The Development and Clinical Testing of a Movement Quality Outcome Measure for Patients with Neurological Conditions: The Leeds Movement Performance Index

Background In modern neurological physiotherapy practice, a patient’s neuroplasticity is harnessed, teaching them to develop motor control at ‘impairment’ level. Consequently, the patient relearns ‘normal’ movement, which in turn enables them to gain more efficient function and independence that has significant impact on their ‘life’. However, there are no outcome measures that capture the patient’s quality of movement, or the specific effects of physiotherapy intervention. Such an outcome measure, the Leeds Movement Performance Index, was developed to fill this gap. It was hypothesised to be a valid, reliable and clinically useful tool. Methods A multi-centre, three-part, mixed-methods study was undertaken with three groups of neurological physiotherapists (n=34) and patients with neurological diagnoses (n=42). A range of quantitative and qualitative methods were used: Consensus methods to develop the new outcome measure; psychometric tests to examine reliability and validity against existing outcome measures in the field; focus groups, face-to-face interviews and reflective writing to further explore clinical utility. Results The Leeds Movement Performance Index was shown to be a tool with strong measurement properties i.e.: internal consistency (Chronbach’s, overall scale=0.862), inter-rater reliability (ICC=0.959); test-re-test reliability (rho=0.792); and criterion validity compared with the Berg Balance Scale (rho=0.468, SD±2). Thematic analysis demonstrated robust content validity and clinical utility. Furthermore, it un-expectedly revealed that the Leeds Movement Performance Index also supported fundamental aspects of neurological physiotherapy clinical practice, including assessment, analysis and clinical reasoning, and potential usefulness as an education aid. Conclusion The Leeds Movement Performance Index makes an important and novel contribution to the field of neurological physiotherapy, both clinically and within research practice. It is the first outcome measure to conceptually map the nature and definition of quality of movement for patients with motor impairment, and it captures the impact of neurological physiotherapy intervention more responsively compared with other outcome measures routinely used within the field