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Correspondence of classifications between parents of children with cerebral palsy aged 2 to 6 years and therapists
Ashlyn T Jewell1, Ashley I Stokes, Doreen J Bartlett
1School of Physical Therapy, Faculty of Health Science, The University of Western Ontario, London, Ontario, Canada.
Insights
Parents and therapists show substantial agreement and reliability when using the Gross Motor Function Classification System (GMFCS) for children with cerebral palsy. This tool aids in assessing motor function in young children with cerebral palsy.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) significantly impacts motor function in children.
- Accurate assessment of motor function is crucial for effective intervention and management.
- The Gross Motor Function Classification System (GMFCS) is a standard tool for classifying motor function in CP.
Purpose of the Study:
- To evaluate the agreement and reliability of parent-reported GMFCS classifications compared to therapist classifications.
- To assess the utility of a lay version of the GMFCS for parent use in children with CP.
Main Methods:
- Study included 132 parents and their children with CP aged 2-6 years.
- Parents completed the GMFCS Family Report Questionnaire, while therapists used the GMFCS.
- Agreement assessed via precise agreement and Cohen's kappa; reliability via intraclass correlation coefficient (ICC).
Main Results:
- Precise agreement between parents and therapists was 77%.
- Chance-corrected agreement (kappa) was 0.70 (95% CI 0.61-0.79), indicating substantial agreement.
- Reliability (ICC) was 0.95 (95% CI 0.93-0.96), demonstrating high reliability.
Conclusions:
- Parental reporting using a lay GMFCS version shows substantial agreement and reliability with therapist assessments for children aged 2-6 years.
- A slight tendency for parents to over-report functional limitations was observed.
- Findings support the use of parent-reported GMFCS as a valuable tool in managing children with cerebral palsy.
Aim:
The aim of this study was to determine the agreement and reliability of parent report using a lay version of the Gross Motor Function Classification System (GMFCS) among children with cerebral palsy in the two youngest age bands.
Method:
Data were obtained from the Canadian section of the Movement and Participation in Life Activities of Young Children study database. One hundred and thirty-two parents of two groups of children participated: children aged 2 to 4 years (35 males, 26 females; mean age 3y 2mo; SD 5mo) and children aged 4 to 6 years (39 males, 32 females; mean age 4y 11mo; SD 6mo) at the final data collection point. Therapists classified motor function using the GMFCS and parents used the GMFCS Family Report Questionnaire, with parents and therapists being masked to the others' responses. Agreement between respondents was determined using precise agreement and Cohen's unweighted kappa statistic. Reliability between respondents was determined using the intraclass correlation coefficient (ICC).
Results:
Overall, precise agreement was 77%, chance-corrected agreement was κ = 0.70 (95% confidence interval [CI] 0.61-0.79), and reliability was ICC = 0.95 (95% CI 0.93-0.96).
Interpretation:
These values indicate substantial agreement and reliability between parents of children aged 2 to 6 years and therapists. Some parents had a tendency to rate their children as more functionally limited than did therapists, leading us to question whose the true criterion standard' rating should be.
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