Modeling the distribution and progression of motor ability among children with cerebral palsy: An analysis of three
Rachel Sanderlin1, Charlotte Schluger1, Joe Wu1
1Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA.
Insights
Reference centiles for children with cerebral palsy (CP) show similar longitudinal performance, but caution is advised when applying them in new settings. These tools are generally sufficient for clinical and research use.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Reference centiles for gross motor function are crucial for children with cerebral palsy (CP) in clinical and research settings.
- The generalizability of existing reference centiles to new populations is not well understood.
Purpose of the Study:
- To evaluate the cross-sectional and longitudinal performance of three reference centiles for describing motor function in children with CP (aged 2-12 years).
- To assess the applicability of these centiles in a large, urban US pediatric hospital setting.
Main Methods:
- Retrospective observational study design.
- Cross-sectional performance assessed by quartile distribution analysis.
- Longitudinal performance evaluated using prediction errors and correlations between predicted and observed scores.
Main Results:
- Hanna's reference centiles demonstrated better cross-sectional distribution compared to Duran's.
- Longitudinal prediction errors were generally under 6 GMFM points across various time scales (6-24 months) for all centiles.
- Prediction errors increased with shorter time scales, younger age, and higher motor ability.
Conclusions:
- All three reference centiles exhibited comparable longitudinal performance, making them suitable for most clinical and research applications.
- Differences in cross-sectional performance exist between centile sets.
- Careful consideration is recommended when applying these centiles in settings with varying standards of care.
Background:
Reference centiles describing gross motor function in children with cerebral palsy (CP) are used in clinical and research settings to guide treatments and evaluate interventions. However, it is unknown how existing references generalize to populations in novel settings.
Aims:
The aim of this study is to evaluate the cross-sectional and longitudinal performance of three reference centiles to describe the motor function of children with CP aged 2-12 years at a large urban US pediatric hospital through a retrospective observational study.
Methods:
and Procedures: We assessed cross-sectional performance by ranking our clinical population by quartile distributions described by the references. We assessed longitudinal performance by analyzing the distribution of prediction errors and correlations between predictions and observed scores.
Outcomes And Results:
For cross-sectional distribution, the reference centiles by Hanna more closely described our population than those by Duran. For longitudinal progression, prediction error was less than 6 GMFM points for most records at 24-, 12-, and 6-month time scales for all three sets of reference centiles, but higher at a 48-month time scale. Prediction errors increased at younger ages and higher motor ability.
Conclusions And Implications:
Despite differences in cross-sectional performance, all three reference centiles achieved similar longitudinal performance and are sufficient for most clinical and research uses. Caution should be used when applying these curves to locations with different standards of care.
