Measuring treatment outcome in children with developmental coordination disorder; responsiveness of six outcome measures

Figures & data

Figure 1. Flow of patients.

Table 1. Patient and sociodemographic characteristics of 41 children with Developmental Coordination Disorder.

Sex
Male (%)	34	(82.9%)
Age in years median (IQR 25;75) Range	7.8	(7.2;9.2)	5.7–12.2
Comorbidities n (%)
None	20	(48.8%)
ADHD (suspected)	5	(12.2%)
Autism (suspected)	10	(24.4%)
ADHD and autism (suspected)	1	(2.4%)
ADHD (diagnosed)	3	(7.3%)
Autism (diagnosed)	1	(2.4%)
ADHD and autism (diagnosed)	1	(2.4%)
Medication use n (%)
ADHD	3	(8.3%)
Therapy mean (SD)
Number of sessions	15.1	(3.9)
Total therapy time in hours	32.8	(7.3)
Treatment n (%)
Combined physical and occupational therapy	41	(100%)
Additional treatment (%)
Speech therapy	23	(56.1%)
Psychotherapy	22	(53.7%)
Tansoderberg group	3	(7.3%)
Play/Sports group	4	(9.8%)
Hydrotherapy	4	(9.8%)
Parental counseling
Social work counseling	21	(51.2%)

Numbers and (%) unless indicated otherwise. SD: Standard Deviation; IQR 25;75: Inter Quartile Range 25^th & 75^th percentile; Tansoderberg group: speech therapy group focussing on coping with dysphasia in daily life.

Table 2a. Responsiveness and change over time of the 6 used outcome measures in 41 children with DCD in rehabilitation.

Outcome measure	Mean T1 (SD)	Mean T2 (SD)	Mean difference (95% CI)	t-statistic (p-value)	ES	SRM	Improved n (%)	No change n (%)
Movement ABC-2 (n = 41)
Total score	3.56 (2.03)	4.41(2.77)	0.85 (0.22;1.49)	2.72 (0.010)*	0.42	0.43	22 (54%)	11 (27%)
Manual dexterity	4.73 (2.45)	5.29 (2.74)	0.56 (−0.42;1.55)	1.15 (0.257)	0.23	0.18	21 (51%)	3 (7%)
Ball skills	5.93 (2.73)	6.83 (2.53)	0.90 (0.10;1.70)	2.28 (0.028)*	0.33	0.36	21 (51%)	7 (17%)
Static and dynamic balance	4.80 (2.65)	5.71(3.07)	0.90 (−0.60;1.86)	1.90 (0.065)	0.34	0.30	20 (49%)	9 (22%)
DCD-daily (n = 26)
Total score	30.88 (5.48)	28.67 (5.10)	−2.21 (−3.65;−0.77)	−3.17 (0.004)*	0.40	0.62	16 (62%)	1 (4%)
Quality score	33.27 (4.80)	29.69 (4.68)	−3.58 (−5.20;−1.96)	−4.55 (0.000)*	0.74	0.89	20 (77%)	1 (4%)
Time score	28.69 (7.17)	27.19 (6.92)	−1.50 (−2.91;−0.09)	−2.19 (0.038)*	0.21	0.43	14 (54%)	1 (4%)
Canadian Occupational Performance Measure (n = 37)
Satisfaction score	4.47 (1.21)	6.52 (1.17)	2.04 (1.67;2.42)	11.02 (0.000)*	1.70	1.81	36 (97%)	0 (0%)
Performance score	4.30 (1.23)	6.32 (1.20)	2.02 (1.58;2.46)	9.33 (0.000)*	1.65	1.53	35 (95%)	2 (5%)
Behaviour Rating Inventory of Executive Function
(BRIEF parents) (n = 34)
Global executive composite score	52.85 (7.37)	50.76 (6.50)	−2.09 (−4.10;−0.73)	−2.11 (0.043)*	0.28	0.36	19 (56%)	1 (3%)
Behavioural regulation index	48.68 (9.17)	47.68 (9.26)	−1.00 (−3.51;1.51)	−0.81 (0.424)	0.11	0.14	15 (44%)	4 (12%)
Metacognition index	55.21 (6.99)	52.85 (5.91)	−2.35 (−4.35;−0.35)	−2.39 (0.023)*	0.34	0.41	19 (56%)	2 (6%)
Behaviour Rating Inventory of Executive Function
(BRIEF teachers) (n = 29)
Global executive composite score	57.76 (5.91)	54.07 (7.64)	−3.69 (−6.04;−1.34)	−3.21 (0.003)*	0.62	0.60	22 (76%)	0 (0%)
Behavioural regulation index	54.76 (7.50)	52.69 (8.22)	−2.07 (−4.61;0.47)	−1.67 (0.106)	0.28	0.31	16 (55%)	2 (7%)
Metacognition index	59.10 (6.44)	54.48 (7.70)	−4.62 (−7.12;−2.13)	−3.79 (0.001)*	0.72	0.70	21 (72%)	2 (7%)
TNO-AZL Questionnaire for Children’s Health-Related Quality of Life (TACQOL) (n = 34)
Body functioning	26.88 (3.71)	27.26 (3.96)	0.38 (−1.02;1.78)	0.56 (0.582)	0.10	0.10	17 (50%)	6 (18%)
Motor functioning	26.09 (4.22)	26.74 (4.34)	0.65 (−0.86;2.15	0.88 (0.387)	0.15	0.15	21 (62%)	2 (6%)
Daily functioning	26.10 (4.29)	29.30 (3.98)	3.20 (1.45;4.95)	3.74 (0.001)*	0.75	0.68	25 (74%)	3 (9%)
Cognitive functioning	20.97 (6.02)	23.26 (4.47)	2.29 (0.17;4.41)	2.21 (0.035)*	0.38	0.40	21 (62%)	2 (6%)
Social functioning	28.97 (2.70)	29.06 (2.57)	0.09 (−0.74;0.92)	0.22 (0.825)	0.03	0.04	11 (32%)	10 (29%)
Positive emotional functioning	14.09 (1.80)	14.26 (2.15)	0.18 (−0.57;0.92)	0.48 (0.634)	0.10	0.08	12 (35%)	13 (38%)
Negative emotional functioning	11.00 (2.75)	11.48 (2.86)	0.48 (−0.35;1.32)	1.19 (0.244)	0.18	0.21	17 (50%)	7 (21%)
	Percentile cut − off scores T1	Percentile cut − off scores T2	Difference over time (p)
Systematisch Opsporing Schrijfproblemen-2-NL (n = 29)	n (%)	n (%)			x	x	Improved n (%)	Status quo n (%)
Quality score			0.096				10 (35%)	14 (48%)
≤ p5	18 (62.1)	16 (55.2)
p6-15	10 (34.5)	6 (20.7)
≥ p16	1 (3.4)	7 (24.1)
Speed score			0.059				9 (31%)	17 (59%)
≤ p5	8 (27.6)	6 (20.7)
p6-15	11 (37.9)	7 (24.1)
≥ p16	10 (34.5)	16 (55.2)

*p < 0.05 on the Wilcoxon’s signed rank matched pairs test or paired T-test.

Only outcomes for children who completed the outcome measures both at baseline and at end of treatment are reported in this table.

The corresponding number of children is shown behind each outcome measure.

An effect size (Effect Size (ES) and Standardized Response Mean (SRM)) of >0.2 is considered a small effect, >0.5 a moderate effect and >0.8 a large effect.

Table 2b. Responsiveness and change over time based on treatment goals.

Treatment goal (n)	Mean T1	Mean T2	Mean difference	t-statistic			Improved	No change
Outcome measure	(SD)	(SD)	(95% CI)	(p-value)	ES	SRM	n (%)	n (%)
Ball skills (n = 30)
Movement ABC-2 (n = 30)
Total score	3.47 (2.00)	4.57 (2.93)	1.10 (0.37;1.83)	3.08 (0.004)*	0.55	0.56	17(57%)	8 (27%)
Ball skills	6.03 (2.95)	7.10 (2.56)	1.07 (0.72;2.06)	2.19 (0.036)*	0.36	0.40	17 (57%)	4 (13%)
Balance (n = 28)
Movement ABC-2 (n = 28)
Total score	2.89 (1.91)	3.96 (2.95)	1.07 (0.30;1.84))	2.86 (0.008)*	0.56	0.54	16 (57%)	7 (25%)
Static and dynamic balance	4.04 (2.53)	4.96 (2.89)	0.93 (−0.67;1.92)	1.91 (0.066)	0.37	0.36	15 (54%)	6 (21%)
Independent selfcare (n = 31)^a
DCD-daily (n = 22)
Total score	31.09 (5.75)	28.93 (5.50)	−2.16 (−3.79;−0.52)	−2.75 (0.012)*	0.38	0.59	13 (59%)	1 (5%)
Quality score	33.18 (5.12)	29.73 (5.03)	−3.45 (−5.21;−1.69)	−4.08 (0.001)*	0.67	0.87	17 (77%)	1 (5%)
Time score	29.23 (7.43)	27.59 (7.30)	−1.64 (−3.15;−0.12)	−2.25 (0.036)*	0.22	0.48	12 (55%)	1 (5%)
Task Orientation and Process skills (n = 39)^b
Behaviour Rating Inventory of Executive Function (BRIEF parents) (n = 32)
Global executive composite score	53.25 (7.29)	51.09 (6.53)	−2.16 (−4.28;−0.03)	−2.07 (0.047)*	0.30	0.37	18 (56%)	1 (3%)
Behavioural regulation index	49.25 (9.13)	48.66 (8.57)	−0.59 (−3.20;2.00)	−0.47 (0.645)	0.07	0.08	13 (41%)	4 (9%)
Metacognition index	55.44 (6.96)	52.84 (6.09)	−2.59 (−4.63;−0.55)	−2.59 (0.014)*	0.37	0.46	18 (56%)	2 (6%)
Behaviour Rating Inventory of Executive Function (BRIEF teachers) (n = 27)
Global executive composite score	57.89 (6.08)	53.81 (7.83)	−4.07 (−6.55;−1.60)	−3.39 (0.002)*	0.67	0.65	22 (81%)	0 (0%)
Behavioural regulation index	55.07 (7.68)	52.48 (8.46)	−2.59 (−5.21;0.03)	−2.04 (0.052)	0.34	0.39	16 (59%)	2 (7%)
Metacognition index	59.11 (6.54)	54.19 (7.76)	−4.93 (−7.58;−2.27)	−3.19 (0.001)*	0.75	0.74	20 (74%)	1 (4%)
	Percentile cut − off scores T1	Percentile cut − off scores T2
	n (%)	n (%)	Difference over time (p)		x	x	Improved n (%)	Status quo n (%)
Writing (n = 36)^c
Systematisch Opsporing Schrijfproblemen-2-NL (n = 28)								1
Quality score			0.058				10 (36%)	4 (50%)
≤ p5	18 (64%)	15 (54%)
p6-15	9 (32%)	6 (21%)
≥ p16	1 (3%)	7 (25%)
Speed score			0.059				9 (32%)	16 (57%)
≤ p5	8 (29%)	6 (21%)
p6-15	11 (39%)	7 (25%)
≥ p16	9 (32%)	15 (54%)

*p < 0.05 on the Wilcoxon’s signed rank matched pairs test or paired T-test.

^aThe number of patients having treatment goals on independent selfcare was 31 but due to age limitations of the DCDdaily data of only 22 patients was used for analysis.

^bNot for all children with a task orientation and process skills goal a pre- and post treatment measure for the BRIEF parents and teachers was available for analysis. The number of children taken into account for analysis are stated behind the outcome measure.

^cNot for every child with a writing skills goal a pre- and post treatment measure of the SOS-2-NL was available for analysis. The number of children taken into account for analysis are stated behind the outcome measure.

Only outcomes for children who had set the specific goals mentioned in the table and who completed the outcome measures both at baseline and at end of treatment are reported in this table. The corresponding number of children having set a specific goal is shown behind each treatment goal.

An effect size (Effect Size (ES) and Standardized Response Mean (SRM)) of >0.2 is considered a small effect, >0.5 a moderate effect and >0.8 a large effect.

Table 3. Correlations between outcome measures showing significant change over time in the functioning of children with DCD.

	MABC2		DCD daily			COPM		BRIEF Parents		BRIEF Teachers		TACQOL
Kendall’s Tau	Total	Ball skills	Total	Quality	Speed	Satisfaction	Performance	Global	Metacognition	Global	Metacognition	Daily functioning	Cognitive functioning
MABC-2
Total	1.00
Ball skills	0.44	1.00
	(p0.000)
DCDdaily
Total	−0.50	−0.26	1.00
	(p0.000)	(p0.06)
Quality	−0.42	−0.25	0.72	1.00
	(p0.003)	(p0.09)	(p0.000)
Time	−0.56	−0.31	0.78	0.48	1.00
	(p0.000)	(p0.03)	(p0.000)	(p0.001)
COPM
Satisfaction	0.17	0.03	−0.26	−0.28	−0.29	1.00
	(p0.16)	(p0.78)	(p0.07)	(p0.06)	(p0.05)
Performance	0.006	−0.04	−0.11	−0.22	−0.06	0.49	1.00
	(p0.96)	(p0.74)	(p0.47)	(p0.13)	(p0.67)	(p < 0.001)
BRIEF Parents
Global executive composite score	0.13	0.03	−0.08	−0.03	−0.17	0.05	−0.05	1.00
	(p0.29)	(p0.80)	(p0.60)	(p0.86)	(p0.25)	(p0.67)	(p0.66)
Metacognition	0.09	0.03	−0.04	−0.04	−0.12	0.11	0.05	0.76	1.00
	(p0.43)	(p0.80)	(p0.79)	(p0.81)	(p0.42)	(p0.37)	(p0.66)	(p < 0.001)
BRIEF Teachers
Global executive composite score	−0.05	0.09	0.11	−0.02	0.19	0.09	0.10	0.07	0.11	1.00
	(p0.66)	(p0.47)	(p0.45)	(p0.89)	(p0.20)	(p0.45)	(p0.42)	(p0.53)	(p0.35)
Metacognition	−0.16	0.05	0.15	0.04	0.26	0.06	0.05	0.01	0.07	0.75	1.00
	(p0.19)	(p0.69)	(p0.31)	(p0.77)	(p0.08)	(p0.63)	(p0.69)	(p.096)	(p0.56)	(p < 0.001)
TACQOL
Daily functioning	0.06	−0.05	−0.20	−0.25	−0.15	0.15	0.17	−0.04	0.03	−0.10	0.02	1.00
	(p0.62)	(p071)	(p0.20)	(p0.10)	(p0.32)	(p0.23)	(p0.18)	(p0.77)	(p0.78)	(p0.77)	(p0.82)
Cognitive functioning	−0.07	0.03	0.22	0.10	0.43	−0.09	−0.16	−0.10	−0.01	0.09	0.22	0.13	1.00
	(p0.56)	(p0.82)	(p0.82)	(p0.54)	(p0.007)	(p0.49)	(p0.23)	(p0.42)	(p0.99)	(p0.25)	(p0.08)	(p0.30)

MABC-2: Movement Assessment Battery Children 2; COPM: Canadian Occupational Performance Measure; BRIEF: Behavior Rating Inventory of Executive Functioning; TACQOL: TNO-AZL Questionnaire for Children’s Health-Related Quality of Life.