Related Experiment Video
Updated: Aug 7, 2026
Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis
Published on: March 23, 2019
A prospective evaluation of the WeeFIM in patients with cerebral palsy undergoing orthopaedic surgery
James O Sanders1, Sharon L McConnell, Ron King
1Shriners Hospitals for Children, Erie, PA, USA. jsanders@shrinenet.org
Insights
The WeeFIM scale shows limitations in assessing functional outcomes for pediatric orthopedic surgery patients with cerebral palsy, particularly due to ceiling effects and content validity issues in certain patient groups.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Cerebral Palsy Research
Background:
- The Functional Independence Measure for Children (WeeFIM) is commonly used in pediatric rehabilitation.
- Its utility in surgical pediatric orthopedic patients with cerebral palsy has not been established.
Purpose of the Study:
- To evaluate the validity and responsiveness of the WeeFIM in pediatric orthopedic patients undergoing surgery for cerebral palsy.
Main Methods:
- The WeeFIM was administered to 468 surgical cerebral palsy patients preoperatively and at 6 and 12 months postoperatively.
- Age-adjusted change scores were analyzed using parametric and nonparametric statistical tests.
Main Results:
- The WeeFIM differentiated between cerebral palsy subtypes (hemiplegic, diplegic, tetraplegic).
- Overall age-adjusted scores improved postoperatively, but significant ceiling effects were observed in diplegic and hemiplegic patients.
- Responsiveness was limited for certain surgical types, especially lower extremity surgery in tetraplegic patients.
Conclusions:
- The WeeFIM reflects neurological severity but has ceiling effects and limited content validity in specific pediatric orthopedic cerebral palsy populations.
- Its use is recommended only for tetraplegic patients with upper extremity surgery and rhizotomy patients.
- General use is not advised for lower extremity/spine surgery or hemiplegic patients with upper extremity surgery.
Purpose:
Although frequently used in pediatric rehabilitation settings, the WeeFIM has not been tested in surgical pediatric orthopaedic patients.
Methods:
The WeeFIM was administered to patients with surgical cerebral palsy at defined intervals preoperatively and at both 6 and 12 months postoperatively. The age-adjusted change scores from baseline to follow-up were tested both parametrically and nonparametrically.
Results:
Four hundred sixty-eight patients had baseline evaluations. There were 161 six-month follow-up assessments and 108 twelve-month follow-up assessments. The baseline WeeFIM was able to separate children with different patterns of cerebral palsy. Hemiplegic patients had higher scores than diplegic and tetraplegic patients. Overall age-adjusted scores were improved at both 6 (mean increase 2.0) and 12 months (mean increase 2.2). The instrument showed significant ceiling effects for diplegic and hemiplegic patients with lower or upper extremity surgery and limited responsiveness for lower extremity surgery in tetraplegic patients. Parametrically, it showed improvements in mobility for both rhizotomy and tetraplegic upper extremity surgery. Nonparametric tests were not significant for rhizotomy mobility improvement.
Conclusions:
Although the WeeFIM adequately reflects the severity of neurological involvement in pediatric orthopaedic patients with cerebral palsy, it has a significant ceiling effect in diplegic and hemiplegic patients limiting responsiveness and lacks content validity for tetraplegic patients. The instrument may have some use in tetraplegic patients with upper extremity surgery and in rhizotomy patients. We recommend against its general use for orthopaedic surgery in patients with cerebral palsy lower extremity or spine surgery and in hemiplegic patients with upper extremity surgery.