The screening Hand Assessment for Infants: Feasibility, validity, and reliability based on parents' recordings

Aim: To evaluate the concurrent validity and interrater reliability of remote screening Hand Assessment for Infants (s-HAI) in infants aged 3.5 to 12 months at risk of unilateral cerebral palsy (CP), and to assess the feasibility of parents administering and recording the s-HAI play session using a smartphone app. Method: In this observational study, 30 infants (10 females) at risk of unilateral CP were assessed with remote s-HAI, administered by their parents, and compared with the HAI conducted in a clinical setting. The quality of the s-HAI recordings was assessed and parents' experiences were collected using a questionnaire. The Spearman's rank correlation coefficient (r(s)) was calculated for the Each Hand Sum score of s-HAI and the corresponding six-item HAI. The interrater reliability of the s-HAI recordings was calculated using the intraclass correlation coefficient2,1. Results: Parents recorded the s-HAI play session with good quality and found it feasible. A strong correlation of r(s)= 0.86 (p < 0.001) was found between the s-HAI and the six-item HAI. Interrater reliability was 0.96 (95% confidence interval [CI] = 0.92-0.99) for the affected hand, 0.95 (95% CI = 0.90-0.98) for the non-affected hand, and moderate to excellent for individual items. Interpretation: The s-HAI measures the same construct as the six-item HAI, demonstrating reliable scoring between raters when administered remotely by parents, making the s-HAI a viable tool for the early identification of infants at risk of unilateral CP.