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Classification of patient-defined hand-arm treatment goals in young people with cerebral palsy and upper extremity
Rosanna M van Ossenbruggen1, Heleen Beckerman2,3, Miryam C Obdeijn4,5
1Faculty of Medicine, Personalized Medicine, VU University, Amsterdam, The Netherlands.
Purpose:
To classify and evaluate patient-defined hand-arm treatment goals in young people with cerebral palsy (CP) undergoing upper extremity surgery.
Materials And Methods:
Patient-defined hand-arm treatment goals were collected from young people with CP and upper extremity spasticity using a semi-structured Canadian Occupational Performance Measure interview. Goals were classified within the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). Inter-rater agreement of the classification was assessed. Frequencies of goals were analyzed, with subgroup analyses across Manual Ability Classification System (MACS) levels.
Results:
Twenty-one participants (62% male; mean age 16.3 years, SD 3.9) reported 107 goals. All but two goals were classified within the Activities and Participation domain with perfect inter-rater agreement (100%). Inter-rater agreement for ICF-CY third- and fourth-level categories was 79.9%. The most frequent categories were grasping (20.5%) and manipulating (11.0%). Patients with MACS-levels IV-V mainly reported goals related to self-care and pain. Patients with MACS-levels I-III focused on bimanual activities.
Conclusion:
Patient-defined hand-arm treatment goals were successfully classified to the Activities and Participation domain, with variation across manual ability levels. Classification into ICF-CY third- and fourth-level categories is anticipated to enhance the development of individualized treatment plans.

