Gross Motor Function Classification System in patients with cerebral palsy: interobserver reliability between parents and orthopaedic specialists

Abstract

Background: The widely used Gross Motor Function Classification System (GMFCS) was designed to improve understanding and subsequent treatment of children with cerebral palsy. Previous studies investigating reliability between physician and family report of GMFCS have focused on limited age groups or mobility levels. The current study aims to investigate the GMFCS agreement between pediatric orthopaedic healthcare professionals (HCP) and families across all age groups for children with cerebral palsy. Methods: A total of 124 participants completed this prospective study at an orthopaedic children’s hospital. The HCP and family classified the mobility level of each child with cerebral palsy using the GMFCS. Each group was blinded to the other’s assessment of the child. Agreement reliability in GMFCS assessment between parents of children with cerebral palsy and HCP was determined. Results: The interclass correlation coefficient between parents and HCP was 0.92. There was agreement between HCP and parents in 69% of the children evaluated. These findings are similar to results of previous studies. Of those in which there was disagreement, 97% differed by one GMFCS level. In those that differed, the parents provided a lower functional level in 54%, in contrast to previous studies that reported much higher percentages. Conclusions: These findings add to the reliability of the GMFCS being used as a tool for effective communication between HCP and parents of those children with cerebral palsy across all age groups. This reliability can assist with the development of goals and expectations for that child.

Measurement properties of the Gross Motor Function Classification System, Gross Motor Function Classification System‐Expanded & Revised, Manual Ability Classification System, and Communication Function Classification System in cerebral palsy: a systematic review with meta‐analysis

“…The GMFCS was cited in 24 of the studies included 2,4,30,32–34,36,37,40,41,43,50–55,57–59,65,67–69 . The tool was administered to 3164 children (42% female, mean age 7y 4mo).…”

“…The GMFCS was cited in 24 of the studies included. 2,4,30,[32][33][34]36,37,40,41,43,[50][51][52][53][54][55][57][58][59]65,[67][68][69] The tool was administered to 3164 children (42% female, mean age 7y 4mo). Intra-and inter-rater reliability, measurement error, responsiveness, construct validity, and cross-cultural validity were evaluated; 1714 raters were involved in reliability studies (1321 parents; 393 health care professionals).…”

“…The GMFCS was adapted cross-culturally into Brazilian Portuguese 37 according to the guidelines by Beaton et al 70 The Japanese version 41 was translated from English into Japanese by one of the authors of the study. The Greek 32 Very good Chagas et al 33 Very good Choi et al 34 Doubtful Very good El et al 35 Doubtful Eliasson et al 4 Adequate Very good Doubtful Gorter et al 36 Adequate Hidecker et al 6 Very good Adequate Hiratuka et al 37 Doubtful Hustad et al 38 Doubtful Very good Jang et al 39 Adequate Ko et al 40 Very good Very good Kondo et al 41 Doubtful L€ owing et al 42 Very good Very good Mayson et al 68 Doubtful McDowell et al 69 Doubtful Morris et al 43 Adequate Morris et al 44 Doubtful Mutlu et al 45 Doubtful Mutlu et al 46 Doubtful Very good € Ohrvall and Eliasson 47 Doubtful € Ohrvall et al 48 Very good € Ohrvall et al 49 Very good Oskoui et al 50 Very good Palisano et al 2 Adequate Inadequate Palisano et al 3 Inadequate Palisano et al 51 Very good Papavasiliou et al 52 Adequate Park et al 53 Very good Peck et al 54 Doubtful Piscitelli et al 55 Adequate Adequate Very good Inadequate Plasschaert et al 56 Very good Randall et al 57 Very good Riyahi et al 58 Adequate Adequate Sanz Mengibar et al 59 Adequate Very good Shi et al 60 Adequate Adequate Silva et al 61 Very good Silva et al…”