title: Outcome assessments in children with cerebral palsy, part II: discriminatory ability of outcome tools.
abstract: Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to III, participated in this prospective multicenter, cross-sectional study. All tools were completed by parents and participants when appropriate. Effect size indices (ESIs) for parametric variables and odds ratios for non-parametric data quantified the magnitude of differences across GMFCS levels. Binary logistic regression models determined discrimination, and receiver operating characteristic curves addressed sensitivity and specificity. Between Levels I and II, the most discriminatory tools were Gross Motor Function Measure (GMFM-66), velocity, and WeeFIM Mobility. Between Levels II and III, the most discriminatory tools were GMFM Dimension E, Pediatric Functional Independence Measure (WeeFIM) Self-Care and Mobility, cadence, and Gillette Functional Assessment Questionnaire Question 1. Large ESIs were noted for Parent and Child reports of Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function, Parent report of PODCI Global Function, GMFM Dimension E, and GMFM-66 across all GMFCS level comparisons. The least discriminatory tools were the Quality of Life and cognition measures; however, these are important in comprehensive assessments of treatment effects.
authors.affiliation: Shriners Hospital for Children, Northern California Motion Analysis Laboratory, Sacramento, CA 95817, USA. abagley@shrinenet.org
authors.forename: Anita M
authors.initials: AM
authors.lastname: Bagley
authors.forename: George
authors.initials: G
authors.lastname: Gorton
authors.forename: Donna
authors.initials: D
authors.lastname: Oeffinger
authors.forename: Douglas
authors.initials: D
authors.lastname: Barnes
authors.forename: Janine
authors.initials: J
authors.lastname: Calmes
authors.forename: Diane
authors.initials: D
authors.lastname: Nicholson
authors.forename: Diane
authors.initials: D
authors.lastname: Damiano
authors.forename: Mark
authors.initials: M
authors.lastname: Abel
authors.forename: Richard
authors.initials: R
authors.lastname: Kryscio
authors.forename: Sarah
authors.initials: S
authors.lastname: Rogers
authors.forename: Chester
authors.initials: C
authors.lastname: Tylkowski
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000145:classification*; D019957:Motor Skills Disorders / Q000145:classification* / Q000150:complications / Q000175:diagnosis; D009985:Orthopedics / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index