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Stability of the gross motor function classification system
Robert J Palisano1, David Cameron, Peter L Rosenbaum
1Program in Policy Decision-making, McMaster University, Hamilton, Ontario, Canada. robert.j.palisano@drexel.edu
Insights
The Gross Motor Function Classification System (GMFCS) demonstrates excellent stability in children with cerebral palsy (CP), with most remaining in their initial classification over time.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) significantly impacts gross motor function in children.
- The Gross Motor Function Classification System (GMFCS) is a widely used tool for classifying motor function in CP.
- Assessing the longitudinal stability of GMFCS is crucial for understanding disease progression and treatment effectiveness.
Purpose of the Study:
- To evaluate the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP).
- To determine if children with CP maintain their GMFCS level over time.
- To provide evidence supporting the reliability of GMFCS for tracking motor development.
Main Methods:
- Longitudinal study involving 610 children with CP, assessed 2-7 times.
- Classifications were made at 6-month intervals for children under 6 years and 12-month intervals for those 6 years and older.
- Statistical analysis using weighted kappa coefficients to measure agreement between initial and final GMFCS ratings.
Main Results:
- 73% of children with CP remained in the same GMFCS level throughout the study.
- Excellent chance-corrected agreement was observed (kappa = 0.84 for <6 years, 0.89 for >=6 years).
- Children in GMFCS Levels I and V were least likely to be reclassified; younger children tended towards lower levels if reclassified.
Conclusions:
- The GMFCS demonstrates high stability in classifying gross motor function in children with cerebral palsy.
- Findings support the use of GMFCS as a reliable measure for assessing motor function over time in pediatric CP populations.
- The GMFCS provides a consistent framework for monitoring functional status and outcomes in children with CP.
Abstract:
The aim of this study was to assess the stability of the Gross Motor Function Classification System (GMFCS) by examining whether children with cerebral palsy (CP) remain in the same level over time. Participants were 610 children with CP (342 males, 268 females; mean age 6y 9mo [SD 2y 10mo]), range 16mo-13y). Children were assessed 2 to 7 times (mean 4.3) at 6-month (children <6y old) or 12-month(children >or=6y old) intervals. Seventy-three per cent of children remained in the same level for all ratings. The weighted kappa coefficient between the first and last ratings was 0.84 for children less than 6 years old and 0.89 for children at least 6 years old, indicating excellent chance-corrected agreement. Children initially classified in Levels I and V were least likely to be reclassified. There was a tendency for children younger than 6 years who were reclassified to be done so to a lower level of ability. The results provide evidence of stability of the GMFCS.
