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The Cerebral Palsy Profile of Health and Function: Upper-Extremity Domain's Sensitivity to Change Following
Namrata Grampurohit1, Mary Slavin2, Pengsheng Ni2
1Department of Occupational Therapy, College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA.
Insights
The upper-extremity Cerebral Palsy Profile of Health and Function (CP-PRO) Computerized Adaptive Test (CAT) effectively detects functional changes after surgery in children with cerebral palsy. It shows superior sensitivity in the initial six months post-operation compared to other common measures.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Quality of Life Measurement
Background:
- Cerebral palsy (CP) significantly impacts a child's quality of life and functional abilities.
- Assessing functional changes after upper-extremity (UE) surgery in children with CP is crucial for guiding treatment and rehabilitation.
- Existing measures may have limitations in detecting subtle functional improvements post-intervention.
Purpose of the Study:
- To evaluate the efficacy of the upper-extremity Cerebral Palsy Profile of Health and Function (CP-PRO) Computerized Adaptive Test (CAT) in detecting functional changes after UE surgery.
- To compare the sensitivity of the UE CP-PRO CAT against established measures like the Pediatric Outcomes Data Collection Instrument (PODCI), ABILHAND-Kids, and the Box and Blocks test.
Main Methods:
- A longitudinal study involving children with CP undergoing UE musculoskeletal surgery.
- Data collected pre-surgery and at 6, 12, and 24 months post-surgery using UE CP-PRO CAT, PODCI-UE, ABILHAND-Kids, and Box and Blocks tests.
- Statistical analysis included calculating effect size (ES) and standardized response mean (SRM) to compare measure sensitivity.
Main Results:
- The UE CP-PRO CAT demonstrated moderate and significantly greater effect sizes (ES=0.40, SRM=0.53) from baseline to 6 months compared to PODCI-UE (ES=0.18, SRM=0.25).
- No other tested measures showed significantly greater sensitivity than the UE CP-PRO CAT at any time point.
- The UE CP-PRO CAT detected significant improvement in Manual Ability Classification System level II patients (SRM=0.70, ES=0.70) within 6 months.
Conclusions:
- The UE CP-PRO CAT is a highly sensitive tool for detecting changes in upper-extremity function in the crucial first six months after surgery in children with CP.
- Its performance is comparable to other established measures at 12 and 24 months post-surgery.
- The UE CP-PRO CAT offers a valuable, sensitive method for monitoring functional recovery and informing clinical decisions.
Purpose:
The Cerebral Palsy Profile of Health and Function (CP-PRO) Computerized Adaptive Tests (CAT) are quality of life measures developed specifically for use in children with cerebral palsy. This study examined the ability of the upper-extremity (UE) CP-PRO CAT to detect change in function after UE surgery compared with the Pediatric Outcomes Data Collection Instrument (PODCI), ABILHAND-Kids, and Box and Blocks test.
Methods:
From 2009 to 2013, children with cerebral palsy who had UE musculoskeletal surgery completed the UE CP-PRO CAT, PODCI-UE, ABILHAND-Kids, and Box and Blocks tests before surgery (97 children) and at 3 postoperative intervals: 6 months (80 children), 12 months (73 children), and 24 months (52 children). Mean, SD, effect size (ES), and standardized response mean (SRM) values for each measure at each time interval and each level of the Manual Ability Classification System were calculated and compared. Finally, the minimal detectable change at the 90% confidence level was determined.
Results:
Values for the ES (0.40) and SRM (0.53) for the UE CP-PRO CAT at baseline to 6 months were moderate and significantly greater than the PODCI-UE (ES, 0.18; SRM, 0.25). The ES and SRM for the PODCI-UE, ABILHAND-Kids, and Box and Blocks tests were not significantly greater than for the UE CP-PRO CAT at any period. From baseline to 6 months, the UE CP-PRO CAT detected a large and significant improvement for Manual Ability Classification System level II (SRM, 0.70; ES, 0.70). The minimal detectable change for the UE CP-PRO CAT was 5.20.
Conclusions:
The UE CP-PRO CAT is significantly better in detecting change in UE function in the first 6 months after surgery and is comparable to other measures at 12 and 24 months.
Type Of Study/Level Of Evidence:
Diagnostic II.