Correspondence of classifications between parents of children with cerebral palsy aged 2 to 6 years and therapists using the Gross Motor Function Classification System

Abstract

AIM The aim of this study was to determine the agreement and reliability of parent report using a lay version of the Gross Motor Function Classification System (GMFCS) among children with cerebral palsy in the two youngest age bands. METHOD Data were obtained from the Canadian section of the Movement and Participation in LifeActivities of Young Children study database. One hundred and thirty-two parents of two groups of children participated: children aged 2 to 4 years (35 males, 26 females; mean age 3y 2mo; SD 5mo) and children aged 4 to 6 years (39 males, 32 females; mean age 4y 11mo; SD 6mo) at the final data collection point. Therapists classified motor function using the GMFCS and parents used the GMFCS Family Report Questionnaire, with parents and therapists being masked to the others' responses. Agreement between respondents was determined using precise agreement and Cohen's unweighted kappa statistic. Reliability between respondents was determined using the intraclass correlation coefficient (ICC).RESULTS Overall, precise agreement was 77%, chance-corrected agreement was j=0.70 (95% confidence interval [CI] 0.61-0.79), and reliability was ICC=0.95 (95% CI 0.93-0.96).INTERPRETATION These values indicate substantial agreement and reliability between parents of children aged 2 to 6 years and therapists. Some parents had a tendency to rate their children as more functionally limited than did therapists, leading us to question whose the true criterion standard' rating should be.Cerebral palsy (CP) refers to a group of permanent, non-progressive disorders of development of motor function affecting movement and posture in addition to causing activity limitation.1 The Gross Motor Function Classification System (GMFCS) was first described by Palisano et al. 2 to classify the motor function of children with CP. An expanded version that includes older age bands and revision of some details was subsequently published.3 Differences in motor function are reflected in the five classification levels of the GMFCS. Children classified in level I can walk without restrictions but they lack more advanced gross motor abilities. Those in level V are limited in self-mobility, even with the use of assistive technology. 2 Children are assigned a level based on their functional capabilities and typical performance according to specific age bands (<2y, 2-4y, 4-6y, 6-12y, 12-18y The GMFCS is widely used among healthcare professionals to determine clinical decisions involving future rehabilitation, equipment needs, and functional mobility goals. Typically, the parent or guardian has more insight into their child's overall abilities because they view the child in various environments over a longer period of time.11 Accordingly, it is important to determine the level of agreement between healthcare professionals and parents when classifying a child with CP using versions of the GMFCS.Reliability of family report using the GMFCS has been established for children aged between 6 and 12 years (intraclass correlation coefficient [ICC]=0....

Gross Motor Function Classification System Expanded &amp; Revised (GMFCS E &amp; R): reliability between therapists and parents in Brazil

“…The children classified as levels IV and V require the use of assistive technology (manual or powered wheelchair), which depends on contextual factors 12 such as accessibility to these resources, architectural barriers, as well as personal factors including acceptance of colleagues and family 12 . The cost of a wheelchair in Brazil is high, however, the Brazilian government has increased funding for the Health System to provide free wheelchairs at national, state, and municipal levels 18 .…”

“…The GMFCS Family Report Questionnaire 9 has been used by parents of children with CP to classify gross motor function and has been shown to be consistent with those of health professionals in studies conducted in both Canada 9 and the UK 10,11 . Such classification may differ due to children's varying performance in relation to methods of mobility 12 in different environments (home, school, hospital). Families will almost certainly know their children's ability across a broader range of settings 11 .…”

“…There is great variability in the mobility of children with CP, which depends on environmental and personal factors 12 . Most of the mothers in this study did not work outside the home, but rather spent the entire day with their children and knew the child's performance in each environment (home, school, community).…”

Confiabilidade do Sistema de Classificação da Função Motora Grossa Ampliado e Revisto (GMFCS E & R) entre estudantes e profissionais de saúde no Brasil

“…The GMFCS E&R translation into Brazilian Portuguese made in accordance with the ones suggested by Center For Childhood Disability Research (CanChild) and made available on their website * was conducted in 2010 by a group of occupational therapists and one neurologist 7 . The validity and reliability of the original version of the GMFCS have been extensively studied and well established among health professionals in different countries (physical therapists, pediatricians, orthopedists, physiatrists, and occupational therapists) 6,8,9,10 , and parents 8,[11][12][13][14][15] , which is also beginning to occur with the extended and revised version (GMFCS E&R) 16 . The GMFCS can easily be incorporated into clinical practice, allowing comparisons of children accompanied by different clinicians with similar functional levels, and also can predict the gross motor function of children with cerebral palsy 17 .…”

The use of the Gross Motor Function Classification System in cerebral palsy registers: quo vadis?

“…As recent studies have shown, families will almost certainly know their children's ability best in a broader range of settings; the family assessment for the GMFCS may be the most suitable method of data collection for registries worldwide. 6,7 This commentary is on the article by Ramstad et al on pages 1013-1018 of this issue.…”