Establishing Minimal Clinically Important Differences for Scores on the Pediatric Evaluation of Disability Inventory for Inpatient Rehabilitation

Iyer, Lakshmi V; Haley, Stephen M.; Watkins, Mary P.; Dumas, Helene M.

doi:10.1093/ptj/83.10.888

Cited by 123 publications

(56 citation statements)

References 29 publications

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“…A key factor when considering the clinical utility of a measure is its administrative burden. The Klein-Bell ADL 45 Goodness of fit: 90% to AMPS-M, 95% to AMPS-P (n = 162, 3-15 y, well children) 31 Moderate correlations between AMPS-M and COPM-P r = 0.67, and AMPS-P and COPM-S r = 0.64 (n = 33, 3-15 y, DCD/CP/ASD/other) 46 KGM: Distinguish between healthy individuals and individuals with multiple sclerosis, stroke, Alzheimer and psychiatric disorders 21 No equivalent assessment method Moderate correlation between AMPS and FIM r = -0.62 (persons with dementia) 21 Moderate-excellent correlations between AMPS and SIB r = 0.62-0.85 21 Progression of age-related mean scores; meets assumption of developmental progression of adaptive behaviour 27 Significant difference between 5 out of 7 supplementary norm groups (children and adults with various disabilities) compared to standardisation mean 27 VABS DLS explains variance in GMFCS, cognitive impairment, and age (p < 0.001) (n = 110, 9-13 y, CP) 54 VABS DLS (Personal) and ABILHAND-Kids: adj r 2 = 0.84, MACS adj r 2 = 0.77 VABS DLS (Domestic) and ABILHAND-Kids: adj r 2 = 0.62, MACS adj r 2 = 0.45 (n = 94, 12-16 y, CP) 44 Moderate to strong correlations between VABS DLS and Capacity Profile domains: adj r 2 = 0.85 (n = 94, 12-16 y, CP) 55 WeeFIM Adapted from adult Functional Independence Measure (FIM); review by 8 interdisciplinary experts 56 Principal Component Analysis identified two distinct dimensions: motor and cognitive 28 Direct relationship between WeeFIM Self-Care domain and GMFCS level 57 Discriminates between patterns of CP; ceiling effect for children with hemiplegia and diplegia undergoing lower limb surgery 39 Correlation between PODCI Upper Extremity domain and WeeFIM Self Care: r = 0.68 58 WeeFIM 36 Responsive over time 63,64 and sensitive to change after SDR, 65 CIMT, 34 and botulinum toxin type-A injections: SC domain, 66 Scale requires 60 to 180 minutes for administration which significantly reduces its clinical utility. The ABILHAND-Kids was the quickest assessment to administer and score, taking only 5 to 10 minutes for administration.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of activities of daily living measures for children and adolescents with cerebral palsy

James

Ziviani

Boyd

2013

Develop Med Child Neuro

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AIM This study aimed to systematically review the psychometric properties and clinical utility of measures of activities of daily living (ADL) for children with cerebral palsy (CP) aged 5 to 18 years.METHOD Five electronic databases were searched to identify available ADL measures with published psychometric data for school-aged children with CP. Measures were included if at least 60% of the items addressed ADL in the full assessment or in an independent domain. A modified CanChild Outcome Rating Form was used to report the validity, reliability, responsiveness, and clinical utility of the measures.RESULTS Twenty-six measures were identified and eight met inclusion criteria. The Pediatric Evaluation of Disability Inventory (PEDI) had the strongest psychometric properties but was limited by its age range. The Assessment of Motor and Process Skills (AMPS) was the most comprehensive evaluation of underlying motor and cognitive abilities yet further psychometric testing is required for children with CP.INTERPRETATION The PEDI should be used to measure ADL capability in elementary school aged children. The AMPS is the best measure to evaluate ADL performance or capacity and is suitable for all ages. Future research should examine the reliability of the AMPS to determine its stability in children and adolescents with CP.The focus of assessment and treatment of children with cerebral palsy (CP) has changed in response to the introduction of the International Classification of Functioning, Disability and Health (ICF). 1 The ICF has evolved since its inception and today comprises four components: (1) body structures; (2) body functions; (3) activities and participation; and (4) environmental factors.2 The conceptualisation of disability in the ICF highlights its biopsychosocial nature and emphasises the need to support individuals to achieve optimal capacity and participation in all aspects of life.3 Broadening intervention goals to address all areas of functioning necessitates the identification of outcome measures that capture each aspect. 4 Cerebral palsy is defined as 'a group of permanent disorders of the development of movement and posture, causing activity limitations, that are attributed to non-progressive disturbances which occurred in the developing fetal or infant brain '. 5 Activities of daily living (ADL) are tasks that are fundamental to supporting participation across school, home and community environments. ADL are conceptualised in the 'Activities and Participation' domain of the ICF and defined as life tasks required for self-care and self-maintenance such as grooming, bathing, eating, and doing chores. 6 These tasks are classified as either (1) personal ADL tasks, which are oriented towards self-care (e.g. grooming, bathing); or (2) instrumental ADL tasks, which are oriented towards sustaining independence and require a higher level of physical and cognitive competency than personal ADL (e.g. preparing meals, taking care of pets). 7 Personal ADL are more commonly performed by younger children, whi...

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Section: Discussionmentioning

confidence: 99%

A systematic review of activities of daily living measures for children and adolescents with cerebral palsy

James

Ziviani

Boyd

2013

Develop Med Child Neuro

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“…FOCUS change scores were evaluated to determine whether or not a 'minimal clinically important difference' (MCID) had occurred. A 'minimal clinically important difference' (MCID) is defined as minimal changes in the child's function that are considered to be important to both the clinician and parent (Iyer et al 2003). At the end of treatment, parent and speechlanguage pathologists were independently asked to complete a Parent training = 14% *The top three medical diagnoses for each group are reported.…”

Section: Methodsmentioning

confidence: 99%

Measuring communicative participation using the FOCUS^©: Focus on the Outcomes of Communication Under Six

Thomas‐Stonell

Washington

Oddson

et al. 2013

Child

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BackgroundThe FOCUS© is a new outcome tool for use by both parents and clinicians that measures changes in the communicative participation skills of preschool children. Changes in communicative participation skills as measured by the FOCUS were compared across three groups of children: those with speech impairments only (SI), those with language impairments only (LI) and those with both speech and language impairments (S/LI).MethodsParticipating families (n = 112, 75 male children) were recruited through 13 Canadian organizations. Children ranged from 10 months to 6 years 0 months (mean = 2.11 years; SD = 1.18 years) and attended speech-language intervention. Parents completed the FOCUS at the start and end of treatment. There were 23 children in the SI group, 62 children in the LI group and 27 children in the S/LI group. The average amount of the children's therapy varied from 7 to 10 h.ResultsThe FOCUS captures changes in communicative participation for children with a range of communication disorder types and severities. All three groups of children made clinically important improvements according to their FOCUS scores (MCID ≥ 16 points). The FOCUS captured improvements in intelligibility, independent communication, play and socialization.ConclusionsThe FOCUS measured positive changes in communicative participation skills for all three groups of children after 7–10 h of speech-language therapy. An outcome measure that targets only specific speech and language skills would miss many of the important social function changes associated with speech-language treatment.

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“…8,9 When clinicians are raters, the VAS validly identifies the minimal clinically important difference on the Pediatric Evaluation of Disability Inventory. 10 Based on these two parameters, combined with regular visits to our outpatient department (LS and JSHV), a decision was made with the parents either to continue the drug or taper it off.…”

Section: Methodsmentioning

confidence: 99%

Levetiracetam therapy for treatment of choreoathetosis in dyskinetic cerebral palsy

Vles

Hendriksen

Visschers

et al. 2009

Develop Med Child Neuro

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Dyskinetic cerebral palsy (CP) is a movement disorder that is difficult to treat and which causes major disability. We report on two female patients (aged 5y and 8y) who experienced severe perinatal asphyxia and developed dyskinetic CP, clinically characterized by choreoathetosis. Neuropsychological testing of these children showed a low average developmental quotient and no attentional deficit. Monotherapy with levetiracetam was initiated to improve balance control and fine motor skills. Treatment was evaluated by use of video and the Visual Analog Scale. In both children an impressive improvement of balance control and fine motor skills was observed. No side effect occurred. Furthermore, both patients showed more interest and pleasure during activities according to their parents. In a recent multidisciplinary evaluation of the initiated therapy, the parents, the therapist, and the rehabilitation doctor all confirmed that the effect initially observed was still present at 14 and 26 months later. To our knowledge, this report on two patients with dyskinetic CP is the first suggesting that levetiracetam may offer an alternative to the standard therapy of involuntary, uncontrolled movements in this group of patients.Cerebral palsy (CP) is a non-progressive disorder of posture or movement caused by a lesion of the developing brain. The Surveillance of Cerebral Palsy in Europe (SCPE) has classified CP into three main groups (spastic, dyskinetic, and ataxic), which are based on clear neurological signs indicating pathology in the cerebral motor systems. Dyskinetic CP presents involuntary, uncontrolled, recurring, and, occasionally, stereotyped movements. SCPE uses dystonic and choreoathetotic subtypes for subgrouping dsykinetic CP.1 The pathophysiology of dyskinesia in CP is not fully elucidated, but existing evidence suggests that disorders of the basal ganglia play a role in this entity. The symptomatic treatment of this movement disorder is still very difficult. In a retrospective survey of 22 children with extrapyramidal CP, only a minority showed a functional improvement using trihexyphenidyl, which is a centrally active muscarinic antagonist. 2Several anticonvulsants seem to be efficacious for the treatment of (paroxysmal) involuntary movement disorders. On the basis of a recent report about levetiracetam efficacy in the treatment of movement disorders, we started levetiracetam in two patients with dyskinetic CP unresponsive to conventional drugs mostly used in such cases. 3To our knowledge, this report on two patients with dyskinetic CP, is the first suggesting that levetiracetam may offer an alternative to standard therapy of involuntary, uncontrolled movements in this group of patients. METHODInformed consent of the parents was obtained for both patients. Levetiracetam was only started when the other available drugs usually prescribed failed. Baclofen (GABAagonist) and artane (Muscarine-antagonist) were tried but ª

show abstract

Establishing Minimal Clinically Important Differences for Scores on the Pediatric Evaluation of Disability Inventory for Inpatient Rehabilitation

Cited by 123 publications

References 29 publications

A systematic review of activities of daily living measures for children and adolescents with cerebral palsy

A systematic review of activities of daily living measures for children and adolescents with cerebral palsy

Measuring communicative participation using the FOCUS^©: Focus on the Outcomes of Communication Under Six

Levetiracetam therapy for treatment of choreoathetosis in dyskinetic cerebral palsy

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Establishing Minimal Clinically Important Differences for Scores on the Pediatric Evaluation of Disability Inventory for Inpatient Rehabilitation

Cited by 123 publications

References 29 publications

A systematic review of activities of daily living measures for children and adolescents with cerebral palsy

A systematic review of activities of daily living measures for children and adolescents with cerebral palsy

Measuring communicative participation using the FOCUS©: Focus on the Outcomes of Communication Under Six

Levetiracetam therapy for treatment of choreoathetosis in dyskinetic cerebral palsy

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Product

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Measuring communicative participation using the FOCUS^©: Focus on the Outcomes of Communication Under Six