Reliability and validity of the Upper Limb Physician's Rating Scale in children with cerebral palsy

Area of Science:

• Pediatric Rehabilitation
• Neurology
• Movement Science

Background:

• Cerebral palsy (CP) significantly impacts motor function, particularly in the upper limbs of affected children.
• Botulinum toxin type A injections are a common intervention to manage spasticity in children with CP.
• Objective outcome measures are crucial for evaluating the effectiveness of interventions like botulinum toxin therapy.

Purpose of the Study:

• To evaluate the interrater and intrarater reliability of the Upper Limb Physician's Rating Scale (ULPRS).
• To assess the concurrent validity of the ULPRS against the Melbourne Assessment of Unilateral Upper Limb Function (MUUL).
• To determine the clinical utility of the ULPRS as an outcome measure for spastic upper limbs in children with CP.

Main Methods:

• Thirty children with spastic CP (aged 5-13 years) participated in the study.
• The ULPRS was administered by four physicians on two separate occasions using video recordings.
• The MUUL was assessed by an occupational therapist; reliability and validity were analyzed using ICC, kappa, and Pearson correlation coefficients.

Main Results:

• The ULPRS demonstrated high interrater reliability (ICC=0.94) and excellent intrarater reliability (ICC=0.99-1.00).
• Subitem reliability for the ULPRS ranged from substantial to almost perfect agreement.
• A strong positive correlation (r=0.751, p<0.05) was found between the ULPRS and MUUL scores.

Conclusions:

• The ULPRS exhibits high reliability for total scores, both within and between raters.
• The significant concurrent validity with the MUUL supports the ULPRS as a valuable clinical tool.
• The ULPRS is a reliable and valid measure for assessing spastic upper limb function in children with CP.