sprake is van een mislukte poging of weinig motivatie, dan wordt een nieuwe poging gestart.
De uitslag (niveau) wordt genoteerd in de iPad onder tabblad ‘springen-coördinatie’ Bij opmerkingen kan genoteerd worden als een kind veel corrigerende (arm)bewegingen maakt of moeite heeft met kaatsen/doorspringen.
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Appendix C: Explanation Obstacle Course (in Dutch)
Start Finish
Je loopt via de bank omhoog, op de kast. Dan spring je met 2 benen tegelijk van de kast af. Daarna loop je om de pion heen. Dan loop je over de ene bank, en daarna over de andere bank. Daarna slalom je om de pionnen heen en tik je een voor een de pionnen aan met je hand. Je loopt weer om de pion heen. Op de lange mat doe je 2 keer een koprol waarbij je na elke koprol gelijk weer
probeert te gaan staan. Dan klim je over de brug en loop je om de pion heen. Je pakt de grote bal uit de korf, gooit die met 2 handen tegen de muur in de hoepel en dan vang je de bal met 2 handen weer op. Je legt de bal terug in de korf. Hinkel door de hoepels heen op je rechterbeen. Klim op de kast. Op de trampoline doe je een streksprong.
Finish Start
Je begint op de dikke mat. Je klimt over de kast heen. Je hinkelt door de hoepels met je linkerbeen. Gooi de kleine bal tegen de muur en vang hem weer op. Leg de bal terug in de korf en loop om de pion heen. Zwaai onder de brug door. Op de lange mat doe je 2 keer een koprol waarbij je gelijk weer probeert te gaan staan. Loop om de pion heen. Slalom weer om de pionnen heen en tik de pionnen aan met je hand. Loop over de banken heen. Loop om de pion heen. Klim op de kast en loop over de bank naar beneden.
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Appendix D: Expert questionnaire
Welkom!
Bedankt dat u wilt meewerken aan ons onderzoek. U ziet in totaal 30 video’s van leerlingen
van 8 tot 11 jaar. De video’s beginnen uit zichzelf met spelen; wij vragen u om elke video 1
keer in zijn geheel te bekijken. Binnen de vragenlijst kunt u om technische redenen niet
terugkeren naar de vorige vraag; ga dus pas door naar de volgende vraag wanneer u zeker
bent van uw antwoorden.
De kinderen hebben vooraf een algemene uitleg gekregen over de route door de
hindernisbaan. Ze moeten bijvoorbeeld een koprol maken op de lange mat, over de rekstok
klimmen/draaien, de grote bal tegen de muur in de hoepel gooien en weer vangen, en een
streksprong maken op de trampoline. Op de terugweg moeten de kinderen een tennisbal tegen
de muur gooien en weer vangen, onder de rekstok door zwaaien, weer een koprol maken en
lopen over de lange bank.
Soms houden kinderen zich niet helemaal aan deze uitleg; dit hoeft u niet te beoordelen. Het
gaat bij het beoordelen van de motoriek om het gehele beeld; niet om de deeltaken in de
hindernisbaan. Neem bij de beoordeling van de motoriek de leeftijd van het kind in acht.
Deze staat vermeld bij de video.
Belangrijk:
Werkt u op een MacBook? Gebruik dan Safari om de video’s te bekijken.
Werkt u op een Windows computer? Gebruik dan Internet Explorer om de video’s te
bekijken.
De vragenlijst wordt vanzelf opgeslagen. U kunt tussendoor stoppen en later verder gaan; u
zult dan direct verder gaan bij de video waar u was gebleven.
Per video worden de volgende vragen gesteld:
1 Wat is uw algemene indruk van de grof-motorische vaardigheid van dit kind?
Antwoord: 10 punts-schuifbalk:
Zeer laag 0 --- 10 zeer hoog
2 Ik deel het kind als volgt in:
Antwoord: 3 mogelijkheden:
Knop A: Geen motorische problemen (groen)
Knop B: Risicogroep, extra binnenschoolse gymlessen is wenselijk
Knop C: zeer waarschijnlijk problemen, kind moet doorverwezen worden naar
JGZ-arts
Beantwoord de volgende vragen op een schaal van 1 tot 10 (waarbij 1=zeer laag en 10= zeer
hoog). (1 decimaal achter de komma).
3 Beoordeel de balans-vaardigheid van dit kind
Antwoord: 10 punts-schuifbalk:
34
