title: Determinants of functional independence and quality of life in children with spina bifida.
abstract: OBJECTIVE
  To investigate determinants of functional independence and study which functional abilities were determinants for 'health-related quality of life' in children with myelomeningocele.
  
  
  METHODS
  Cross-sectional study by means of clinical assessment, 'disability' measurement and questionnaires. Uni- and multivariate logistic regression models were used to investigate factors that were determinants for these outcomes. Results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI).
  
  
  METHODS
  Outpatient spina bifida clinic at a university hospital.
  
  
  METHODS
  One hundred and twenty-two children with myelomeningocele. Mean age 7.9; range 1-18 years.
  
  
  METHODS
  Functional independence as measured by the Pediatric Evaluation of Disability Inventory (PEDI), and quality of life as measured by the Spina Bifida Health Related Quality of Life Questionnaire.
  
  
  RESULTS
  Lesion level below L3 (OR 0.4, 95% CI 0.1-1.0), mental status of IQ > or =80 (OR 4.2, 95% CI 1.2-14.9), having no contractures in lower extremities (OR 3.4, 95% CI 1.3-8.8), and having normal strength of knee extensor muscles (OR 4.1, 95% CI 1.4-11.5) were most strongly associated with independence in self-care. Mental status (OR 16.1, 95% CI 2.8-93.9), having no contractures in lower extremities (OR 1.5, 95% CI 1.4-5.3), and normal strength in knee extensors (OR 11.0, 95% CI 1.3-97.0) were the most important determinants for independence in mobility. Concerning functional abilities, being independent with regard to mobility was the most important determinant for 'health-related quality of life' (OR 5.3, 95% CI 1.6-17.4).
  
  
  CONCLUSIONS
  In children with myelomeningocele, good muscle strength, mental ability and being independent in mobility appeared to be much more important for daily life function and quality of life than other medical indicators of the disorder.
authors.affiliation: Department of Paediatric Physiotherapy, Room KB 02.056.0, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands. M.A.G.C.Schoenmakers@umcutrecht.nl
authors.forename: M A G C
authors.initials: MA
authors.lastname: Schoenmakers
authors.forename: C S P M
authors.initials: CS
authors.lastname: Uiterwaal
authors.forename: V A M
authors.initials: VA
authors.lastname: Gulmans
authors.forename: R H J M
authors.initials: RH
authors.lastname: Gooskens
authors.forename: P J M
authors.initials: PJ
authors.lastname: Helders
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006801:Humans; D007223:Infant; D007717:Knee / Q000503:physiopathology; D016015:Logistic Models; D008591:Meningomyelocele / Q000503:physiopathology* / Q000523:psychology*; D008603:Mental Health; D018482:Muscle, Skeletal / Q000503:physiopathology; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires