Implementation Fidelity of a Smartphone Application for Population-Based General Movement Assessment: the Early Moves Study

Caroline F Alexander; Sarah E Hall; Alison Salt; Alicia Spittle; Catherine Morgan; Tiffany Grisbrook; Alishum Ali; Natasha Amery; Sue-Anne Davidson; Ashleigh Thornton; Mary Sharp; Emily Young; Robert S Ware; Desiree Silva; Roslyn Ward; Nadia Badawi; Samudragupta Bora; Roslyn N Boyd; Susan Woolfenden; Catherine Elliott; Jane Valentine

doi:10.1016/j.jpeds.2025.114710

Implementation Fidelity of a Smartphone Application for Population-Based General Movement Assessment: the Early Moves Study

J Pediatr. 2025 Jun 26:114710. doi: 10.1016/j.jpeds.2025.114710. Online ahead of print.

Authors

Caroline F Alexander¹, Sarah E Hall², Alison Salt³, Alicia Spittle⁴, Catherine Morgan⁵, Tiffany Grisbrook⁶, Alishum Ali⁷, Natasha Amery⁸, Sue-Anne Davidson⁹, Ashleigh Thornton⁶, Mary Sharp¹⁰, Emily Young¹¹, Robert S Ware¹¹, Desiree Silva¹², Roslyn Ward⁷, Nadia Badawi⁵, Samudragupta Bora¹³, Roslyn N Boyd¹⁴, Susan Woolfenden¹⁵, Catherine Elliott², Jane Valentine³

Affiliations

¹ Curtin University, Perth, Western Australia; The Kids Research Institute Australia, Perth, Western Australia. Electronic address: caroline.alexander@curtin.edu.au.
² Curtin University, Perth, Western Australia; The Kids Research Institute Australia, Perth, Western Australia.
³ The Kids Research Institute Australia, Perth, Western Australia; Perth Children's Hospital, Perth, Western Australia; The University of Western Australia, Perth, Western Australia.
⁴ University of Melbourne, Parkville, Victoria.
⁵ Cerebral Palsy Alliance Research Institute, The University of Sydney, New South Wales.
⁶ The Kids Research Institute Australia, Perth, Western Australia; The University of Western Australia, Perth, Western Australia.
⁷ Curtin University, Perth, Western Australia.
⁸ Perth Children's Hospital, Perth, Western Australia; King Edward Memorial Hospital, Perth, Western Australia.
⁹ Curtin University, Perth, Western Australia; The Kids Research Institute Australia, Perth, Western Australia; Perth Children's Hospital, Perth, Western Australia.
¹⁰ Perth Children's Hospital, Perth, Western Australia; The University of Western Australia, Perth, Western Australia; King Edward Memorial Hospital, Perth, Western Australia.
¹¹ Griffith University, Nathan, Queensland.
¹² The Kids Research Institute Australia, Perth, Western Australia; The University of Western Australia, Perth, Western Australia; Joondalup Health Campus, Perth, Western Australia; Edith Cowan University, Perth, Australia.
¹³ Health Services Research Center, University Hospitals Research & Education Institute and Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
¹⁴ Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland.
¹⁵ University of Sydney, Sydney, New South Wales; Sydney Local Health District, Sydney, New South Wales.

PMID: 40581097
DOI: 10.1016/j.jpeds.2025.114710

Abstract

Objectives: To describe the infant and maternal characteristics of the Early Moves cohort and to assess representativeness to the general population, and to evaluate the implementation fidelity of an application-based collection of General Movement Assessment (GMA) videos at writhing and fidgety age.

Study design: Prospective observational study. Mothers who had recently delivered or were enrolled to deliver at maternity hospitals in Perth, Western Australia, were recruited from November 2019 to December 2023. Sociodemographic and infant clinical characteristics were extracted from hospital records. Parents were invited to record GMA videos using the Baby Moves smartphone app, which were assessed for scorability by certified GM assessors.

Results: 3,002 infants (mean gestation, 38.9 ± 1.7 weeks; 46.6% female) were recruited. Infants were representative of the local population with respect to key infant risk factors, although mothers were more likely to be Caucasian and reside in higher socioeconomic suburbs compared with Perth metropolitan births. Overall adherence was 76%, with 2,272 families returning at least one scorable GMA video, with the majority (>69%) requiring personalized reminders to upload. Risk factors for nonengagement were infant prematurity, special care nursery stay, low maternal age, low socioeconomic status, minority ethnicity, and single caregiver mothers.

Conclusions: Inclusive recruitment strategies and broad inclusion criteria supported participation from diverse sociodemographic groups and infants representative of the local population on key medical risk factors. Parent-recorded GMA can be implemented in a large population-based cohort, though app-based notifications alone may be insufficient to facilitate engagement. Population-based applications should ensure targeted implementation strategies to support priority families.