Outcome assessments in children with cerebral palsy, part II: discriminatory ability of outcome tools

Dev Med Child Neurol. 2007 Mar;49(3):181-6. doi: 10.1111/j.1469-8749.2007.00181.x.

Abstract

Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to III, participated in this prospective multicenter, cross-sectional study. All tools were completed by parents and participants when appropriate. Effect size indices (ESIs) for parametric variables and odds ratios for non-parametric data quantified the magnitude of differences across GMFCS levels. Binary logistic regression models determined discrimination, and receiver operating characteristic curves addressed sensitivity and specificity. Between Levels I and II, the most discriminatory tools were Gross Motor Function Measure (GMFM-66), velocity, and WeeFIM Mobility. Between Levels II and III, the most discriminatory tools were GMFM Dimension E, Pediatric Functional Independence Measure (WeeFIM) Self-Care and Mobility, cadence, and Gillette Functional Assessment Questionnaire Question 1. Large ESIs were noted for Parent and Child reports of Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function, Parent report of PODCI Global Function, GMFM Dimension E, and GMFM-66 across all GMFCS level comparisons. The least discriminatory tools were the Quality of Life and cognition measures; however, these are important in comprehensive assessments of treatment effects.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Activities of Daily Living
  • Adolescent
  • Analysis of Variance
  • Cerebral Palsy / complications*
  • Cerebral Palsy / diagnosis
  • Cerebral Palsy / therapy
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Disability Evaluation*
  • Female
  • Humans
  • Male
  • Motor Skills / classification*
  • Motor Skills Disorders / classification*
  • Motor Skills Disorders / complications
  • Motor Skills Disorders / diagnosis
  • Orthopedics / methods
  • Outcome Assessment, Health Care / methods*
  • Prospective Studies
  • Reproducibility of Results
  • Severity of Illness Index