The translation, cross-cultural adaptation and validation of the General Movement Checklist were carried out, with the evaluation of 105 recorded videos of preterm and term infants. Preterm infants were less than 37 weeks of postmenstrual age, and full-term infants were more than 37 weeks postmenstrual age to 5 weeks of postterm age. These videos were recorded at the Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”. All parents signed informed consent forms.
The study was divided into 2 stages. In the first stage, 20 videos were selected from the total sample, and were evaluated by 3 medical professionals with the instrument in its original language. Evaluators A and C, with basic and advanced certification in the evaluation of general movements by the GMT, and evaluator B, with elementary knowledge of general movements. Assessments were performed on two occasions with a time interval of 2 weeks to avoid bias. Intraobserver and interobserver reliability were determined by comparing the assessments using Cohen's kappa test.
The second stage consisted of the translation, cross-cultural adaptation and validation of the instrument in its version translated into Spanish. With the permission of the original authors [10], the translation and cross-cultural adaptation of the General Movement checklist were carried out according to international guidelines [11–13] and consisted of the following stages: direct translation, synthesis of translations, reverse translation, expert committee review and second expert committee review. Figure 1
Direct translation. Two independent translations were created from the English version of the instrument by two translators with a native Spanish language and great command of the English language, both of whom are expert translators belonging to the American Translators Association. Translator 1 had knowledge of the objectives and concepts considered in the study. Translator 2 lacked prior knowledge about the instrument and the objectives.
Synthesis of translations. The two direct translations obtained previously, by translators and a health professional with previous experience in cross-cultural adaptation of health instruments, were compared, and the first version was obtained in Spanish.
Reverse translation. The translation into the original language (English) of the first version in Spanish was carried out by two native-language English translators (translators 3 and 4), and expert translators belonging to the American Translators Association; these translators were unrelated to the purpose of the translation and were not informed of the concepts explored.
Review and consolidation by a committee of experts. An expert in methodology, a physical and rehabilitation medicine physician with a fellow in pediatric rehabilitation and the translators who participated in the previous stages (translators 1, 2, 3 and 4), who were in charge of consolidating the versions obtained were consulted. They held a discussion to reach a consensus and achieve semantic and conceptual equivalence in the translation. In this phase, the preliminary version of the General Movement checklist was obtained in the Spanish language.
After this review, the preliminary version of the checklist was evaluated by two rehabilitation specialists. The participants completed the questionnaire with comprehension questions and were asked to write suggestions. The difficulties and suggestions of the two professionals were reviewed.
Second review by committee of experts. This committee comprised of 8 experts (five physicians specializing in physical and rehabilitation medicine, four whom were fellows in pediatric rehabilitation, two of whom had a master’s degree in medical sciences, one who was a psychologist with a doctorate in cognitive psychology, one who was a neonatologist and one who was a physiotherapist specializing in pedagogy informatics by means of the Delphi method using a Likert scale from 1 to 3. The opinions of the experts on the items that made up the instrument were obtained to determine the content validity.
The final version of the General Movement checklist in the Spanish language was developed. Online resource 1.
The internal consistency of the checklist was assessed with Cronbach's alpha test.
We also compared the results obtained from the assessment of the videos with the checklist, with the General Movement Optimality Score-Revised (GMOS-R) and with the clinical diagnosis at 2 years of corrected age.