Reliability Measurement of the PIOMI Premature Infant Oral Motor Intervention Brenda S. Lessen, PhD, RN Illinois Wesleyan University Clare A. Morello,

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Reliability Measurement of the PIOMI Premature Infant Oral Motor Intervention Brenda S. Lessen, PhD, RN Illinois Wesleyan University Clare A. Morello, BSN, RN Children’s Hospital of Illinois Reliability Rating Tool Response to Study Data Abstract Training Prior to Reliability Study Amateur video using term infant to demonstrate steps PIOMI tool One on one instructions Hand model practice Training Revisions Based on Study Professional video using preterm infant; added correct timing PIOMI tool with pictures/less text Kept one on one instructions Kept hand model practice A reliability study was conducted in a Level III NICU to determine the reliability of the Premature Infant Oral Motor Intervention (PIOMI). The PIOMI is a five minute, pre-feeding intervention developed to improve feeding skills in the premature infant. Three registered nurses (RNs) were recruited and trained to perform the PIOMI. A specific training plan was established, and a reliability rating tool was developed. Two observers rated three RNs performing the PIOMI twice each on premature infants. The reliabilities among the observers (interobserver), among different RNs (interuser), and of the same RN performing the PIOMI twice (test-retest) were calculated. The PIOMI demonstrated high interobserver (97.57%), interuser (97.59%), and test-retest (97.58%) reliabilities. CORRECT ORDER OF STEPS CORRECT TECHNIQUE IN EACH STEP CORRECT TIME TO PERFORM EACH STEP Interobserver Reliability: Consistency in which more than one observer can correctly rate the person performing the PIOMI. Interuser Reliability: Consistency in which the PIOMI can be performed correctly between multiple persons. Test-retest Reliability: Ability of each person to perform the PIOMI consistently more than once. Discussion The PIOMI Reliability Rating Tool was found to be accurate and usable for measuring correct time, technique, and order and among more than one rater. It is also recommended for use in training. Strong reliability is essential to assure that an intervention can be fully and properly implemented before translating evidence-based interventions into practice. Effective training is imperative to achieve high levels of reliability, and the specific type of training must be measured along with any reliability data. Subject Demographics Age Gender Ethnic/Racial Background Experience in the NICU Number of Times Performing Oral Motor at Study Site Number of Times Performing the PIOMI Prior to This Study RN A 54 Female Caucasian 34 >100 25 RN B 29 7 >50 RN C 37 13 20-30 Reliability Results Correct Order Correct Technique Correct Timing TOTAL RELIABILITY Interobserver 100% 97.20% 95.52% 97.57% Interuser 97.59% RN A and RN B 95.83% 93.33% 96.39% RN A and RN C 97.87% 98.58% RN B and RN C 97.92% 95.45% 97.79% Test-Retest 97.58% RN A 95.65% 98.55% RN B 95.35% 98.45% RN C 87.23% 95.74% IRB Approval This research protocol was approved by the Illinois Wesleyan University Institutional Review Board, Peoria Institutional Review Board, OSF Saint Francis Nursing Review Board, and OSF Clinical Research Office. Both authors also completed the Collaborative Institutional Training Initiative (CITI) curriculum for Biomedical Researchers on Human Research. Written consent was obtained from all subjects. Acknowledgements The PIOMI demonstrated high interobserver (97.57%), interuser (97.59%), and test-retest (97.58%) reliabilities. This study was partially funded by Illinois Wesleyan University. Illinois Wesleyan University had no role in the study design, implementation or publication. We would like to thank EmmaLee McMullen, Cheryl Lopeman, and Tina Neisler for their assistance in data collection Weakest Reliabilities Targeted for Training Primary References Lessen, B.S. & Morello, C.A. (2012) Reliability Measurement of the Premature Infant Oral Motor Intervention. (Under Review) Journal of Neonatal Nursing Lessen, B.S. (2011) Effect of the Premature Infant Oral Motor Intervention on Feeding Progression and Length of Stay in Preterm Infants, Advances in Neonatal Care, 11 (2), 129-139. Interobserver Reliability Interuser Reliability Test-Retest Correct Technique Cheek C-Stretch 94.44% 91.67%-100.00% 83.33%-100.00% Lip Curl 94.12% 75.00%-100.00% 80.00%-100.00% Midblade of Tongue 88.89% 100.00% Correct Time 86.67%-100.00% 66.67%-100.00% 60.00%-100.00% 3 steps were found more difficult to consistently perform within the correct time frame and/or using the correct technique.