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Stability of the Gross Motor Function Classification System in children and adolescents with cerebral palsy: a
Ann Alriksson-Schmidt1,2, Eva Nordmark3, Tomasz Czuba4
1Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden.
Insights
The Gross Motor Function Classification System (GMFCS) demonstrates stability in children with cerebral palsy (CP). Factors influencing changes in GMFCS levels were analyzed, revealing transient shifts are more common than permanent ones.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- The Gross Motor Function Classification System (GMFCS) is a widely used tool for classifying motor function in children with cerebral palsy (CP).
- Understanding the stability and factors influencing GMFCS changes is crucial for accurate prognosis and intervention planning.
Purpose of the Study:
- To investigate the long-term stability of the GMFCS in a large population-based sample of children with CP.
- To identify factors that may influence changes in GMFCS levels over time.
Main Methods:
- Retrospective cohort registry study utilizing data from a CP follow-up program in Sweden.
- Inclusion criteria: children with CP and at least two GMFCS ratings.
- Analysis included subtype, sex, age at ratings, time between ratings, number of assessors, and birth cohort using descriptive statistics and logistic regression.
Main Results:
- Analysis of 736 children with CP (born 1990-2007) with 7922 assessments (1995-2014).
- 56% maintained the same GMFCS rating throughout; median of 11 ratings per child.
- Downward GMFCS changes (improved function) were more frequent in levels II and III; upward changes (declined function) were least likely in unilateral spastic CP.
Conclusions:
- The findings support the inherent stability of the GMFCS classification.
- This study provides further insights into the dynamic properties of GMFCS, highlighting factors associated with observed changes.
Aim:
To investigate the stability and to determine factors that affect change in the Gross Motor Function Classification System (GMFCS) in a sample from the total population with cerebral palsy (CP) in two regions of Sweden.
Method:
Retrospective cohort registry study based on the follow-up programme for CP. Children with CP and a minimum of two GMFCS ratings were included. Subtype, sex, ages at GMFCS ratings, time between ratings, number of ratings, assessor change, and birth cohort were analysed in relation to initial GMFCS levels, with descriptive statistics and logistic regression models.
Results:
Ninety-three per cent (n=736) of children with CP born between 1990 and 2007 were included, resulting in 7922 assessments between 1995 and 2014. Fifty-six per cent of the children received the same GMFCS rating at all assessments, with a median of 11 individual GMFCS ratings (range 2-21) and a median of three different assessors (range 1-10). Changes were often transient; downward change (higher performance) was more likely in GMFCS levels II and III than in the other levels. The probability of upward change (lower performance) was lowest in unilateral spastic CP.
Interpretation:
The results support the stability of the GMFCS shown previously and add new information on the properties of the classification.
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