Parents' and therapists' perceptions of the content of the Manual Ability Classification System, MACS

Abstract

The Manual Ability Classification System (MACS) is a newly developed five-level classification that describes how children with cerebral palsy (CP) use their hands when handling objects in daily life. Since the MACS level is to be determined by asking the parents or someone else who knows the child well, it is important that the classification is meaningful and easy to understand. The aim of this study was to investigate the content validity based on parents' and therapists' descriptions of the children's ability to use their hands in daily manual tasks. Twenty-five children were represented by a parent and a therapist. After a short presentation of MACS, the respondents rated the child's MACS level. Subsequently, in a short interview, they described their thoughts about the child's ability, the classification, and the scoring process. Parents and therapists found that MACS gives a good description of how children with CP use their hands in daily activities. They found the differences between the five levels meaningful and generally easy to determine. A unique description of the children's ability at each level confirmed the validity. This provided evidence which strengthened the content validity of MACS in a descriptive way. Additional information complementing the existing leaflet could facilitate the scoring process.

Upper limb function and deformity in cerebral palsy: a review of classification systems

“…17 The MACS is also recommended by this review as a suitable tool for classifying upper limb function as it has evidence of interrater reliability 10,30,31 and content validity. 10,11 However, Plasschaert et al 31 advocated cautious use of the system in children with CP under the age of 2 years because of lower reliability values compared with children aged between 2 and 5 years (j=0.55 and 0.67 respectively). Moreover, the studies that evaluated the validity of the MACS 10,11 only included children between 8 and 12 years of age.…”

“…10,11 However, Plasschaert et al 31 advocated cautious use of the system in children with CP under the age of 2 years because of lower reliability values compared with children aged between 2 and 5 years (j=0.55 and 0.67 respectively). Moreover, the studies that evaluated the validity of the MACS 10,11 only included children between 8 and 12 years of age. As a result it is not clear whether it is possible to evaluate validly manual ability using the MACS in younger children.…”

“…The MACS enables classification of manual ability, and when used with the GMFCS gives a broad overview of an individual's capabilities. 11 The purpose of classification tools is to discriminate between individuals at one point in time. Although less complex than other means of assessment, upper limb classification systems are used by many health-care professionals, and thus require full evaluation for psychometric rigor including validity and reliability.…”

The Manual Ability Classification System

“…Its content validity has been established through focus groups, literature review, and detailed interviews. 7,11 Reliability is supported by ICC values greater than 0.75 (regarded as "excellent reliability") 23 for children between 4 and 18 years of age and adults aged between 18 and 24 years, although it was not originally designed for the adult population. Substantial agreement 24 has been obtained for classification of children between 2 and 5 years of age but only moderate agreement 21 for children under 2 years.…”

“…7 Content validity was further explored by interviews with parents and therapists. 11 Findings in these validity studies demonstrated that the descriptions of each level and the difference between the levels of the MACS are clear and meaningful in describing the performance of manual tasks of children with CP. In this scoping review, 9 publications were identified, which focused on reliability of the MACS.…”