Gross Motor Function Classification System: impact and utility

Morris, Christopher; Bartlett, Doreen

doi:10.1111/j.1469-8749.2004.tb00436.x

Cited by 175 publications

(64 citation statements)

References 65 publications

(62 reference statements)

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“…Formal CP classification methods, such as the GMFCS, have been developed in order to standardize the clinical variability, which is one of the major characteristics of CP 3) . In addition, the GMFCS is now extensively used in developmental research and clinical practice 4) , and its relation with measures of gait 5) , energy efficacy 6) , participation restriction 7) , and healthrelated quality of life 8) in the population with CP has been explored. It has been noted that traditional classification systems describing CP type by limb distribution (hemiplegia, diplegia, and quadriplegia), albeit useful for clinical and epidemiological purposes, have limited value as indicators of mobility.…”

Section: Introductionmentioning

confidence: 99%

The Reliability and Concurrent Validity of the GMFCS for Children with Cerebral Palsy

Woo

Her

2011

J Phys Ther Sci

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Abstract.[Purpose] To determine inter-rater and intra-rater reliability using video recordings, and the concurrent validity of the Gross Motor Function Classification System (GMFCS).[Subjects] The subjects who were assessed were 71 children with cerebral palsy (CP; 46 boys, 25 girls) who were divided into three age groups according to the GMFCS guidelines; 0-2 years, 2-4 years, and 4-6 years.[Methods] Eleven pediatric physical therapists rated 71 video recordings of children with CP to test inter-rater reliability. Two of them rescored the same video recordings to test intra-rater reliability at an interval of one month. Concurrent validity was evaluated by comparing GMFCS levels with the subscale of the Pediatric Evaluation of Disability Inventory (PEDI) such as self-care, mobility, and social ability.[Results] By age group, inter-rater reliability was high (ICC = 0.994, 0.993, and 0.996 respectively). Intra-rater reliability was also high (ICC = 0.972-0.996), and correlation was higher between GMFCS level and the mobility domain of PEDI than between GMFCS level and non-motor domains of PEDI. [Conclusion] This study confirmed the reliability and validity of the GMFCS, supporting its use in clinical practice and research.

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Section: Introductionmentioning

confidence: 99%

The Reliability and Concurrent Validity of the GMFCS for Children with Cerebral Palsy

Woo

Her

2011

J Phys Ther Sci

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“…It is represented by a 5-point ordinal scale in which the higher the level, the less able the child. It is now used extensively in developmental research and clinical practice, 3 and its relation with measures of gait, 4,5 energy efficiency, 4,6 participation restriction, 7 and health-related quality of life [8][9][10] in the population with CP has been explored. Although increasing numbers of papers lend weight to the validity of the GMFCS, 1,4,11,12 very few papers have explored the reliability of the classification system.…”

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confidence: 99%

Interobserver agreement of the Gross Motor Function Classification System in an ambulant population of children with cerebral palsy

McDowell

Kerr

Parkes

2007

Develop Med Child Neuro

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Gross Motor Function Classification System (GMFCS) level was reported by three independent assessors in a population of children with cerebral palsy (CP) aged between 4 and 18 years (n=184; 112 males, 72 females; mean age 10y 10mo [SD 3y 7mo]). A software algorithm also provided a computed GMFCS level from a regional CP registry. Participants had clinical diagnoses of unilateral (n=94) and bilateral (n=84) spastic CP, ataxia (n=4), dyskinesia (n=1), and hypotonia (n=1), and could walk independently with or without the use of an aid (GMFCS Levels I-IV). Research physiotherapist (n=184) and parent/guardian data (n=178) were collected in a research environment. Data from the child's community physiotherapist (n=143) were obtained by postal questionnaire. Results, using the kappa statistic with linear weighting (κ κ lw ), showed good agreement between the parent/guardian and research physiotherapist (κ κ lw =0.75) with more moderate levels of agreement between the clinical physiotherapist and researcher (κ κ lw =0.64) and the clinical physiotherapist and parent/guardian (κ κ lw =0.57). Agreement was consistently better for older children (>2y). This study has shown that agreement with parent report increases with therapists' experience of the GMFCS and knowledge of the child at the time of grading. Substantial agreement between a computed GMFCS and an experienced therapist (κ κ lw =0.74) also demonstrates the potential for extrapolation of GMFCS rating from an existing CP registry, providing the latter has sufficient data on locomotor ability.In 1997 Palisano et al. 1 presented an alternative approach to the classification of cerebral palsy (CP) with publication of the Gross Motor Function Classification System (GMFCS). Based upon the concepts of disability and functional limitation as laid out by the World Health Organization, 2 it classifies children on the level of their motor ability. It is represented by a 5-point ordinal scale in which the higher the level, the less able the child. It is now used extensively in developmental research and clinical practice, 3 and its relation with measures of gait, 4,5 energy efficiency, 4,6 participation restriction, 7 and health-related quality of life [8][9][10] in the population with CP has been explored. Although increasing numbers of papers lend weight to the validity of the GMFCS, 1,4,11,12 very few papers have explored the reliability of the classification system. Palisano et al.'s landmark paper 1 demonstrated good interrater reliability (κ=0.75) between all five GMFCS levels in 40 children with CP aged 2 to 12 years. A subsequent study demonstrated excellent interrater reliability between a developmental paediatrician and a senior physiotherapist using retrospective chart review. 13 In two recent studies 14,15 a concise questionnaire, used to obtain family report of GMFCS level, demonstrated excellent reliability with that assigned by various health professionals.So far, no study has reported the feasibility of assigning a child with CP to a GMFCS level using data it...

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“…1,2,4 Since the original description by Palisano et al 1 in 1997, the GMFCS has become widely accepted, widely used, and is considered by many to be an essential tool to communicate about gross motor function in CP. 5,6 The GMFCS is a valid and reliable classification tool which is expected to be relatively stable over time, with or without intervention. Palisano et al 3 reported that 73% of 610 children with CP remained at the same GMFCS level at multiple ratings over time, and McCormick et al 7 found that GMFCS level at age 12 years was highly predictive of adult gross motor function.…”

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confidence: 99%

Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Rutz

Tirosh

Thomason

et al. 2012

Develop Med Child Neuro

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ABBREVIATIONS FMSFunctional Mobility Scale GPS Gait Profile Score SEMLS Single-event multilevel surgery AIM There are conflicting reports about the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) after orthopaedic surgery. We studied the stability of the GMFCS in children with bilateral spastic CP after single-event multilevel surgery, using the Gait Profile Score (GPS) as the primary outcome measure.METHOD This was a retrospective cohort study of 107 children (46 females, 61 males) with bilateral spastic CP, classified as GMFCS level II or III, who underwent surgery at a single tertiary institution between 1997 and 2008. The mean age at surgery was 10 years 7 months (SD 2y 8mo). The primary outcome measure was the GPS. Changes in GMFCS level were studied at multiple time points before and after intervention.RESULTS Gait dysfunction was partially corrected, with a mean improvement of 28% in the GPS.The GMFCS remained stable and unchanged in 95% of children and improved by one level in 5% of children. The improvement in GPS was three times the minimal clinically important difference. The mean age at final postoperative GPS assessment was 11 years 10 months (SD 2y 10mo) and at final GMFCS assessment was 15 years 7 months (SD 3y 9mo).INTERPRETATION Stability of the GMFCS was confirmed in the majority of children with bilateral spastic CP after single-event multilevel surgery, despite statistically and clinically significant improvements in gait dysfunction and functional mobility. This information is important in realistic goal-setting and in counselling families.The Gross Motor Function Classification System (GMFCS) is a standardized method to classify gross motor function in children with cerebral palsy (CP) from 1 to 18 years of age. 1,2It is a five-level categorical grading system which classifies differences in gross motor function that are meaningful and significant to children with CP and their families.3 Distinctions between GMFCS levels are based on functional limitations with an emphasis on sitting and walking and the need for assistive devices and wheeled mobility. Children may be quickly and easily classified at any given time, such as during a clinic appointment or gait laboratory assessment, by determining which level best corresponds to the child's current gross motor function. A set of age-appropriate descriptive criteria are used and good correlations have been demonstrated between classifications assigned by parents and by health professionals. 1,2,4 Since the original description by Palisano et al. 1 in 1997, the GMFCS has become widely accepted, widely used, and is considered by many to be an essential tool to communicate about gross motor function in CP. 5,6The GMFCS is a valid and reliable classification tool which is expected to be relatively stable over time, with or without intervention. Palisano et al. 3 reported that 73% of 610 children with CP remained at the same GMFCS level at multiple ratings over time , and McCormick et ...

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Gross Motor Function Classification System: impact and utility

Cited by 175 publications

References 65 publications

The Reliability and Concurrent Validity of the GMFCS for Children with Cerebral Palsy

The Reliability and Concurrent Validity of the GMFCS for Children with Cerebral Palsy

Interobserver agreement of the Gross Motor Function Classification System in an ambulant population of children with cerebral palsy

Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

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