Psychometric properties of clinician-reported and performance-based outcomes cited in a scoping review on spinal manipulation and mobilization for pediatric populations with diverse medical conditions: a systematic review

Figures & data

Figure 1. Clinical outcome assessment (COA) categories that were identified by a scoping review on spinal manipulation and mobilisation in paediatric populations [2]. Clinician-reported and performance-based outcome assessments were the focus of this report. All listed outcomes were included in our search however the bolded ones were those identified in the literature to have psychometric properties for paediatric populations.

Table 1. Characteristics of included studies.

Author (Year)	Country of Publication	Outcome Measure	Disorder Studied	Professional	Age Range	Sex Ratio (Male : Female)	n	Psychometric Addressed
Aimsamrarn et al. [12]	Thailand	AIMS	Healthy participants	Physiotherapist	1 to 18 months	22:08	30	Reliability, Validity
Albuquerque et al. [13]	Brazil	AIMS	Pre-term infants	NR	3 to 16 months (corrected age)	57:51	108	Reliability, Validity
Almeida et al. [14]	Brazil	AIMS	Healthy premature infants	Physiotherapist	0 to 18 months	25:21	88	Reliability, Validity
Bartlett and Fanning [15]	Canada	AIMS	Pre-term infants	Physiotherapist	8 months (corrected age)	28:32	60	Reliability, Validity
Blanchard et al. [16]	United States	AIMS	Healthy participants	Physiotherapist	0 to 12 months	NR	14	Reliability
Boonzaaijer et al. [17]	Netherlands	AIMS	Healthy participants	Physiotherapist	16 to 54 weeks	24:24	48	Reliability, Validity
Campbell and Kolobe [18]	United States	AIMS	Healthy participants and infants at risk for developmental disability	NR	9 to 18 weeks	47:43	90	Validity
Campbell et al. [19]	United States	AIMS	Healthy and preterm participants.	Physiotherapist	<12 months	52:44	96	Validity
Campos et al. [20]	Brazil	AIMS	Healthy participants	NR	37 to 41 weeks gestation	NR	43	Validity
Chiquetti et al. [21]	Brazil	AIMS	Healthy participants	NR	17 weeks (corrected age)	349:301	650	Validity
Darrah [22]	Canada	AIMS	At risk infants developmental delay	Physiotherapist	4 to 18 months	65:60	125	Validity
Darrah et al. [23]	Canada	AIMS	Healthy participants	Physiotherapist	4 to 8 months	87:77	164	Validity
Darrah et al. [24]	Canada	AIMS	Healthy participants	Physiotherapist	2 weeks to 18 months	20:25	45	Reliability
Darrah et al. [25]	Canada	AIMS	Healthy and preterm participants.	Physiotherapist	2 weeks to 18 months	338:312	650	Validity
Dumas et al. [26]	United States	AIMS	Chronically ill infants	Physiotherapist	3 to 450 days	26:27	53	Validity
Fauls et al. [27]	Australia	AIMs	Children requiring physiotherapy	Physiotherapist	0 to 5 years	50:34	84	Validity
Fetters and Tronick [28]	United States	AIMS	Healthy participants	Physiotherapist	4 to 15 months	16:23	39	Validity
Fleuren et al. [29]	Netherlands	AIMS	Healthy participants	Physiotherapist	0 to 12 months	63:37	118	Reliability Validity
Ga and Kwon [30]	Korea	AIMS	Healthy participants	Physiotherapist	4 to 60 months	119:107	226	Reliability Validity
Harris et al. [31]	Canada	AIMS	At risk and healthy infants	Physiotherapist	4 to 6.5 months	73:71	At risk: 86 Typical: 58 Total: 114	Validity
Heineman et al. [32]	Netherlands	AIMS	NICU infants	Medical Doctor	4 to 18 months	49:31	80	Validity
Heineman et al. [33]	Netherlands	AIMS	Pre-term Infants	NR	25 to 43 weeks gestation	34:25	205	Validity
Hoskens et al. [34]	Belgium	AIMS	Healthy participants	Physiotherapist	19 days to 18 months	62:60	122	Validity
Jeng et al. [35]	Taiwan	AIMS	Pre-term infants	Physiotherapist	24 to 36 weeks	Reliability: 27:18 Validity: 21:20	45 41	Reliability Validity
Krosschell et al. [36]	United States	AIMS	Muscular dystrophy	Physiotherapist	NR	NR	23	Reliability
Lackovic et al. [37]	Serbia	AIMS	Healthy participants	Medical Doctor	0 to 14 months	34:26	60	Reliability
Lefebvre et al. [38]	Canada	AIMS	Pre-term infants	Physiotherapist	26.3 weeks (SD 1.4)	91:69	160	Validity
Morales-Monforte et al. [39]	Spain	AIMS	At risk infants developmental delay	Physiotherapist	24 to 41 weeks gestation	27:23	50	Reliability, Validity
Pai-Jun and Campbell [40]	United States	AIMS	Healthy participants.	Physiotherapist	3 to 12 months	NR	97	Validity
Pin et al. [41]	Australia	AIMS	Pre-term infants	Physiotherapist	<18 months	NR	62	Reliability
Pin et al. [42]	Hong Kong	AIMS	Pre-term infants	Physiotherapist	4 to 12 months	15:16	31	Validity
Piper et al. [43]	Canada	AIMS	Healthy participants	Physiotherapist	0 to 18 months	285:221	221 291 Total: 506	Reliability, Validity
Rizzi et al. [44]	Italy	AIMS	Neurologically compromised infants	NR	0 to 18 months	46:40	86	Validity
Saccani and Valentini [45],	Brazil	AIMS	Healthy participants	NR	0 to 18 months	407:378	795	Validity
Quezada-Villalobos et al. [46]	Chile	AIMS	Preterm and term infants at risk motor control problems	NR	10 to 16 months	Full term: 48:47 Preterm: 10:10	115	Reliability
Siegle and de Sá [47]	Brazil	AIMS	Babies exposed to HIV	NR	0 to 18 months	42:33	75	Validity
Silva et al. [48]	Brazil	AIMS	Healthy participants	Nurse	123 to 196 days	26:24	50	Reliability
Snyder et al. [90]	United States	AIMS	At risk infants developmental delay	Physiotherapist	2 months, 19 days to 16 months, 23 days	16:19	35	Reliability, Validity
Spittle et al. [49]	Australia	AlMS	Preterm infants	Osteopath	<1 year	47:40	87	Validity
Suir et al. [50]	Netherlands	AIMS	Healthy participants	Physiotherapist	2 weeks to 19 months	263:236	499	Reliability Validity
Syrengelas et al. [51]	Greece	AIMS	Full term and preterm infants	NR	1 to 19 months	Preterm 251:152 Full-term 584:454	Preterm: 403 Full-term: 1038 Total: 1441	Validity
Syrengelas et al. [52]	Greece	AIMS	Healthy participants	Physiotherapist	7 d to 18 months	250:174	424	Reliability, Validity
Tse et al. [53]	Canada	AIMS	Healthy and at-risk infants	Other person employed in childcare, early intervention, and health care	4 to 6.5 months	60:61	At risk: 72 Typical:49 Total: 121	Reliability, Validity
Tupsila et al. [54]	Thailand	AIMS	Healthy participants	Physiotherapist	0 to 14 months	314:260	574	Validity
Valentini and Saccani [55]	Brazil	AIMS	Healthy participants	Physiotherapist	0 to 18 months	291:270	561	Reliability Validity
Valentini and Saccani [56]	Brazil	AIMS	Healthy participants	Physiotherapist	1 to 18 months	394:372	766	Reliability, Validity
van Hus et al. [57]	Netherlands	AIMS	Healthy participants	Physiotherapist	<12 months	63:53	116	Validity
van Schie et al. [58]	Netherlands	AIMS	Healthy Participants	Physiotherapist	0 to 2 years	20:12	32	Validity
Wang et al. [59]	China	AIMS	Developmental delay	Physiotherapist	0 to 9 months	29:21	50	Reliability, Validity
Yeh et al. [60]	Taiwan	AIMS	Healthy participants	Physiotherapist	25 to 39 weeks	18:11	29	Validity
Adams and Hewell [61]	United States	LATCH	Healthy breastfed infants and their mothers	Lactation Consultant	Mothers: 20 to 29 years Infants: NR	NR	35 dyads	Reliability
Altuntas et al. [62]	Turkey	LATCH	Healthy participants	NR	NR	NR	46 feeds	Reliability, Validity
Báez León et al. [91]	Spain	LATCH	Breastfeeding, healthy participants	Nurse	Mothers: 32 years; Infants: 37 to 41 weeks gestation	NR	20 dyads	Reliability
Chapman et al. [63]	United States	LATCH	Healthy infants, obese/overweight mothers	Medical Doctor	Mother: 29 years (SD 5.5) Infant: 39.3 weeks (SD 1.2)	NR	45 dyads	Reliability
DaConceição et al. [64]	Brazil	LATCH	Healthy participants	Lactation Consultant	Mothers: 34 year Infant: 39 weeks	Infant: 88:72	160 dyads	Validity
DaConceição et al. [65]	Brazil	LATCH	Healthy participants	Lactation Consultant	NR	NR	160 dyads	Reliability, Validity
Dolgun et al. [66]	Turkey	LATCH	Healthy infants and their mothers	Mother/ translator	Mothers: 19 to 45 years Infants: < 6 months	Infant: 66:61	127 dyads	Reliability, Validity
Kumar et al. [67]	United States	LATCH	Breastfeeding healthy participants	Lactation Consultant	Neonate/Infant: 1 day to 6 weeks	Infant: 134:114	250 dyads	Validity
Lau et al. [68]	Singapore	LATCH	Healthy participants	Trained Research Assistant	Neonate: 48 to 72 hours	Infant: 477:430	907 dyads	Reliability, Validity
Riordan and Koehn [69]	United States	LATCH	Healthy participants	Nurse	infant: full gestation/40 weeks	NR	28 feeds, 13 dyads	Reliability
Adam et al. [70]	Australia	Cobb Angle	Scoliosis	Medical Doctor	NR	NR	12	Reliability
Al-Bashir et al. [71]	India, Jordan, United States	Cobb Angle	Scoliosis	Medical Doctor	10 to 18 years	14:14	28	Validity
Allen et al. [72]	Canada	Cobb Angle	Adolescent idiopathic scoliosis	Medical Doctor	NR	NR	22	Reliability,Validity
Brink [73]	Netherlands	Cobb Angle	Idiopathic scoliosis	Medical Doctor	10 to 17 years	10:90	33	Reliability
De Carvalho et al. [74]	France	Cobb Angle	Scoliosis	Medical Doctor	NR	NR	20	Reliability, Validity
Gstoettner et al. [75]	Austria	Cobb Angle	Scoliosis	Medical Doctor	NR	NR	48	Reliability
Kumar et al. [76]	India	Cobb Angle	Adolescent idiopathic scoliosis	Medical Doctor	NR (adolescents implied)	NR	20	Reliability
Livanelioglu et al. [77]	Turkey	Cobb Angle	Scoliosis	Physiotherapist	9 to 18 years	9:42	51	Reliability, Validity
Loder et al. [78]	United States	Cobb Angle	Scoliosis	Medical Doctor	<10 years	17:47	64	Reliability
Marchetti et al. [79]	Brazil	Cobb Angle	Scoliosis	Medical Doctor	5 to 18 years	42:48	90	Reliability, Validity
Mehta et al. [80]	Korea	Cobb Angle	Scoliosis	Medical Doctor	<7 to > 10 years	NR	318	Reliability
Pruijs et al. [81]	Netherlands	Cobb Angle	Scoliosis	Medical Doctor	8.1 to 21.2 years	6:35	41	Reliability, Validity
Safari et al. [82]	Iran	Cobb Angle	Scoliosis	NR	4 to 40 years	NR	14	Reliability
Stokes and Aronsson [83]	United States	Cobb Angle	Scoliosis	Medical Doctor	NR	NR	27	Reliability
Xiaohua et al. [84]	United States	Cobb Angle	Scoliosis	Chiropractor	NR	NR	20	Reliability
Watson and Mac Donncha [85]	Ireland	Posture Assessment	Healthy participants	NR	15 to 17 years	114:00	114	Reliability

Key: AIMS = Alberta Infant Motor Scale; LATCH = Latch, Key: Audible Swallow, Type of Nipple, Comfort, Hold; HIV = human immunodeficiency virus; NICU = neonatal intensive care unit; SD = standard deviation; NR = not reported; n = sample size, dyad = mother and infant pair.

Table 2. Population per outcome measure.

Outcome Measure	Age of Population Studied	Medical Condition
AIMS	0–5 years old (51 studies 10,215 participants)	Neurologically compromised (145 participants) At risk (undefined) (582 participants) Preterm (<38 weeks’ gestation) (1437 participants) Chronically ill (107 participants) Exposed to human immunodeficiency virus (HIV, 75 participants) Typical (7869 participants).
LATCH	Neonates, Infants and mothers (10 studies, 1717 paired participants, 46 undetermined feeds)	Healthy infants
Cobb Angle	Children/Adolescents (15 studies, 808 participants)	Idiopathic adolescent scoliosis
Postural Assessment	Adolescents (1 study, 114 participants)	Healthy participants

Key: AIMS = Alberta Infant Motor Scale; LATCH = Latch, Audible Swallow, Type of Nipple, Comfort, Hold; HIV = human immunodeficiency virus.

Table 3. Summary of findings for each COA included 1) criteria rating for good measurement property (sufficient (+), insufficient (-), inconsistent (±), indeterminate (?); see gray highlighted ROW) for each measurement property (content validity, structural validity, internal consistency, reliability, measurement error, hypothesis testing for construct validity, cross-cultural validity, criterion validity, and responsiveness), 2) overall rating across measurement properties for each COA (sufficient (+), insufficient (–), or indeterminate (?); see gray highlight COLUMN), and 3) certainty of evidence (GRADE). Note that the author(s) with risk of bias score by psychometric property were rated as very good (VG), adequate (A), doubtful (D), or inadequate (I) (i.e. Allen 208 (D)).

COA	Content Validity Structural Validity	Reliability	Validity (Construct, Cross-cultural, Criterion)
Criteria Rating	Internal Consistency	Measurement Error	Responsiveness	Overall Rating across Measurement Properties	Certainty of Evidence (GRADE)
AIMS	Content Validity: -Relevance founded on functional sequences in early motor development. Piper (1992)^¶ (A); -Pertinence: (k) = 0.82 to 0.93 (1 study, n = 766) Valentini (2012) (D) -Comprehensiveness 84-items reduced to 56-items by 291 PTs and 6 international experts. Piper (1992)^¶ (A) -Comprehensibility feasibility tested(1 study, n = 291 PT and 6 experts) Piper (1992)^¶ (A) - PROM item’s assessed and appropriately worded: assessed clarity k = 0.51 to 0.87 (1 study, n = 766) Valentini (2012) (D) Structural Validity: Rasch Analysis = 51.05 (SD 8.28) (1 study, n = 97) Pai-jun (2004) (D) Internal Consistency: α = 0.88 to 0.99, (4 studies, n = 1437), Lackovic (2020) (I), Morales-Monforte (2017) (VG), Valentini (2011) (VG), Valentini (2012) (VG)	Test-retest: α = 0.85 to 0.998 (4 study, n = 1525)Lackovic (2020) (I), Valentini (2012) (VG), Piper (1992) (A), Valentini (2011) (D) Intra-rater: ICC = 0.55 to 0.99, (8 studies, n = 1720) Aimsamrarn (2019) (I)Albuquerque (2018) (VG), Boonzaaijer (2017) (VG), Jeng (2000) (A), Morales-Monforte (2017) (D), Pin (2010) (VG), Silva (2013) (VG), Valentini (2011) (D), Valentini (2021) (VG) Inter-rater: ICC = 0.55 to 0.99, (23 studies, n = 2962) Aimsamrarn (2019) (I), Albuquerque (2018) (VG), Almeida (2008) (VG), Bartlett (2003) (D), Blanchard (2004) (D), Boonzaaijer (2017) (VG), Darrah (1996) (VG), Darrah (1998b) (D), Fleuren (2007) (A), Jeng (2000) (A), Krosschell (2018) (VG), Ga (2011) (I), Lackovic (2020) (I), Morales-Monforte (2017) (D), Pin (2010) VG, Piper (1992) (A), Quezada-Villalobos (2010) (VG), Snyder (2008) (VG), Suir (2019) (I) Syrengelas (2010) (A), Tse (2008) (I), Valentini (2011) (D), Wang (2018) (VG) Measurement error:- SEM = 0.92 to 0.96 (1 study, n = 48) Boonzaaijer 2017 (VG) - SEM varied by age (1 study, n = 45) Jeng 2000 (A) - SDC NR - LoA NR	Construct Validity: -Comparison of ASQ-3-GM rs = 0.697 (1 study, n = 37) Fauls (2020) (VG) -Comparison to BSID or BSID-II or BSID-III or BSITD had varied results rs = 0.36 to 0.969(10 studies, n = 879) Aimsamrarn (2019) (D), Almeida (2008) (VG), Campos (2006) (I), Darrah (1996) (VG), Harris (2010) (VG), Hoskens (2018) (D), Jeng (2000) (VG), Morales-Monforte (2017) (VG), Piper (1992) (A), Siegle (2018) (A) -Comparison with CBDS classification rs = 0.34 (1 study, n = 766) Valentini (2012) (VG) -Comparison with DSCB k = 0.309 (1 study, n = 561) Valentini (2011) (I) -Consistency of GMA results between the home and clinic recorded videos k = 0.869 (1 study, n = 29) Yeh (2020) (VG) -Comparison to HINTat 4 to 6 months rs = 0.831 or 10 to 12.5 months, rs = - 0.84 (1 study, n = 121) Tse (208) (VG) -Comparison to PDGMS or PDGMS-2 rs = 0.72 to 0.97 or ICC > 0.90 (4 studies, n = 287) Piper (1992) (A), Snyder (2008) (VG), van Hus (2013) (I), Wang (2018) (VG)	(+) sufficient	High ⊕⊕⊕⊕
			-Comparison to TIMP or IMP rs = 0.64 to 0.91 or rs = 0.37 to 0.54 through the various ages (5 study, n = 1111) Campbell (2000) (VG), Chiquetti (2020) (D), Heineman (2013) (VG), Heineman (2013) (VG), Rizzi (2021) (VG) -Comparison to TIMP at 30, 60 and 90 days: ICC = 0.20 to 0.67 (1 study, n = 96) Campbell (2002) (VG) -Comparison of the PEDI-CAT: rs = 0.32 (1 study, n = 53) Dumas (2015) (A) -Comparison sub-items at varied ages and positions significant differences identified (1 study, n = 31) Pin (2020) (A) -Comparison premature vs other age categories p < 0.0001 (1 study, n = 1441)Syrengelas (2016) (A) -Comparison of original and contemporary norms: ICC = 0.99 (1 study, n = 650) Darrah (2014) (VG) Cross-cultural Validity: -Significantly more Dutch children score below the cut off scores (1 study, n = 118) Fleuren (2007) (VG) -Comparison of Brazilian and Canadian norms: t-test: < 2.614 -Comparison of Greece and Canadian norms: no significant difference -Comparison of Thai score and Canadian norms: significantly higher (3 study, n = 2110) Saccani (2012) (A), Syrengelas (2010) (I), Tupsila (2020) (VG)
			Criterion Validity: -Predictive validity -10^th percentile cut-off had varied results Sensitivity 75.8%, Specificity 92.9% (4 study, n = 642) Albuquerque (2018) (I), Darrah (1998) (VG), Ga (2022) (VG), Harris (2020) (VG) -Abnormal vs suspicious: 8^th month: varied results, Sensitivity 100%, Specificity 90.8% (2 study, n = 125+164) Darrah (1996) (VG), Darrah (1998) (VG) -High false positive rate at 4 month, improved at 7 months (1 study, n = 39) Fetters (2000) (D) -Predict BSID of various levels <85; <70 at 4 months or 10 to 12 months (see 7) (1 study, n = 160) Lefebvre (2016) (VG) -Predict DSCB ICC = 0,96 (1 study, n = 561) Valentini (2011) (I) -Predict IMPAUC = 0.85 (1 study, n = 86) Rizzi (2021) (VG) -Predict MAABC-2 scores or NSMDA at 4 or 12 months: Accuracy 80 to 92% (1 study, n = 87), Spittle (2015) (VG) -Predicting motor and mental outcome after perinatal hypoxicischaemic encephalopathy Sensitivity 100%, Specificity 80%, van Schie (2010) (D) -Predictive power limited to group of infants aged 3 months vs 9 months p < 0.001 (1 study, n = 766) Valentini (2012) (VG) -Concurrent validity-3 subgroups different F = 11.03, df 59, p < 0.001 (1 study, n = 60)Bartlett (2003) (VG) -Comparison live and home video ICC = 0.99 (1 study, n = 48) Boonzaaijer (2017) (VG) Responsiveness: SDC N R; MIC N R; ROC NR
Criteria Rating	+|+|+	+|+	+|+|+|?
LATCH	Content Validity: NR Structural Validity: Exploratory Factor Analysis resulted in removal of C (Comfort), Confirmatory Factor Analysis 4-items GFI 0.994 to 0.995 (1 study, n = 907) Lau (2016) (VG) Internal Consistency: 5-item α = 0.25 to 0.70, 4-item α = 0.74 (2 studies, n = 1067) Da Conceicao (2017) (D), Lau (2016) (VG)	Inter-rater: ICC = 0.79 to 0.96, (7 studies, n = 484) Adams (1997) (D), Altuntas (2014) (D), Baez Leon (2008) (VG), Chapman (2016) (A), Da Conceicao (2017) (A), Da Conceicao (2018) (A), Riordan (1997) (VG) Test-retest: NR Measurement error: SEM NR; SDC NR; LoA NR	Construct Validity: -Comparison on Infant Breast-Feeding Assessment Tool rs = 0.69 to 0.71, (2 studies, n = 74) Altuntas (2014) (A), Riordan (1997) (D) -Mother-Baby Assessment rs = 0.88, (2 studies, n = 74) Altuntas (2014) (A), Riordan (1997) (D) -Bristol Breast-feeding Assessment Tool rs = 0.76, (1 study, n = 127), Dolgun (2018) (VG) Cross-cultural Validity: Forward and back translation to Portuguese CVI >0.90 (60%)(1 study, n = 160) Da Conceicao (2018) (I) Criterion Validity: -Predictive -9 or higher during 16 to 24 hours period after birth: Sensitivity 75%, Specificity 63% (1 study, n = 250) Kumar (2006) (VG) -Predicting exclusive or nonexclusive breast-feeding success: 4 items: (cut off 3.5 and 5.5): Sensitivity 94 to 95%, Specificity 0 to 2%, Likelihood Ratio = 0.96, ROC analysis confirmed high sensitivity (1 study, n = 907) Lau (2016) (VG) Responsiveness: SDC NR; MIC NR; ROC NR	(+) sufficient	MODERATE ⊕⊕⊕⊝ downgraded due to imprecision (-1: total 10 studies, n < 100; no meta-analysis)
CriteriaRating	?|+|+	+|?	+|-|+|?
Cobb Angle	Content Validity: NA Structural Validity: NA Internal Consistency: NA	Intra-rater: ICC = 0.92 to 0.97, or rs = 0.980 (10 studies, n = 654) Adam (2005) (I), Allen (2008) (D), Brink (2018) (D), DeCarvalho (2007) (D), Gstoettner (2007) (A), Kumar (2009) (A), Lodar (2004) (I), Marchetti (2017) (I), Mehta (2009) (D), Stokes (2006) (I) Inter-rater: ICC = 0.75 to 0.96, or rs = 0.986 (11 studies, n = 713) Allen (2008) (D), Brink (2018) (D), DeCarvalho (2007) (D), Gstoettner (2007) (A), Kumar (2009) (A), Livanelioglu (2016) (A), Lodar (2004) (I), Marchetti (2017) (A), Mehta (2009) (D), Stokes (2006) (I), Xiaohua (2013) (D) Test-retest: NA Measurement error:- SEM 40 degrees of freedom(1 study, n = 41) Pruijs 1995 (I) - SEM 4.8 degrees thoracic and SEM 3.8 degrees lumbar (1 study, n = 90) Marchetti (2017) (A) - MDC thoracic spine 9.3 degrees and MDC lumbar spine 7.5 degrees (1 study, n = 90) Marchetti (2017) (A) - LoA NR	Construct Validity: -Comparison manual and automated ICC = 0.30 -Comparison manual and semiautomated (outliers removed) ICC = 0.70 (1 study, n = 22) Allen (2008) (D) -Comparison manual and computer algorithm rs = 0.80 (1 study, n = 28) Al-Bashir (2019) (VG) -Comparison between small films and plain-films measurements ICC = 0.95 (1 study, n = 20) De Carvalho (2007) (I) -Comparison of Cobb1 to smart mouse1 or smart mouse2: rs = 0.93 and 0.87 (1 study, n = 51) Livanelioglu (2016) (VG) -Compared to measuring apex angle and linear measurements: Thoracic spine: rs = 0.79 (1 study, n = 90) Marchetti (2017) (D) -“New” semi-automated method compared to gold standard difference in mean was 4 degrees (1 study, n = 14) Safari (2019) (I) Cross-cultural Validity: NA Criterion Validity: NA Responsiveness: SDC NR; MIC NR; ROC NR	(?) indeterminate	LOW ⊕⊝⊝⊝downgraded due to limitation in inconsistency (-1: numerous studies are rated doubtful or inadequate in study design); indirectness (-1: about 20% of population was between 18 to 40 years of age)
Criteria Rating	NA|NA|NA	+|+	+|NA|NA|?
Postural Assess-ment	Content Validity: NR Structural Validity: NA Internal Consistency: NA	Intra-rater:10-items for Bland and Altman agreement 86.6 to 100%, (1 study, n = 114)Watson (2000) (I) Inter-rater:10-items for Bland and Altman agreement 93.3 to 100%, (1 study, n = 114)Watson (2000) (I) Measurement error: SEM NR; SDC NR; LoA NR	Construct Validity: NR Cross-cultural Validity: NR Criterion Validity: NR Responsiveness:- SDC NR; MIC NR; ROC NR	(?) indeterminate	VERY LOW ⊝⊝⊝⊝ downgraded due to limitation in risk of bias (-2: COSMIN score= inadequate, only agreement was assessed; poor statistical analysis) indirectness (-1: biased population) imprecision (-1: one study with sample size n = 114)
CriteriaRating	?|NA|NA	?|?	?|?|?|?

Key: ¶ Piper and Darrah 1994 (text book) detail theories of motor development and construction of a Motor Assessment Tool for the Developing Infant. COA = clinical outcome assessment; Criteria Rating: “+” = sufficient, “−” = insufficient, “?” = indeterminate, consistent with criteria defined in Table 1 from [88]AIMS = Alberta Infant Motor Scale; BSID = Bayley Score of Infant Development; CBDS = Child Behavior Development Scale; CVI = Content Validity Index; DSCB = Development Scale of Child Behaviour; GFI = Goodness of Fit Index; GMA = General Movement Assessment; LATCH = “L” identifies how well the infant latches onto the breast. “A” identifies the amount of audible swallowing noted. “T” identifies the mother’s nipple type. “C” identifies the mother’s level of comfort. “H” indicates the amount of help the mother needs to hold her infant to the breast; LoA = Limits of Agreement; MIC = Minimal important change; α = Cronbach’s alpha; ρ = Pearson’s correlation coefficient; r_s = Spearman’s ranked correlation coefficient (rho); ICC = interclass correlation coefficient; k = Cohen’s kappa; MABC-2 = Movement Assessment Battery for Children 2 Edition; n = sample size; NSMDA = Neuro-Sensory Motor Development Assessment; NA = not applicable; NR = not reported; PDGMS = Peabody Development Gross Motor Scale; PEDI-CAT = Pediatric Evaluation of Disability Inventory Computer Adaptive Test; ROC = receiver operation curve; SDC = smallest detectable change; SEM = standard error of measurement; TIMP = Test of Infant Motor Performance.

Table 4. Summary of results for Alberta Infant motor Scale (AIMS).

Author (year)	Country of Origin	n	Psychometric	COSMIN Score RoB	Results
Aimsamrarn et al. [12]	Thailand	30	Reliability (Intra-rater)	I	Assessor 1 ICC = 0.99 (95% CI: 0.98 to 0.99)
				I	Assessor 2 ICC = 0.98 (95% CI: 0.92 to 0.99)
			Reliability (Inter-rater)	I	ICC = 0.98 (95% CI: 0.98 to 0.99)
		30	Construct Validity	D	With comparison to the BSID – II ρ = 0.969, P < 0.01
Albuquerque et al. [13]	Brazil	108	Reliability (Intra-rater)	VG	ICC = 0.99 (95% CI 0.98 to 1.00)
			Reliability (Inter-rater)	VG	ICC = 0.99 (95% CI 0.99 to 1.00)
			Predictive Validity	I	R^2 = 0.93, R^2 = 0.92 after ceiling effect considered.
					5^th percentile cut-off: Sensitivity 51.5%, Specificity 98.4%, Positive Predictive Value 889.5%, Negative Predictive Value 88.6%
					10^th percentile cut-off: Sensitivity 75.8% Specificity 92.9%, Positive Predictive Value 73.5%, Negative Predictive Value 93.6%
Almeida et al. [14]	Brazil	88	Reliability (Inter-rater)	VG	ICC = 0.99
			Construct Validity	VG	When compared to BSID: Total population: rs = 0.95, R^2 = 0.90
					6m: rs = 0.74, R^2 = 0.55
					12m rs = 0.89, R^2 = 0.79
Bartlett and Fanning [15],	Canada	7	Reliability (Inter-rater)	D	ICC = 0.95 (95% CI: 0.73 to 0.99)
		5		D	ICC = 0.98 (95% CI: 0.87 to 0.99)
		60	Criterion Validity	VG	total and subscale score for three subgroups were significantly different (F = 11.03, df 59, P<0.001) subgroups were normal, suspect, and abnormal.
Blanchard et al. [16]	USA	14	Reliability (Inter-rater)	D	total score: ICC = 0.98 to 0.99
Boonzaaijer et al. [17]	Netherlands	48	Reliability(Inter-rater) Measurement Error	VG	ICC = 0.99, SEM = 0.92
			Reliability (Intra-rater) Measurement Error	VG	ICC = 0.99, SEM = 0.96
			Concurrent Validity	VG	Comparison between live and home video: ICC = 0.99 (95% CI 0.89 to 0.99) SEM = 1.41 (95% CI: 1.63 to 0.80)
Campbell and Kolobe [18],	United States	90	Construct Validity	VG	Comparison with TIMP: Raw scores: rs = 0.64 (p < 0.0001)
					percentiles: rs = 0.60 (p < 0.0001)
Campbell et al. [19]	USA	96	Construct Validity	VG	With comparison to TIMP: ICC = 0.20 to 0.67 p < 0.001
Campos et al. [20]	Brazil	43	Construct Validity	I	With comparison to BSID – II: 5^th percentile cut-off: Sensitivity 100%, Specificity 78.37%, k = 0.5
					10^th percentile cut-off: Sensitivity 100%, Specificity 48.64%, k = 0.2
Chiquetti et al. [21]	Brazil	650	Construct Validity	D	Weak to moderate correlation with TIMP t = 0.24
Darrah [22]	Canada	12	Reliability (Inter-rater)	VG	Total score: ICC = 0.98
		125	Predictive Validity	VG	Abnormal vs suspicious: 4^th month: Sensitivity 87.5%, Specificity 78.0%, Positive Predictive Value 36.8%, Negative Predictive Value 97.7%, 8^th month: Sensitivity 100%, Specificity 90.8%, Positive Predictive Value 61.5%, Negative Predictive Value 100%
			Construct Validity	VG	Comparison with BSID II 4^th month: ICC = 0.42, 8^th month: ICC = 0.5
Darrah et al. [23]	Canada	164	Predictive Validity	VG	Abnormal vs Normal/Suspicious: 4^th month (10^th percentile cut-off): Sensitivity 77.3%, Specificity 81.7%, Positive Predictive Value 39.5%, Negative Predictive Value 95.8%
					8^th month (5^th percentile cut-off): Sensitivity 86.4%, Specificity 93%, Positive Predictive Value 65.5%, Negative Predictive Value 97.8%
					Abnormal/Suspicious vs Normal 4^th month (10^th percentile cut-off): Sensitivity 58.3%, Specificity 82.8%, Positive Predictive Value 48.8%, Negative Predictive Value 87.6%
					8^th month (5^th percentile cut-off): Sensitivity 63.9%, Specificity 95.3%, Positive Predictive Value 79.3%, Negative Predictive Value 90.4%
Darrah et al. [24]	Canada	45	Reliability (Inter-rater)	D	ICC > 0.99
Darrah et al. [25]	Canada	650	Construct Validity	VG	Comparison of original and contemporary norms: ICC = 0.99
Dumas et al. [26]	United States	53	Construct Validity	A	Comparison of the PEDI = CAT: rs = 0.32 P = 0.02 (fair association)
Fauls et al. [27]	Australia	37	Construct Validity	VG	Comparison of ASQ-3-GM rs = 0.697
Fetters and Tronick [28],	United States	39	Construct Validity	D	High false positives at 4 months. Improved specificity/sensitivity at 7 months
Fleuren et al. [29]	Netherlands	118	Reliability (Inter-rater)	A	total score: rs = 0.99
			Cultural Validity	VG	significantly more Dutch children score below the cut off scores of 10% (29% of Dutch children) and 5% (17% of Dutch children)
Ga and Kwon [30]	Korea	226	Reliability (Inter-rater)	I	97.7% between three testers
		226	Construct Validity	VG	Sensitivity of Korean ASQ-3-GM 76.3 to 90.2% when compared to less than 10^th percentile cut off of AIMS
Harris et al. [31]	Canada	144	Construct Validity	VG	Comparison of BSID – II: 4 to 6 months evaluation: rs = 0.36
					10 to 12 months evaluation: rs = 0.4
					2 to 3 years comparison: rs = 0.55
		144	Predictive Validity	VG	4 to 6.5 month (cut-off less than 5^th percentile): Sensitivity 12.3%, Specificity 94.3%, Positive Predictive Value 58.3%, Negative Predictive Value 62.1 %
Heineman et al. [32]	Netherlands	80	Construct Validity	VG	With comparison to IMP performance domain: Total score (corrected age) rs = 0.91 (95% CI 0.68 to 0.94)
					total score (raw scores) rs = 0.94, p < 0.005
Heineman et al. [33]	Netherlands	205	Construct Validity	VG	With comparison to IMP: Fair to moderate correlation (rs = 0.37 to 0.54 through the ages)
Hoskens et al. [34]	Belgium	122	Construct Validity	D	With comparison to BSID – III: rs = 0.59 to 0.98 (p < 0.001) overall rs = 0.98
Jeng et al. [35]	Taiwan	45	Reliability (Intra-rater)	A	0 to 3 months ICC = 0.85 to 0.98, SEM = 0.17 to 0.55 4 to 7 months ICC = 0.90 to 0.98, SEM = 0.32 to 1.24 >8 months ICC = 0.97 to 0.99, SEM = 0.01 to 0.73
			Reliability (Inter-rater)	A	0 to 3 months ICC = 0.73 to 0.97, SEM = 0.16 to 0.68 4 to 7 months ICC = 0.75 to 0.98, SEM = 0.4 to 1.24 >8 months ICC = 0.98 to 0.99 SEM = 0.01 to 0.59
		41	Construct Validity	VG	with comparison to BSID: 6 months rs = 0.78 12 months rs = 0.90 (p < 0.0001)
Krosschell et al. [36]	United States	23	Reliability (Inter-rater)	VG	2014 training: ICC = 0.95 (95% CI 0.76 to 1.00)
					2015 training: ICC = 0.98 (95% CI 0.93 to 1.00)
Lackovic et al. [37]	Serbia	60	Internal consistency	I	α 3 months = 0.93 to 0.941
					7 months = 0.997 to 0.998
					14 months = 0.996 to 0.998
			Reliability (Test – retest)	I	α = 0.940 to 0.998
			Reliability (Inter-rater)	I	total ICC = 0.75
Lefebvre et al. [38]	Canada	160	Predictive Validity	VG	Predictive Validity: 4 month AIMS ability to predict BSID < 85 Sensitivity 0.66% (95% CI 0.55 to 0.77), Specificity 0.53% (95% CI 0.45 to 0.64), Positive Predictive Value 0.55% (95% CI 0.45 to 0.65), Negative Predictive Value 0.65% (95% CI 0.54 to 0.76)
					BSID < 70: Sensitivity 0.78% (95% CI 0.61 to 0.95), Specificity 0.48% (95% CI 0.4 to 0.56), Positive Predictive Value 0.20% (95% CI 0.12 to 0.29), Negative Predictive Value 0.93% (95% CI 0.87 to 0.99)
					10 to 12 months AIMS
					BSID < 85 Sensitivity 0.44% (95% CI 0.32 to 0.57) Specificity 0.82% (95% CI 0.73 to 0.90), Positive Predictive Value 0.67% (95% CI 0.52 to 0.81), Negative Predictive Value 0.64% (95% CI 0.54 to 0.73)
					BSID < 70: Sensitivity 0.65% (95% CI 0.42 to 0.87), Specificity 0.75% (95% CI 0.67 to 0.82) Positive Predictive Value 0.26% (95% CI 0.13 to 0.39), Negative Predictive Value 0.94% (95% CI 0.89 to 0.97)
Pai-Jun and Campbell [40]	United States	97	Structural Validity	D	Rasch ability measure for infants: 51.05 (SD = 8.28) in non-extreme scoring infants. Infit mean square: 0.92 Outfit mean square: 0.63
Morales-Monforte et al. [39]	Spain	50	Reliability (Intra-rater)	D	ICC > 0.98
			Reliability (Inter-rater)	D	ICC = 0.98 (95% CI 0.82 to 1.00)
			Internal Consistency	VG	KR 20 scales: 0.88 to 0.99
			Construct Validity	VG	With comparison to BISD – III rs = 0 to 3 months 0.973, 4 to 8 months 0.693 9 to 18 months: 0.957
Pin et al. [41]	Australia	62	Reliability (Intra-rater)	VG	ICC = 0.99
			Reliability (Inter-rater)	VG	ICC = 0.85 to 0.97
Pin et al. [42]	Hong Kong	31	Construct Validity	A	Sub items: rs = 0.315 to 0.621 (3 areas with significant differences: 4 months supine, 12 months standing score and total score)
Piper et al. [43]	Canada	221	Reliability (Inter-rater)	A	rs = 0.996
		138 291 PT;6 International experts	Reliability (Test-retest) Content	A A	rs = 0.993 Relevance - stemmed from functional sequences and variations that occur in early motor development. Comprehensiveness − 84 items reviewed and rated by pediatric physiotherapists in Alberta and 291 members of the Paediatric Division of the Canadian Physiotherapy Association. 6 international experts to revise the 84 items to 59 items. Comprehensibility – tested for feasibility with 97 low risk normal infants; 15 minutes, no handling, minimal space, and equipment required.
		506	Construct Validity	A	when compared to BSID: rs = 0.98
				A	when compared to PDGMS: rs = 0.97
Quezada-Villalobos et al. [46]	Chile	115	Reliability (Inter-rater)	VG	Total score: ICC = 0.94 SEM of total = 3.1 points
Rizzi et al. [44]	Italy	86	Construct Validity	VG	With comparison to IMP: total rs = 0.076, Performance domain: rs = 0.89 (p < 0.001)
			Predictive Validity	VG	AUC = 0.85 (p < 0.001, 95% CI 0.77 to 0.94)
Saccani and Valentini [45]	Brazil	795	Cultural Validity	A	Comparison of Brazilian and Canadian norms: t-test: <± 2.614 (p < 0.0001)
				I	No significant differences between genders
Siegle and de Sá [47]	Brazil	75	Construct Validity	A	with comparison to BSITD 1 month: rs = 0.57 (95% CI 0.20 to 0.82), 2 months rs = 0.44 (95% CI 0.29 to 0.63), 3 months: rs = 0.03 (5% CI −0.43 to 0.48), 4 months: rs = 0.53 (95% CI 0.23 to 0.74) 4 months: rs = 0.53 (95% CI 0.23 to 0.74), 8 months: rs = 0.51 (95% CI 0.16 to 0.74), 12 months: rs = 0.59 (95% CI 0.32 to 0.78)
Silva et al. [48]	Brazil	50	Reliability (Intra-rater)	VG	ICC = 0.55 to 0.95 for categories (prone, supine, sitting and standing)
Snyder et al. [86]	United States	35	Reliability (Inter-rater)	VG	ICC = 0.98 (95% CI 0.96 to 0.99)
			Construct Validity	VG	Comparison of PDGMS-2 rs= 0.90 to 0.97
Spittle et al. [87]	Australia	87	Predictive Validity	VG	Accuracy for predicting motor impairment was good. Motor impairment on the MABC-2 (scores < or = 5^th and < or = 15^th) was most accurately predicted by the AIMS at 4 months, whereas cerebral palsy was most accurately predicted by the NSMDA at 12 months. Best accuracy was achieved when combining NSMDA and AIMS at 4 months as follows: MABC</= 15^th Accuracy 80 (95% CI 70, 88); MABC </= 5^th Accuracy 84 (95% CI 74, 91); Cerebral Palsy Accuracy 92 (95% CI 84 to 97).
Suir et al. [50]	Netherlands	499	Reliability (Inter-rater)	I	% agreement = 97.80%
			Cultural Validity	D	(Dutch) = 1.18 x (Canada), 7% proportion explained variance
Syrengelas et al. [52]	Greece	424	Reliability (Inter-rater)	D	ICC = 0.99 (95% CI 0.99 to 0.99)
			Cultural Validity	I	No significant difference with Canada norms x 2 to 3 months, no significant differences in the 5^th and 90^th percentile
Syrengelas et al. [51]	Greece	1441	Construct Validity	A	Total AIMS score significantly lower for premature infants (p < 0.0001) at each age category
					The rate of mean increase did not differ between premature and full-term infants.
Tse et al. [53]	Canada	121	Reliability (Inter-rater)	I	ICC = 0.72 to 0.98 for HINT and AIMS (not sub divided)
			Construct Validity	VG	With comparison to HINT 4 to 6.5m ρ = 0.831 (n = 121)
					10 to 12.5 months ρ = − 0.84 (n = 109)
Tupsila et al. [54]	Thailand	574	Cultural Validity	VG	Thai scores lower for 01, 1–2, 2–3 and 3–4 months, with a moderate to large effect size, from 6–14 Thai scores were higher. Overall Thai infant scores were significantly higher with a moderate effect size.
Valentini and Saccani [55]	Brazil	561	Reliability (Inter-rater)	D	ICC = 0.86 to 0.99
			Reliability (Intra-rater)	D	ICC = 0.915 to 0.993
			Reliability (Test-retest)	D	rs = 0.85 p < 0.001
			Internal Consistency	VG	α = 0.88
			Construct Validity		correlation with DSCB: w = 0.319, k = 0.309, McNemar-Bower test: 0.047
			Predictive Validity	I	Comparison to DSCB ICC = 0.96 (95% CI 0.89 to 0.99, p < 0.0001)
Valentini and Saccani [56]	Brazil	766	Internal Consistency	VG	Total score: α = 0.90 (subscales: 0.84 to 0.92)
			Content Validity	D	Language Clarity: k = 0.51 to 0.87 Pertinence: k = 0.82 to 0.93
			Reliability: Test-retest Inter-rater Intra-rater Construct Concurrent Validity Discriminant Validity Predictive Validity	VG VG VG VG VG VG	rs = 0.98 ICC = 0.86 to 0.99 ICC = 0.91 to 0.99 Comparison to CBDS classification moderate positive and significant correlation rs = 0.34, p = 0.03 Full-term vs preterm groups significant difference between for the raw score (t = - 4.84, p < 0.001) and percentile (t = -1.99, p < 0.05). predictive power (p < 0.001) was limited to the group of infants aged from 3 months to 9 months.
van Hus et al. [57]	Netherlands	116	Construct Validity	I	With comparison to the PDGMS rs = 0.726 p < 0.001)
van Schie et al. [58]	Netherlands	32	Predictive Validity	D	Predicting motor and mental outcome after perinatal hypoxic ischemic encephalopathy: Sensitivity 100% (95% CI 87 to 100), Specificity 80% (95% CI 48 to 80), Positive Predictive Value: 92 (95% CI 80 to 92), Negative Predictive Value (95% CI 0 to 40)
Wang et al. [59]	China	50	Reliability (Inter-rater)	VG	ICC = 0.99 (95% CI 0.98 to 0.99)
			Construct Validity	VG	With comparison to PDGMS −2: ICC > 0.90 for all subscale except RE ICC = 0.75
					k = AIMS 5^th percentile cut-off 0.580 to 0.724 moderate
Yeh et al. [60]	Taiwan	29	Construct Validity	VG	Consistency of GMA results between the home and clinic recorded videos was very good (k = 0.869; P < 0.05).

Key: COSMIN RoB Score: very good (VG), adequate (A), doubtful (D), and inadequate (I); ASQ-3- GM = Ages and Stages Questionnaire; AIMS = Alberta Infant Motor Scale; AUC = area under curve; BSITD = Bayley Scale of Infant and Toddler Development; BSID – II = Bayley Score of Infant Development − 2nd Edition; BSID = Bayley Score of Infant Development; CBDS = Child Behaviour Development Scale; CI = confidence interval; DSCB = Development Scale of Child Behaviour; GMA = General Movement Assessment; HINT= Harris Infant Neuromotor Test; α = Cronbach’s alpha; ρ = Pearson’s correlation coefficient (PCC); r_s = Spearman’s ranked correlation coefficient (rho); ICC = interclass correlation coefficient; k = Cohen’s kappa; R² = Linear Regression; TIMP = Test of Infant Motor Performance; IMP = Infant Motor Profile; MABC-2 = Movement Assessment Battery for Children 2 Edition; n = sample size; NSMDA = Neuro-Sensory Motor Development Assessment; PDGMS-2 = Peabody Development Gross Motor Scale 2nd Edition; PEDI-CAT = Pediatric Evaluation of Disability Inventory Computer Adaptive Test; SD = standard deviation; SEM = standard error of measurement.

Figure 2. The PRISMA diagram for study flow.

Table 5. Summary of results for LATCH.

Author (year)	Country of Origin	n	Psychometric	COSMIN Score RoB	Results
Adams and Hewell [61]	USA	25	Reliability (Inter-rater)	D	Percent agreements: 75 to 100 % between lactation consultant and researcher
					Between professional and mother rs = 0.53
Altuntas et al. [62]	Turkey	46	Reliability	D	Total score: rs = 0.85 to 0.91 (Domains: 0.65 to 0.90)
			Construct Validity	A	Correlation with IBFAT: rs = 0.71
					Correlation with MBA: rs = 0.88
Báez León et al. [94]	Spain	20	Reliability (Inter-rater)	VG	Totals; time (1) rs = 0.894 (2) rs = 0.453 (3) rs = 0.729
Chapman et al. [63]	USA	45	Reliability (Inter-rater)	A	Day 2: ICC 0.79 (95% CI 0.7 to 0.86)
					Day 4: ICC 0.78 (95% CI 0.67 to 0.86)
					Day 7: ICC 0.89 (95% CI 0.83 to 0.93)
DaConceição et al. [64]	Brazil	160	Internal Consistency	D	α global score: 0.25 to 0.32
			Reliability (Inter-rater)	A	ICC = 0.96
DaConceição et al. [65]	Brazil	160	Criterion Validity Cross-Cultural Validity	AI	applied in two specialist nurses simultaneously in the evaluation of 160 feeds in order to validate the reliability of the instrument ICC 0.96 Original version of the translation to Portuguese and back translation of the original instrument and evaluated by the judges CVI: > 0.90 (60%) evaluation of judges concordance coefficient AC 2 Gwett, 0.93 (95% CI 0.91 to 0.96).
Dolgun et al. [66]	Turkey	127	Construct Validity	VG	Comparison of BBAT rs = 0.76
Kumar et al. [67]	USA	250	Predictive Validity	VG	9 or higher during 16 to 24 hours period after birth: Sensitivity 75% Specificity 63% 1.7 times more likely to be solely breastfeeding at 6 weeks. 0 to 8 hours, 6 or more: Sensitivity 92.8% Specificity 30.0% Relative Risk: 2.3 8 to 16 hours: 7 or more: Sensitivity 89%, Specificity 34%, Relative Risk 1.8
Lau et al. [68]	Singapore	907	Structural Validity	VG	Exploratory Factor Analysis resulted in removal of C (Comfort) Confirmatory Factor Analysis 4-item: Goodness-of fit (GFI): 0.994 to 0.995, Adjusted Goodness of Fit (AGFI): 0.971 to 0.976, Incremental Fit Index (IFI): 0.993 to 0.995, Tucker-Lewis Index (TLI): 0.979 to 0.985, Comparative Fit Index (CFI): 0.993 to 0.995, Root Means Square Error of Approximation (RMSEA) = 0.042 to 0.044 5-item: GFI: 0.961 to 0.980, AGFI = 0.883 to 0.941, IFI: 0.889 to 0.957, TLI = 0.772 to 0.957, CFI: 0.886 to 0.956, RMESA: 0.086 to 0.125
			Internal Consistency	VG	α: 4-item: 0.74
					α: 5-item: 0.70
			Predictive Validity	VG	Predicting exclusive or nonexclusive breast-feeding success: 4 items: vaginally delivered (cut off 3.5 and 5.5): Sensitivity 94 to 95%, Specificity 0 to 2%, Positive Predictive Value: 25%, Negative Predictive Value 20 to 47%, Likelihood Ratio = 0.96
Riordan and Koehn [69],	USA	28	Reliability (Inter-rater) Construct validity	VGD	r = 0.11 to 0.46 percent agreement: 0.37 to 0.95 correlation with IBFAT: r = 0.69 correlation with MBA: r = 0.68

Key: COSMIN Risk of Bias (RoB) Score: very good (VG), adequate (A), doubtful (D), and inadequate (I); USA = United States of America; SD = standard deviation; α = Cronbach’s alpha; ρ = Pearson’s correlation coefficient; r_s = Spearman’s ranked correlation coefficient (rho); ICC = interclass correlation coefficient; AGFI = adjusted Goodness of Fit; BBAT = Bristol Breast-feeding Assessment Tool; CFI = Comparative Fit Index; CVI = Content Validity Index; GFI = Goodness-of fit; IBFAT = Infant Breast-Feeding Assessment Tool; IFI = Incremental Fit Index; MBA = Mother-Baby Assessment; n = sample size; RMSFA = Root Means Square Error of Approximation; TLI = Tucker-Lewis Index.

Table 6. Summary of results for Cobb angle.

Author (year)	Country of Origin	n	Psychometric	COSMIN score RoB	Results
Adam et al. [70]	Australia	12	Reliability (Intra-rater)	I	Error ± 7.7 degrees for single reading ±5.9 degrees for multiple readings.
Allen et al. [72]	Canada	22	Reliability (Intra-rater)	D	Manual method: ICC = 0.95Semiautomated: ICC = 0.92 to 0.94
					Automated: ICC = 0.91 to 0.92
			Reliability (Inter-rater)	D	Manual method: ICC = 0.93 to 0.95 (95% CI 0.83 to 0.98)
					Semiautomated: ICC = 0.0.89 to 0.93 (95% CI 0.76 to 0.97)
					Automated: ICC = 0.83 to 0.96 (95% CI 0.63 to 0.98)
			Construct Validity	D	Correlation between manual and automated: ICC = 0.30 (95% CI 0 to 0.6)
					Correlation between semiautomated and automated: ICC = 0.30 (95% CI 0 to 0.6)
					Correlation between manual and semiautomated: ICC = 0.70 (95% CI 0.4 to 0.9) Outliers removed
Al-Bashir et al. [71]	India, Jordan, USA	28	Reliability Construct Validity	I VG	Mean standard deviations: manual: 5.28 degrees Computer algorithm: 2.64 Correlation between manual and computer algorithm: rs = 0.80
Brink et al. [73]	Netherlands	33	Reliability (Inter-rater)	D	Automated: ICC = 0.94 (95% CI 0.85 to 0.95) Manual Spinous Process (SP) angle: ICC = 0.86 (95% CI 0.68 to 0.94) Manual Transverse Process (TP) angle: ICC = 0.84 (95% CI 0.64 to 0.94)
			Reliability (Intra-rater)	D	Automated: ICC = 0.97 Manual SP angle: ICC = 0.96 Manual TP angle: ICC = 0.94
De Carvalho et al. [74]	France	20	Reliability (Inter-rater)	D	30 cm × 90cm: rs = 0.886 ICC = 0.94 (95% CI 0.92 to 0.95)
					14 cm × 42 cm: rs = 0.888 ICC = 0.93 (95% CI 0.91 to 0.95)
			Reliability (Intra-rater)	D	30 cm x 90 cm: rs = 0.0.932 ICC = 0.95 to 0.99
					14 cm × 42 cm: rs = 0.0.832 ICC = 0.91 to 0.98
			Construct Validity	I	Comparison between small films and plain-films measurements ICC = 0.95 (95% CI 0.96 to 0.97); The graphic study of agreement proposed by Altman and Bland showed discordance higher than 10 between 30 to 90 cm radiographs and small radiograph measurements for 16 of 640 measurements.
Gstoettner et al. [75]	Austria	48	Reliability (Inter-rater)	A	Manual set: ICC = 0.96 (95% CI 0.96 to 0.97)
					Digital set: ICC = 0.93 (95% CI 0.92 to 0.93)
			Reliability (Intra-rater)	A	Manual set: ICC = 0.97 (95% CI 0.94 to 0.83)
			Reliability (Intra-rater)	A	Manual set: ICC = 0.97 (95% CI 0.94 to 0.83)
					Digital set: ICC = 0.96 (95% CI 0.90 to 0.98)
Kumar et al. [76]	India	20	Reliability (Inter-rater)	A	Average 4 degrees SD ICC > 0.9
			Reliability (Intra-rater)	A	Average 2 degrees SD ICC > 0.9
Livanelioglu et al. [77]	Turkey	51	Reliability (Inter-rater)	A	ICC = 0.96 (95% CI: 0.93 to 0.97)
			Construct Validity	VG	Comparison of Cobb1 to smart mouse1: rs = 0.93 (95% CI 0.88 to 0.96)
					Comparison of Cobb1 to smart mouse2: rs = 0.87 (95% CI: 0.77 to 0.92)
Loder et al. [78]	USA	64	Reliability (Inter-rater)	I	±7 to 7.9 degrees
			Reliability (Intra-rater)	I	±6.1 to 6.9 degrees
Marchetti et al. [79]	Other: Brazil	tsp: 90	Reliability (Inter-rater)	A	Thoracic spine: ICC = 0.77 (95% CI: 0.67 to 0.84) SEM: 4.8 degrees, MDC: 9.3 degrees
		lsp: 89			Lumbar spine: ICC = 0.87 (95% CI: 0.76 to 0.89) SEM: 3.8 degrees MDC: 7.5 degrees
			Reliability (Intra-rater)	I	Thoracic spine: ICC = 0.75 (95% CI: 0.68 to 0.82) SEM: 5.2 degrees, MDC: 10.2 deg
					Lumbar spine: ICC = 0.76 (95% CI: 0.69 to 0.82) SEM: 4.3 degrees, MDC: 8.5 deg
			Construct Validity	D	Compared to measuring apex angle and linear measurements: Thoracic spine: rs = 0.791 p < 0.001)
					Lumbar spine: rs = 0.689, p < 0.001)
Mehta et al. [80]	Korea	318	Reliability (Inter-rater)	D	rs = 0.986 (both endplate and pedicle measurement)
			Reliability (Intra-rater)		Endplate measurement rs = 0.980
				D	Pedicle measurement rs = 0.986
Pruijs et al. [81]	Netherlands	41	Reliability	I	Measurement error, 40 degrees of freedom, Range 6 to 48 degrees SD 3.67 degrees
Safari et al. [82]	Iran	14	Construct Validity	I	“New” semi-automated method compared to gold standard difference in mean was 4 degrees
Stokes and Aronsson [83],	USA	27	Reliability (Inter-rater)	I	2.3 to 2.7 degrees
			Reliability (Intra-rater)	I	1.8 to 2.4 degrees
Xiaohua et al. [84]	USA	20	Reliability (Inter-rater)	D	Manual method: ICC = 0.92
					Digital method: ICC = 0.97

Key: COSMIN RoB Score: very good (VG), adequate (A), doubtful (D), and inadequate (I); USA = United States of America; ICC = interclass correlation coefficient; SD = standard deviation; p = probability level; r_s = Spearman’s ranked correlation coefficient (rho); ICC = interclass correlation coefficient; MDC = minimal detectable change; SEM = standard error of measurement.

Table 7. Summary of results for postural assessment.

Author (Year)	Country of Origin	n	Psychometric	COSMIN RoB	Results
Watson and Mac Donncha [85],	Ireland	114	Reliability (Intra-rater) Reliability (inter-rater)	I I	10-items for Bland and Altman plot % agreement = 86.6% to 100% 10-items for Bland and Altman plot % agreement = 93.3 to 100%

Key: COSMIN RoB Score: very good (VG), adequate (A), doubtful (D), and inadequate (I); n = sample size.

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