Research Article
Issue Date: September/October 2020
Published Online: July 16, 2020
Updated: August 07, 2020
Developing a Nomogram Model to Predict the Risk of Poor Chinese Handwriting in First Grade
Author Affiliations
  • Yea-Shwu Hwang, ScD, is Assistant Professor, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan, Taiwan; yshwang@mail.ncku.edu.tw
  • Pei-Fang Su, PhD, is Associate Professor, Department of Statistics, National Cheng Kung University, Tainan, Taiwan.
  • Ying-Lu Hsiao, MS, is Occupational Therapist, Healthconn Company, Taipei, Taiwan.
  • Wen-Hui Tsai, MD, PhD, is Pediatrician, Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan, and Assistant Professor, Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan.
  • Jo-Ying Hung, BS, is Master’s Student, Department of Statistics, National Cheng Kung University, Tainan, Taiwan.
Article Information
Pediatric Evaluation and Intervention / School-Based Practice / Research Articles
Research Article   |   July 16, 2020
Developing a Nomogram Model to Predict the Risk of Poor Chinese Handwriting in First Grade
American Journal of Occupational Therapy, July 2020, Vol. 74, 7405205080. https://doi.org/10.5014/ajot.2020.038711
American Journal of Occupational Therapy, July 2020, Vol. 74, 7405205080. https://doi.org/10.5014/ajot.2020.038711
Abstract

Importance: Few predictive models for later handwriting difficulties have been developed for kindergarteners.

Objective: To develop a nomogram for the purpose of detecting the risk of later poor Chinese handwriting among Taiwanese kindergarteners.

Design: One-year prospective longitudinal, observational study.

Setting: Kindergarten and elementary school.

Participants: One hundred fifty-six kindergarteners were included. In first grade, they were grouped into the normal and poor handwriting groups on the basis of handwriting performance in first grade.

Outcomes and Measures: Participants received fine motor (FM), visual–perceptual (VP), and visual–motor integration tests in kindergarten and handwriting assessments in first grade.

Results: Logistic regression results indicated that younger age at school entry and lower scores on measures of FM and VP in kindergarten increased the risk for later poor handwriting. The area under the receiver operating characteristic curve in the nomogram built with these risk factors was .75, indicating that the nomogram had acceptable diagnostic value.

Conclusions and Relevance: This nomogram could be used as a screening tool to detect kindergarteners at risk of poor Chinese handwriting in first grade.

What This Article Adds: This study is the first to establish a nomogram constructed with significant predictors in kindergarten of a child’s probability of poor handwriting later in first grade. This predictive nomogram may help occupational therapists, educators, and parents identify at-risk kindergarteners early for the purpose of early interventions to prevent later poor Chinese handwriting.