title: A prospective evaluation of the WeeFIM in patients with cerebral palsy undergoing orthopaedic surgery.
abstract: OBJECTIVE
  Although frequently used in pediatric rehabilitation settings, the WeeFIM has not been tested in surgical pediatric orthopaedic patients.
  
  
  METHODS
  The WeeFIM was administered to patients with surgical cerebral palsy at defined intervals preoperatively and at both 6 and 12 months postoperatively. The age-adjusted change scores from baseline to follow-up were tested both parametrically and nonparametrically.
  
  
  RESULTS
  Four hundred sixty-eight patients had baseline evaluations. There were 161 six-month follow-up assessments and 108 twelve-month follow-up assessments. The baseline WeeFIM was able to separate children with different patterns of cerebral palsy. Hemiplegic patients had higher scores than diplegic and tetraplegic patients. Overall age-adjusted scores were improved at both 6 (mean increase 2.0) and 12 months (mean increase 2.2). The instrument showed significant ceiling effects for diplegic and hemiplegic patients with lower or upper extremity surgery and limited responsiveness for lower extremity surgery in tetraplegic patients. Parametrically, it showed improvements in mobility for both rhizotomy and tetraplegic upper extremity surgery. Nonparametric tests were not significant for rhizotomy mobility improvement.
  
  
  CONCLUSIONS
  Although the WeeFIM adequately reflects the severity of neurological involvement in pediatric orthopaedic patients with cerebral palsy, it has a significant ceiling effect in diplegic and hemiplegic patients limiting responsiveness and lacks content validity for tetraplegic patients. The instrument may have some use in tetraplegic patients with upper extremity surgery and in rhizotomy patients. We recommend against its general use for orthopaedic surgery in patients with cerebral palsy lower extremity or spine surgery and in hemiplegic patients with upper extremity surgery.
authors.affiliation: Shriners Hospitals for Children, Erie, PA, USA. jsanders@shrinenet.org
authors.forename: James O
authors.initials: JO
authors.lastname: Sanders
authors.forename: Sharon L
authors.initials: SL
authors.lastname: McConnell
authors.forename: Ron
authors.initials: R
authors.lastname: King
authors.forename: Alice
authors.initials: A
authors.lastname: Lanford
authors.forename: Kathleen
authors.initials: K
authors.lastname: Montpetit
authors.forename: Philip
authors.initials: P
authors.lastname: Gates
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Rich
authors.forename: Karin
authors.initials: K
authors.lastname: Shepherd
authors.forename: Tim
authors.initials: T
authors.lastname: Cupp
authors.forename: Richard
authors.initials: R
authors.lastname: Haynes
authors.forename: Patricia
authors.initials: P
authors.lastname: Bush
authors.forename: Fares
authors.initials: F
authors.lastname: Tahir
authors.forename: Julius
authors.initials: J
authors.lastname: Santiago
authors.forename: Donald E
authors.initials: DE
authors.lastname: Lighter
authors.forename: Cathy
authors.initials: C
authors.lastname: Smrcina
authors.forename: Mark L
authors.initials: ML
authors.lastname: Niederpruem
authors.forename: Craig
authors.initials: C
authors.lastname: McDonald
authors.forename: Darryl B
authors.initials: DB
authors.lastname: Curry
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009043:Motor Activity / Q000502:physiology*; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome