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Stability of caregiver-reported manual ability and gross motor function classifications of cerebral palsy
Christine Imms1, John Carlin, Ann-Christin Eliasson
1School of Occupational Therapy, La Trobe University, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. c.imms@latrobe.edu.au
Insights
Caregiver reports of children's cerebral palsy (CP) function using the Manual Ability Classification System (MACS) and Gross Motor Function Classification System (GMFCS) were generally stable over 12 months.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Disability Studies
Background:
- Cerebral palsy (CP) affects motor function, impacting daily life.
- Accurate functional classification is vital for intervention planning and research.
- Caregiver-reported measures like the Manual Ability Classification System (MACS) and Gross Motor Function Classification System (GMFCS) are commonly used.
Purpose of the Study:
- To assess the 12-month stability of caregiver-reported functional classifications in children with CP.
- To evaluate consistency in MACS and GMFCS ratings over time.
Main Methods:
- Longitudinal study of 86 children with CP (aged 11y 8mo at baseline).
- Postal surveys collected caregiver-reported MACS and GMFCS data at two time points, 12 months apart.
- Intraclass correlation coefficients (ICC) were calculated to determine classification stability.
Main Results:
- High stability was observed: 67% of caregivers reported the same MACS level (ICC=0.92) and 79% reported the same GMFCS level (ICC=0.95).
- Caregivers not born in Australia or speaking a language other than English at home showed less MACS stability.
- This linguistic/cultural difference was not significant for GMFCS stability.
Conclusions:
- Caregiver-reported MACS and GMFCS classifications demonstrate good 12-month stability in children with CP.
- While generally stable, potential influences of caregiver background on MACS reporting warrant consideration.
Aim:
To examine the stability of caregiver-reported classifications of function of children with cerebral palsy (CP) measured 12 months apart.
Method:
Participants were 86 children (50 males, 36 females) with CP of all motor types and severities who were recruited into a population-based longitudinal study. Children were aged 11 years 8 months (SD 6 mo) on the first assessment and 12 years 8 months (SD 6 mo) on the second assessment. Data were gathered through a postal survey. Caregivers reported on the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and other demographic characteristics. The percentage absolute agreement and the intraclass coefficient correlation (ICC) equivalent of the weighted kappa were calculated to assess consistency between assessments for the MACS and GMFCS. We also examined associations between changes in classification and background variables.
Results:
Fifty-eight caregivers (67%) classified their child at the same MACS level on both assessments (ICC 0.92; 95% confidence interval [CI] 0.87-0.95), whereas 79% did so with the GMFCS (ICC 0.95; 95% CI 0.92-0.96). The evidence suggests that caregivers who were not born in Australia or who spoke a language other than English in the home were more likely to classify their child differently on the MACS at the second assessment, although this was not evident for the GMFCS.
Interpretation:
Caregiver-reported MACS and GMFCS levels were generally stable over 12 months.
