Development and reliability of the seated posture control measure for therapeutic horseback riding/hippotherapy for children and youth with neuromotor disorders
Authors: Medeiros Mylena , Kanitkar Anuprita , Parmar Sanjay T. , Shay Barbara L. 
Published: July 2023

INTRODUCTION:
The purpose of this study was to produce an evaluative instrument for pediatric therapists to measure change in seated postural control in the context of therapeutic horseback riding/hippotherapy (THR/HPT) for use with children and youth with neuromotor disorders. A clinical evaluation tool, known as the seated postural control measure (SPCM) was identified as the most feasible outcome measure that could be adapted for this purpose. The second aim of the study was to examine the intra- and inter-rater reliability of the adapted clinical measurement tool.

METHODS:
The study contained three phases: Phase 1: Preparation of the preliminary version of the measure; Phase 2: Examining content validity of the measure in a nominal group workshop online consensus surveys with acknowledged experts in THR/HPT; and Phase 3: Examining test-retest and inter-rater reliability. Twenty-four children and youth with neuromotor disorders categorized by Gross Motor Function Classification System levels 1-4, participated. Physiotherapists and occupational therapists at three centers were involved as raters in the reliability study. All participants were assessed simultaneously by two raters scoring independently, to determine inter-rater reliability. The adapted SPCM consisted of 22 items in two domains. Using visual observation and an ordinal three-point scale for scoring, the postural alignment domain included 14 items, observing the alignment of each body segment and categorizing neutral alignments as well as mild and moderate angular deviations. The functional movement domain consisted of 8 functional movement items, using four criterion-referenced levels (0–3), describing the attainment of seated functions such as head and trunk control, reach, grasp and release, and bimanual manipulation both with the horse stationary and walking. Higher grades represent better achievement. The test–retest components were conducted by one rater at each site after a 2-week time interval, to minimize recall bias. The participants had no restrictions or interruptions of usual care or therapies during this period.

RESULTS:
Once the child was seated and rode the horse for 10 min to acclimate, the testing was completed in approximately 20 min. Inter-rater and test–retest reliability was high. For inter-rater reliability 16 out of 22 items obtained excellent reliability, with Intra-class Correlation Coefficient (ICC) values above 0.90, and 6 items scored from 0.81 to 0.90, which is considered good reliability. Similar ICC values obtained for test–retest reliability showed 16 items above 0.90 (excellent reliability) and 6 items with good reliability. Complete agreement of raters occurred for some items in both the alignment and functional sections. Cronbach's alpha was 0.93 for the overall THR/HPT SPCM. Internal consistency for the alignment and functional domains were (0.88 and 0.92, respectively).

CONCLUSION:
The overall goal to develop a descriptive outcome measure to assess seated postural control for children and youth with neuromotor disorders, that would be quick, easy to use, inexpensive, valid, and reliable in the context of THR/HPT was achieved.