Original Article

Turkish Version of Bruininks-Oseretsky Test of Motor Proficiency 2 Brief Form: Its Validity and Reliability in Children with Specific Learning Disability


  • Barkın KÖSE
  • Sedef ŞAHİN
  • Hülya KAYIHAN

Received Date: 17.02.2020 Accepted Date: 15.01.2021 Bezmialem Science 2021;9(2):198-204


Specialists often assess the motor proficiency of children presented with suspected developmental delays. It is essential that the tools used to assess children have highly powerful measurement properties including psychometric properties. The aim of our study, analyze the reliability and construct validity of the Turkish version of the Bruininks Oseretsky Test of Motor Proficiency 2-Brief Form (BOT2-BF) in children with a specific learning disability (SLD).


Participants, which aged between 6 and 14, were included 137 children with SLD and 50 children without any diagnosis. The Turkish version of the BOT2-BF was administered by the researcher in one session to children with SLD twice with a seven days interval. In addition, BOT2-BF was re-apply to 25 children with SLD, which were randomly selected, after 10 days.


The validity results of BOT2-BF were found to be significantly better in all subtests in the control group than in the study group, having higher performance levels (p<0.05). The BOT2-BF demonstrated high test-retest reliability (ICC >0.8) (except Fine Motor Precision (ICC=0.57) and Manual Dexterity Subtest (ICC=0.74) and good internal consistency (Cronbach’s alpha =0.78) for all domains. The inter-rater reliability results were found to be perfectly reliable (ICC >0.9).


The Turkish version of BOT2-BF was found to be a valid and reliable assessment to evaluate motor proficiency in children with SLD.

Keywords: Specific learning disability, motor proficiency, validity, reliability


Specific Learning Disorder (SLD) is a developmental disorder with a neurological origin seen in individuals who actually have normal or above normal intelligence (IQ >85) but no primary psychological disorder, obvious brain damage, or sensory disability, experiencing certain difficulties in the acquisition. Children with SLD encounter many problems in activities, such as listening, speaking, reading, writing, reasoning, math skills, self-governance, understanding social events, and establishing social communication (1-5). Son and Meisels (6) grouped under two main headings and revealed that children with SLD had problems in self-care and academic activities performance.

Children with SLD was observed to face difficulties in performing activities such as shoe lacing, tooth brushing, dressing, buttoning up of clothes, and falling down while climbing up or down the stairs especially in daily living (6,7). In academic life, children have problems in holding a pencil, writing legibly, doing mathematical operations, and simultaneously writing down a text dictated by the teacher (8,9). Given these problems encountered by children with SLD in activities of daily life, weak muscle strength, weakness in fine and gross motor abilities, insufficiency of balance-coordination, visual perception problems, and failure to perform sequential skills come to the forefront as problems of motor proficiency (10-12).

Motor proficiency was defined as the level of realization of motor abilities such as balance, coordination, and orientation using a combination with sensory and perceptual skills (13). Bruininks-Oseretsky Motor Proficiency Test 2 (BOT2), Bruininks-Oseretsky Motor Proficiency Test 2 Brief form (BOT2-BF), Fundamental Movement Pattern Assessment Instrument, and Developmental Sequence of Fundamental Motor Skills Inventory and Gross Motor Development Test are used commonly to assess motor proficiency levels in the children (14-18). Considering the features of these tests used in this field, BOT2-BF comes to the fore for its features like short duration, understandable and easy-to-conduct, and providing holistic evaluation features.

Bruininks-Oseretsky Motor Proficiency Test (BOMPT) was developed in 1972 in order to measure the motor abilities of children aged between 4.5 and 14.5 years (15). BOMPT was updated in 2005 and became BOT2. Thus, BOT2 is applicable to children and youth 4-21 years of age. Administration of the BOT2 contains eight sub-test with 42 items and takes approximately 45-60 min (15). The validity and reliability of the BOT2 was determined by Balli with a study conducted on a group of healthy children aged 5 years in Turkey in 2012 (19).

BOMPT Short Form, which is the old version of BOT2-BF, contains eight sub-test and 14 items. It takes 20-25 min. BOMPT Short Form was updated in 2010 and became BOT 2-BF, reducing the total number of items from 14 to 12. This version takes 15-20 min (13). It is important to show version in different languages due to BOT2-BF could be completed in a short time practically to assess motor abilities in children. Therefore, this study aimed to assess the reliability and validity of the Turkish version of the BOT2-BF among children with SLD.


Our study was evaluated by University Non-invasive Clinical Research Ethics Committee and found to be ethically appropriate on 21.11.2017 with the decision GO17 /892-26. The permission required for the application of the Turkish version of BOT2-BF was obtained at the beginning of the study from the licensee. All participants and their parents agreed to participate in the study and were informed about the study and their consent was obtained.


The study was conducted at the pediatric clinic of the department of Occupational Therapy at the University. Inclusion criteria for the study group were the following: (1) diagnosed with SLD according to Diagnostic and Statistical Manual of Mental Disorders V criteria, (2) between 4-21 years of age, (3) volunteer to participate in the study, (4) absence of other diagnosis (e.g.,., attention deficit hyper-activity, autism, etc.), and (5) not professionally involved in any sportive activity (gym, volleyball, basketball, etc.). Inclusion criteria for the control group were as follows: (1) between 4-21 years of age, (2) voluntary participation to the study, (3) not professionally involved in any sportive activity (gym, volleyball, basketball, etc.), and (4) not born as preterm (20).

In the calculation of minimum sample size, which is 120 children with SLD and 40 children without any diagnosis, the model developed by Tabachnik and Fidell was used (21-23). During the study period, children who applied at the occupational therapy department for treatment were screened as potential participants. In this process, who could not be included or does not continue the study due to various reasons was noted. As a result, 137 healthy children were included in our study as the study group and 50 children without any diagnosis as the control group (Figure 1-Flow Chart).


Demographic Information Form

A demographic information form was completed by participants. Information included participants’ age, gender, class, and dominant hand information.

Bruininks-Oseretsky Test of Motor Proficiency-Brief Form (BOT 2-BF)

BOT2-BF consists of eight sub-tests with 12 items. Test duration takes nearly 15-20 min. Sub-tests and items of BOT2-BF are as follows: (1) Fine Motor Accuracy: Completing the inside of a star and drawing a line along a path; (2) Fine Motor Integration: Copying nested circles and copying a diamond shape; (3) Manual Dexterity: Tying blocks on to a string; (4) Bilateral Coordination: Touching the tip of the nose with the index finger (eyes closed) and drawing a square with the thumb and index finger; (5) Balance: Walking forward heel-to-toe on a line (6) Speed and Agility: Jumping on one foot; (7) Coordination of Upper Extremities: Catching a thrown ball (with one hand) and dribbling; and (8) Endurance: Full push-ups and push-ups on knees (13).

Item point scores for each task are converted to processed points using the Likert scale in each task. The Likert score values for each task are different. The conversion of the item point scores to the processed score is made by finding the processed score on the Likert scale that corresponds to the raw score taken from the best performance. In all items, the second trial is not performed if the child has received a full score on the first attempt. The internal consistency of the test was found to be sufficient (Cronbach’s α=0.87) (13).


Demographic data of participants were recorded. BOT2-BF was applied to the study and control groups to determine the motor capabilities of children. For the determination of test-retest reliability, BOT2-BF was re-administered to the study group a week after the initial evaluations. All evaluations were carried out by a single therapist (BK) during a single face-to-face session with children. Following the second evaluation of the study group, 25 children were randomly selected from the study group to determine the inter-rater reliability, and a third evaluation was carried out on them by another therapist (HK) 10 days after the first two evaluations (24).

Translation and Cross-Cultural Adaptation

The BOT2-BF was adapted from English version into Turkish in accordance with its standard methodology recommended by Beaton et al. (25). The adaptation was performed by two independent native speaking Turkish translators with fluent knowledge in English. The final Turkish version of the adaptation was later translated from Turkish to English by two English native speakers who can speak Turkish fluently to check compatibility. A committee with expertise in this field reviewed the translations and procedure. The comparison of the translation to the original version of the test revealed no inconsistency.

Data Analysis

International Business Machines Statistical Package for the Social Sciences Statistics for Windows version 23.00 was used for statistical analysis of data. The Kolmogorov-Smirnov Test was used to determine whether the data showed normal distribution. Categorical variables were expressed as numbers and percentages, whereas quantitative data were expressed as mean and standard deviation (26-28).

Validity Analysis

A construct validity was used to determine the validity degree of BOT 2-BF. In our study, the construct validity of BOT2-BF was evaluated through Known-Groups validity. This analysis was performed with children who were diagnosed with SLD and children without any diagnosis. The normal distribution assumption could not be obtained, thus the scale scores were analyzed with Mann-Whitney U Test to see whether they were different in two groups, and statistical significance level was accepted to be 0.05 (27,29).

Reliability Analysis

In our study, internal consistency and item analysis methods were used for the analysis of the reliability of the scale, and test-retest method and inter-rater reliability method were used for invariance reliability over time. Internal consistency has been indicated as Cronbach’s alpha value. An alpha value >0.70 is indicative of a satisfactory consistency, whereas values between 0.50 and 0.70 are mean acceptable consistency (30). In our study, mixed model of intra-class correlation coefficient (ICC) was used for the inter-rater and test-retest reliability analyses of BOT2-BF. Intervals used for the interpretation of ICC values include the following: values <0.5 means poor reliability; 0.50-0.74 mean moderate reliability; 0.75-0.90 fine reliability; and >0.90 are defined as excellent degree of reliability (30).


Descriptive Statistics

The average age of children included in the study are as follows: children in the study group (n=137) was 10.07±2.22 years [minimum (min) 6, maximum (max) 14 years] and in the control group (n=50) was 9.94±2.29 years (min: 7, max: 15 years). Both groups had resembled each other (Z=-1.98; p=0.4).


Construct Validity

With the exception of Fine Motor Precision and Strength Tests, validity results of BOT2-BF were found to be significantly better in all other sub-tests in the control group than in the study group, having higher performance levels (p<0.05). Sub-results of the construct validity are shown in Table 1.


Internal Consistency Reliability

As a result of statistical analysis, the internal consistency of BOT2-BF was found to be statistically sufficient (Cronbach’s α=0.78). Results of the internal consistency and item analysis of the test are shown in Table 2.

Test-Retest Reliability

Fine Motor Precision sub-test (ICC=0.57) and Manual Dexterity sub-test (ICC=0.74) of BOT2-BF were found to be moderately reliable. Other sub-tests except those two were found to be between fine and excellent reliable. The invariance reliability sub-results of BOT2-BF over time are presented in Table 3.

Inter-Rater Reliability

All sub-tests of BOT2-BF were found to be perfectly reliable. The inter-rater reliability subscales of BOT2-BF are shown in Table 4.


This study describes the translation and psychometric testing in terms of validity (construct) and reliability (Internal Consistency, Test-Retest, and Inter-Rater) of the Turkish version of the BOT2-BF in children with SLD. Analyzing the psychometric properties of tests in the literature, study examples investigating the features of BOT2 and BOT2-BF were found to be limited. An acceptable reliability and validity were observed only in the study carried out by Lucas et al. (31) using BOT2-BF on children who live in rural areas. As for BOT 2, psychometric features and normative data have been investigated in studies generally conducted on healthy children and children diagnosed with mental retardation (19,31-36). Therefore, studies dwelling into the validity and reliability features of BOT2 and BOT2-BF tests that evaluate motor abilities were also studied (19,34-36).

Factor analysis was used for construct validity in example studies that already exist in literature. However, in our study, construct validity was measured by means of the Known-Groups Validity. This is because the test is not suitable for factor analysis due to the number and distribution of items (26). As our results have satisfactory contract validity between children with SLD and controls matched for age and gender.

For all sub-tests of the Turkish version, the internal consistency of the BOT2-BF was found to be acceptable (coefficient alpha values were ≥0.7). The degree of internal consistency observed in the present study (α=0.78) was lower than that of the original validation study of the BOT2-BF (α=0.85) (13). Other version studies using BOT2-BFwere not found other than the original study in literature. In this respect, our study is the first version study using BOT2-BF and it is also the first study to show its usability in children with SLD.

The original version examined the reliability of BOT 2-BF via test and retest methods. As for the study results, the invariance of items in time varied from medium to good validity (13). In addition, Wuang and Su (36) used the test and retest analysis in the BOT2 version study and found the test to be reliable enough. In our study, the invariance of BOT2-BF in time was examined via test and retest methods similar to the examples in literature. Compatible with the literature, results of the reliability of time invariance ranged from medium to excellent. This point of view, unlike the original version, results of speed and agility and upper-limb coordination sub-tests were found to be higher in our study.

In the original version, Bruininks and Bruininks (13) demonstrated an excellent inter-rater reliability of BOT2-BF. We also measured the inter-rater reliability of the BOT2-BF as an assessment tool in the Turkish version that could make a difference between practitioners. In our study results similar to the original version, the reliability level of items was found to be excellent. Considering these values, our study can be considered to have an excellent degree of reliability, in contrast with results of many examples in literature. The degree of excellence in reliability means that the Turkish version of BOT 2-BF can easily be adopted and used by many experts.

When the version studies in the literature conducted using BOMYT, BOMYT Short Form, BOT2, and BOT 2-BF are considered, sample groups in most studies can be selected from children without disabilities. Studies were conducted in only healthy children, which may be led to a significant deficiency in rehabilitation clinics for children with disability. The application of these tests in the evaluation of rehabilitation programs on disability groups are unknown (13,15,34-37). Thus, we believe that our study will positively contribute both to the literature and clinical professionals, as it has included children with SLD.

Study Limitations

Due to the time limitation in our study, adequate number of participants could not be included to make a better distribution analysis according to ages, which can be regarded as a limitation of our study. Examining the methodology of other studies in the literature, it can be seen that results are introduced according to age distributions (13,36). Taking into consideration the fact that distribution by age can provide positive contributions in the interpretation of evaluations that have been made by experts working in the clinical field, examining those distributions according to ages in the following studies were thought to be crucial.


This has been the first study to evaluate the validity and reliability of the BOT2-BF, which measures motor competence, planning, orientation, coordination, and speed in children with SLD. Considering the fact that studies conducted in this area focus largely on healthy groups, it is thought that it will contribute positively to the development of further study fields to assist both academic and clinical professionals. It is considered essential that further studies where BOT2-BF is used should be conducted to obtain validity and reliability as well as high value of evidence in clinical practices.


Ethics Committee Approval: Our study was evaluated by University Non-invasive Clinical Research Ethics Committee and found to be ethically appropriate on 21.11.2017 with the decision GO17 /892-26.

Informed Consent: All participants and their parents agreed to participate in the study and were informed about the study and their consent was obtained.

Peer-review: Externally peer reviewed.

Authorship Contributions

Concept: B.K., H.K., Design: B.K., S.Ş., E.K., Data Collection or Processing: B.K., S.Ş., Analysis or Interpretation: E.K., Literature Search: B.K., H.K.,  Writing: B.K., S.Ş., E.K., H.K.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: Expenses of our research were covered by the project number 16698 by University Scientific Research Projects Coordination Unit.

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