An independent assessment of reliability of the Melbourne Cerebral Palsy Hip Classification System
M W Shrader1, A L Koenig2, M Falk3
1Department of Orthopedics, University of Mississippi, Jackson, Mississippi, USA.
Purpose:
Neuromuscular (NM) hip dysplasia is common in patients with cerebral palsy (CP). Traditionally, migration percentage (MP) has been used to measure the severity of NM hip dysplasia; however, the MP has some limitations. The purpose of this study is to determine the intra- and inter-reliability of the Melbourne Cerebral Palsy Hip Classification System in the typical paediatric population of patients with CP.
Methods:
A total of 65 anteroposterior pelvis radiographs in patients (age range 12 years to 21 years) with CP spanning all grades (I to VI) of the classification system were identified and collected for analysis in this institutional review board approved study. Four paediatric orthopaedic surgeons and one orthopaedic surgical resident classified each radiograph according to the Melbourne system. Then, at least four weeks later, the raters repeated the process with a re-randomised order of radiographs. Statistical analysis was performed using the intraclass correlation coefficient (ICC) where < 0 denotes poor agreement and > 0.8 indicates almost perfect agreement.
Results:
The interobserver reliability was found to be excellent with the ICC of 0.853 (0.813 to 0.887) and 0.839 (0.795 to 0.877). The intraobserver reliability was also found to be excellent with the ICC in the range of 0.838 to 0.933 among the raters. Subgroup analysis indicated no differences in the reliability of observers based on clinical experience.
Conclusion:
This study independently demonstrates that the Melbourne Cerebral Palsy Hip Classification System for NM hip dysplasia in patients with CP can be reliably used for communication among various healthcare providers and research and epidemiological purposes.
Insights
The Melbourne Cerebral Palsy Hip Classification System demonstrates excellent reliability for assessing hip dysplasia in children with cerebral palsy (CP). This system aids communication among healthcare providers and for research purposes.
Area of Science:
- Orthopaedics
- Paediatric Medicine
- Radiology
Background:
- Neuromuscular hip dysplasia is a common complication in patients with cerebral palsy (CP).
- The traditional migration percentage (MP) measurement for hip dysplasia has limitations.
- A reliable classification system is needed for consistent assessment and communication.
Purpose of the Study:
- To evaluate the intra- and inter-observer reliability of the Melbourne Cerebral Palsy Hip Classification System.
- To assess the system's utility in the paediatric population with CP.
Main Methods:
- Analysis of 65 anteroposterior pelvis radiographs from patients (aged 12-21 years) with CP.
- Classification by five orthopaedic surgeons/residents using the Melbourne system.
- Repeat classification after at least four weeks with re-randomized radiographs.
- Statistical analysis using intraclass correlation coefficient (ICC).
Main Results:
- Excellent inter-observer reliability with ICC scores of 0.853 and 0.839.
- Excellent intra-observer reliability, with ICCs ranging from 0.838 to 0.933.
- No significant differences in reliability based on observer clinical experience.
Conclusions:
- The Melbourne Cerebral Palsy Hip Classification System is reliable for assessing hip dysplasia in CP.
- The system facilitates reliable communication among healthcare providers.
- It is suitable for research and epidemiological studies in CP hip dysplasia.
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