title: The gross motor function classification system for cerebral palsy and single-event multilevel surgery: is there a relationship between level of function and intervention over time?
abstract: BACKGROUND
  The purpose of this study was to determine what effect, if any, an intervention such as Single-event multilevel orthopaedic surgery (SEMLS) might have on the relative stability of the gross motor function classification system (GMFCS) for cerebral palsy over a 5-year time period.
  
  
  METHODS
  Eighty-four children with spastic cerebral palsy who underwent SEMLS were included. The patients had an average of 5.45 procedures during surgery. Mean age at the time of surgery was 6 years. Two blinded physical therapists applied the GMFCS to functional descriptions extracted from outpatient clinical records. The patients were rated preoperatively, 1, 2, and 5 years postoperatively.
  
  
  RESULTS
  Interrater reliability was high, Kw=0.90. Friedman's nonparametric repeated measures analysis of variance was conducted comparing the GMFCS classification levels of the patients preoperatively and 1, 2, and 5 years after SEMLS. The patients as a group showed a significant change to a lower GMFCS classification postsurgery (P<0.001). Children classified at levels I and V of the GMFCS preoperatively showed lesser likelihood of changing functional levels postsurgery.
  
  
  CONCLUSIONS
  The results of this investigation support the concept that interventions, especifically SEMLS, can affect the stability of the GMFCS classification. The majority of children in this study showed changes in gross motor function classification as reflected by lower GMFCS scores after SEMLS intervention. We also found that changes were maintained over a period of 5 years. The results of this study suggest that certain interventions, such as SEMLS, might have an effect on the stability of the GMFCS and that effect may be level-dependent.
  
  
  METHODS
  Retrospective Study by Review of Medical Records. Level III in the Therapeutic Study investigating results of treatment category.
authors.affiliation: Department of Orthopaedics and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA. ellen.godwin@downstate.edu
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Godwin
authors.forename: Charles R
authors.initials: CR
authors.lastname: Spero
authors.forename: Leah
authors.initials: L
authors.lastname: Nof
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Rosenthal
authors.forename: John L
authors.initials: JL
authors.lastname: Echternach
mesh_terms: D002547:Cerebral Palsy / Q000145:classification* / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D002648:Child; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009048:Motor Skills; D018482:Muscle, Skeletal / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome