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Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication

Robert J Palisano1,2, Lisa Avery2, Jan Willem Gorter2,3

  • 1Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, PA, USA.

Developmental Medicine and Child Neurology
|May 5, 2018
PubMed
Summary
This summary is machine-generated.

The Gross Motor Function Classification System (GMFCS) showed greater stability over time compared to the Manual Ability Classification System (MACS) and Communication Function Classification System (CFCS). Classification stability is crucial for tracking children with cerebral palsy (CP).

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Area of Science:

  • Pediatrics
  • Rehabilitation Medicine
  • Developmental Pediatrics

Background:

  • Cerebral palsy (CP) classification systems like GMFCS, MACS, and CFCS are vital for assessing functional abilities.
  • Understanding the stability of these classifications is essential for accurate long-term monitoring and intervention planning.
  • Parent-therapist consensus is increasingly used to enhance classification reliability.

Purpose of the Study:

  • To evaluate the stability of the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) over 1- and 2-year periods.
  • To assess the reliability of consensus-based classification between parents and therapists for these systems.
  • To compare the stability of GMFCS, MACS, and CFCS in children with CP.

Main Methods:

  • A cohort of 664 children with CP (18 months to 12 years) participated, along with their parents and 90 therapists.
  • Consensus classification between parents and therapists was employed to determine functional levels.
  • Stability was measured using linearly weighted kappa coefficients, with a threshold of ≥0.75 for stability.

Main Results:

  • High parent-therapist agreement (≥92%) was observed for GMFCS, MACS, and CFCS.
  • Kappa coefficients indicated good to excellent stability for GMFCS (0.76–0.88), moderate for MACS (0.59–0.73), and variable for CFCS (0.57–0.77).
  • Classification stability was higher for older children (≥4 years) compared to younger children (<4 years) across all systems.

Conclusions:

  • The GMFCS demonstrates greater stability over time compared to MACS and CFCS, likely due to its age-banded descriptions.
  • Consensus classification is a reliable method for assessing function and supports repeated classifications for children with CP.
  • Findings support the utility of these classification systems for tracking functional changes and informing shared decision-making in the care of children with CP.