Variability explained by strength, body composition and gait impairment in activity and participation measures for children with cerebral palsy: a multicentre study

Abstract

Objective: To determine the amount of variability in scores on activity and participation measures used to assess ambulatory individuals with cerebral palsy explained by strength, body composition, gait impairment and participant characteristics. Design: Multicentre prospective cross-sectional study. Setting: Seven paediatric–orthopaedic specialty hospitals. Participants: Three hundred and seventy-seven ambulatory individuals (241 males, 136 females) with cerebral palsy, Gross Motor Function Classification System (GMFCS) levels I–III (I = 148, II = 153, III = 76), ages 8–18 years (mean 12 years 9 months, SD 2 years 8 months). Methods: Participants completed assessments of GMFCS level, patient history, lower extremity muscle strength, Gross Motor Function Measure (GMFM-66), Pediatric Outcomes Data Collection Instrument (PODCI), instrumented gait analysis, 1 minute walk test, Timed Up-and-Go and body composition. Multiple linear regression and bootstrap analyses were performed for each outcome measure, stratified by GMFCS level. Results: The amount of variability in outcome measures explained by participant characteristics, strength, and gait impairment ranged from 11% to 50%. Gait impairment was the most common predictor variable and frequently explained the greatest variance across all outcome measures and GMFCS levels. As gait impairment increased, scores on outcome measures decreased. Strength findings were inconsistent and not a primary factor. Body composition contributed minimally (<4%) in explaining variability. Participant characteristics (cerebral palsy type, gestational age and age at walking onset), were significant predictor variables in several models. Conclusions: Variability in outcome measure scores is multifaceted and only partially explained by strength and gait impairment illustrating the challenges of attempting to explain variation within this heterogeneous population. Clinicians treating individuals with cerebral palsy should consider this when developing treatment paradigms.

Ability of PROMIS Pediatric Measures to Detect Change in Children With Cerebral Palsy Undergoing Musculoskeletal Surgery

“…However, these same procedures may also have adverse effects on mobility activities such as walking, running, or jumping. 7,26 Others have reported similar findings, noting variability in direction of change among measures as well as among subscales within the same measure in children with CP. 7,18,26 …”

Comparison of Gross Motor Outcomes Between Children With Cerebral Palsy From Appalachian and Non-Appalachian Counties

“…The Gross Motor Function Measure, 66 (GMFM-66) was selected as the primary motor outcome measure. This measure is consistently used in clinical care at NCH and is a valid and reliable measure of gross motor development for children with CP 11–16. The GMFM-66 was completed by trained physical or occupational therapists employed at NCH.…”

“…Mean scores on the GMFM-66 are shown in Table 3 by location of habitancy and GMFCS level. Minimal clinical important differences (MCID) in the table were established by Oeffinger et al 15 Participants (GMFCS levels I-III) from Appalachian counties had mean scores on the GMFM that were higher than the MCID compared with participants from non-Appalachian counties.…”

Changes in Ankle Range of Motion, Gait Function and Standing Balance in Children with Bilateral Spastic Cerebral Palsy after Ankle Mobilization by Manual Therapy

“…The gross motor skills of children with CP can be categorized into 5 different levels using the gross motor function classification system (GMFCS). Since the GMFCS level can provide a confounding interpretation of the results, this study used a stratified block randomization form of the level of GMFCS (1 or 2) [ 34 ]. Children with CP were blinded to their treatment.…”