Sonja Mensch

61 Design and content validity After applying the instrument to their own clients, the therapists answered questions on applicability, addressing the comprehensibility of the user manual, the layout (questionnaire and score-form), the items (relevance, comprehensibility, difficulty, number, and suggestions for other questions), the clarity of the answer categories and scoring procedure, and time needed to complete the instrument. There was room for written remarks per item, additions and further tips. The questionnaire also included a question on whether the instrument score measured corresponded to the therapist’s clinical judgment, on a scale of 1 = not at all, to 10 = completely. RESULTS The proposed approach for the development of the new instrument outlined in the methods section of this paper was followed. Step 1: Listing of relevant motor abilities. The survey resulted in 355 therapeutic goals for 75 clients. After removal of duplicates and goals on the levels of body function (such as pain, contractures, dyspnoea) and participation, the remaining goals on the level of activity were translated into motor abilities by the expert focus group. We illustrate this process with the example of the following therapeutic goal ‘Client x is able to sit in his wheelchair during playing’. In this case, the generic motor ability on the level of activities is ‘maintaining body position’ and the specific motor ability is‘maintaining the sitting position’. This motor ability can be specified for different situations and activities of daily life. In our example, the specific situation is ‘sitting in a wheelchair’, whereas ‘during playing’ concerns the level of participation. Step 2: Structure and layout of the instrument. The discussions within the expert group during the repeated consensus procedure resulted in a structure and the layout of the instrument (see table 2); 1. Main body positions (‘Positions’). 2. Specific situations in each body position (‘Situations’). 3. Specific motor abilities in each situation (‘Grouping of motor abilities’). 4. Items with questions (‘Items’). Based on the relevance, the items consisting of motor abilities were clustered within the 12 situations (see Table 3).