Sonja Mensch

148 Chapter 8 Responsiveness was demonstrated by significantly larger score-changes during periods with relevant events than during periods without such influences: mean absolute Movakic score-changes were significantly larger in the group with events ( t =2.21; p =.03), albeit with a moderate effect size (Cohen’s d =.62, 95%-CI .23-1.00). A comparable tendency was seen for intraclass correlation coefficients: in the group with events it was .78 (95%-CI .64-.86) and in the group without events .95 (95%-CI .94-.96). We conclude that Movakic has good construct validity and is responsive to change. However, it was unclear towhat extent the events reported had really influenced the child, nor whether such influences improved or worsened motor function. Further studies should include interpretation of score-changes and what they mean clinically for children and parents. Our experiences clearly demonstrate how complex scientific research in this group of children can be. Chapter 6. The relation between motor abilities and quality of life in children with severe multiple disabilities In a group of 29 children with severe multiple disabilities, motor abilities were scored withMovakic by their own physiotherapists. The parents of these children scored quality of life using the Quality of Life-Profound Multiple Disabilities (QoL-PMD) questionnaire. Scores were compared by means of Pearson correlations. A moderate but significant correlation was found between Movakic and QoL- PMD total scores (r=0.40, p=0.03). Significant correlations with total Movakic scores were specifically found for the quality of life dimensions ‘physical wellbeing’, ‘development’ and ‘activities’. We conclude that in children with severe multiple disabilities, higher scores on motor abilities are associated with higher quality of life scores. Chapter 7. General discussion The careful work of an expert group with longstanding specialist experience in physiotherapeutic treatment of children with severe multiple disabilities resulted in a structured method to objectively evaluate subtle changes in motor abilities. Movakic is a well applicable, reliable and valid instrument. Its scores are sensitive to change. However, scores are influenced just as much by the frequent acute and chronic comorbidity, medical accidents, changes in medicine use, surgery and other events as by physiotherapeutic intervention. In individual clinical practice, therapists should carefully include all of these possible influences in their evaluations of interventions in these children and adults.