title: Classification of manual abilities in children with cerebral palsy under 5 years of age: how reliable is the Manual Ability Classification System?
abstract: OBJECTIVE
  To assess the interobserver reliability of the Manual Ability Classification System (MACS) in young children (age 1-5 years) with cerebral palsy.
  
  
  METHODS
  Interobserver reliability study.
  
  
  METHODS
  A cross-sectional study of a hospital-based population of children with cerebral palsy.
  
  
  METHODS
  Thirty children, 18 boys and 12 girls between 1 and 5 years of age (mean age 2.5 years +/- 14.2 SD, Gross Motor Function Classification System level I-IV).
  
  
  METHODS
  the children were classified by means of the MACS by two independent observers. Interobserver reliability was analysed using Cohen's kappa.
  
  
  RESULTS
  Overall interobserver reliability of the MACS for children aged 1-5 years was moderate, with a linear weighted kappa (kappa) of 0.62 (95% confidence interval (CI) 0.49-0.76). According to the generally accepted categories of agreement, reliability was moderate for children under 2 years of age (kappa = 0.55), and good for children between 2 and 5 years of age (kappa = 0.67).
  
  
  CONCLUSIONS
  Classification of manual ability of young children with cerebral palsy is possible between 2 and 5 years of age. For children younger than 2 years old, it should be done with caution. Further development of the MACS for children under 5 years of age is recommended with an emphasis on age-appropriate descriptions of manual abilities.
authors.affiliation: Sophia Rehabilitation Center, Delft, The Netherlands. v.plasschaert@sophiarevalidatie.nl
authors.forename: V F P
authors.initials: VF
authors.lastname: Plasschaert
authors.forename: M
authors.initials: M
authors.lastname: Ketelaar
authors.forename: M G
authors.initials: MG
authors.lastname: Nijnuis
authors.forename: L
authors.initials: L
authors.lastname: Enkelaar
authors.forename: J W
authors.initials: JW
authors.lastname: Gorter
mesh_terms: D000367:Age Factors; D002547:Cerebral Palsy / Q000145:classification* / Q000453:epidemiology / Q000534:rehabilitation*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006225:Hand; D006801:Humans; D007223:Infant; D008297:Male; D009048:Motor Skills / Q000145:classification*; D015588:Observer Variation; D015203:Reproducibility of Results