Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?

Area of Science:

• Rehabilitation Medicine
• Pediatric Neurology
• Clinical Epidemiology

Background:

• The Gross Motor Function Classification System (GMFCS) is a widely used tool for classifying motor function in children with cerebral palsy.
• Its application in populations other than cerebral palsy (CP) has not been systematically reviewed.
• Understanding its use and limitations outside CP is crucial for appropriate application and development of new tools.

Purpose of the Study:

• To review the application of the GMFCS in populations other than CP.
• To assess the justifications and psychometric adequacy for its use in these populations.
• To provide recommendations for the development of condition-specific or generic gross motor function classification systems.

Main Methods:

• A comprehensive literature search was conducted in PubMed, MEDLINE, and Embase databases from January 1997 to April 2017.
• Search terms included 'GMFCS' and 'Gross Motor Function Classification System'.
• 118 articles meeting inclusion criteria were analyzed for GMFCS application, study type, modifications, and justification.

Main Results:

• The GMFCS was applied to 133 health conditions/clinical descriptions outside of CP.
• Common applications included categorization, use as an independent variable, and as an outcome measure.
• Researchers rarely provided adequate justification or evidence of psychometric adequacy for using GMFCS in these diverse populations.

Conclusions:

• The GMFCS is frequently used in populations beyond CP, often inappropriately.
• There is a need for condition-specific classification systems or a generic system for gross motor function.
• Recommendations are provided for the development and validation of robust classification systems.