Translation, cross-cultural adaptation and validation of the General Movement checklist

Abstract

Background: The Prechtl's General Movement Assessment (GMA) is a widely accepted tool for predicting neurodevelopmental outcomes in infants. However, access to formal training in GMA is limited in low- and middle-income countries, such as Mexico. This study aimed to validate the Spanish version of the General Movement checklist (GMC), a tool designed to facilitate the evaluation of general movements, particularly for clinicians with limited experience.

Methods: An observational, cross-sectional study was conducted on infants with high neurological risk. The inter- and intra-observer reliability of GMC in its original version was analyzed using Cohen's kappa test. The checklist was translated and cross-cultural adapted to Spanish following international guidelines. Its internal consistency was assessed using Cronbach's alpha test. Content validity was determined by a panel of experts (the content validity index (CVI)), criterion and predictive validity were determined using the General Movement Optimality Score-Revised (GMOS-R) and the clinical diagnosis at 2 years corrected age. Receiver Operating Characteristic (ROC) curves were generated to identify the cut-off points on the GMC.

Results: Intra-observer reliability (Kappa = 0.91) and inter-observer reliability (Kappa = 0.75-1.0) demonstrated excellent agreement. Cronbach's alpha was 0.8579. Content validity was strong, with all items achieving a CVI > 0.7. Predictive validity showed high sensitivity (90%) and specificity (92%) when comparing checklist results with the clinical diagnosis.

Conclusions: The Spanish version of the GMC was validated as a reliable and valid tool to guide the early assessment of neurodevelopmental disorders in Mexican infants. Further studies are recommended to confirm these findings.

Keywords: General movement checklist; Neurodevelopmental outcome; Prechtl’s general movement assessment; Spanish version.