title: The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability.
abstract: The Manual Ability Classification System (MACS) has been developed to classify how children with cerebral palsy (CP) use their hands when handling objects in daily activities. The classification is designed to reflect the child's typical manual performance, not the child's maximal capacity. It classifies the collaborative use of both hands together. Validation was based on the experience within an expert group, a review of the literature, and thorough analysis of children across a spectrum of function. Discussions continued until consensus was reached, first about the constructs, then about the content of the five levels. Parents and therapists were interviewed about the content and the description of levels. Reliability was tested between pairs of therapists for 168 children (70 females, 98 males; with hemiplegia [n=52], diplegia [n=70], tetraplegia [n=19], ataxia [n=6], dyskinesia [n=19], and unspecified CP [n=2]) between 4 and 18 years and between 25 parents and their children's therapists. The results demonstrated that MACS has good validity and reliability. The intraclass correlation coefficient between therapists was 0.97 (95% confidence interval 0.96-0.98), and between parents and therapist was 0.96 (0.89-0.98), indicating excellent agreement.
authors.affiliation: Neuropaediatric Research Unit, Astrid Lindgren Children's Hospital, Stockholm, Sweden. ann-christin.eliasson@kbh.ki.se
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Eliasson
authors.forename: Lena
authors.initials: L
authors.lastname: Krumlinde-Sundholm
authors.forename: Birgit
authors.initials: B
authors.lastname: Rösblad
authors.forename: Eva
authors.initials: E
authors.lastname: Beckung
authors.forename: Marianne
authors.initials: M
authors.lastname: Arner
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Ohrvall
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenbaum
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000145:classification* / Q000706:statistics & numerical data; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D033182:Intention; D008297:Male; D019957:Motor Skills Disorders / Q000145:classification* / Q000209:etiology; D015588:Observer Variation; D010243:Paralysis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013223:Statistics as Topic