Validity and clinical utility of functional assessments in children with cerebral palsy

Abstract

Objective: To examine the validity and clinical utility of functional assessments (1-minute walk test, 10-meter walk test, Timed Up & Go [TUG] test, Timed Up and Down Stairs [TUDS] test, sit-to-stand [STS] test, and lateral step-up [LSU] test).

Design: Cross-sectional study.

Setting: Four special schools for adolescents with physical disabilities.

Participants: Adolescents with spastic tetraplegia and diplegia (at levels I-III) were selected through convenience sampling (N=35; mean age, 14.97±2.03y).

Interventions: Not applicable.

Main outcome measures: GMFM-88 (dimensions D and E), 1-minute walk, 10-meter walk, TUG, TUDS, STS, and LSU tests. Data were analyzed using Pearson intercorrelations, multiple regression analysis, and multivariate analysis of variance (MANOVA).

Results: Significant moderate to high intercorrelations were found. Three significant positive predictors emerged (1-minute walk, 10-meter walk, and LSU) with the following regression equation: YGMFM-88 (dimensions D and E) = 5.708 + .402 × X1-minute walk + .920 × XLSU + .404 × X10-meter walk The MANOVA was significant (Λ=.163, F=14.732, P<.001, η(2)=.596), and post hoc comparisons revealed significant differences across Gross Motor Function Classification System Expanded and Revised levels in all paired comparisons for the 1-minute walk and LSU tests. For the 10-meter walk test, significant differences were evident in the level I versus level III and level II versus level III comparisons. No significant differences were found in the 10-meter walk test between levels I and II.

Conclusions: These functional assessments (1-minute walk, LSU, and 10-meter walk tests) are simple to administer, quick, low cost, and user-friendly. Although these assessments are not a substitute for the criterion standard (GMFM-88), they may be used for a quick assessment in adolescents with cerebral palsy (levels I-III) either at school or during rehabilitation, especially when time is limited.

Keywords: CP; Cerebral palsy; GMFCS E&R; GMFM-66; GMFM-88; Gross Motor Function Classification System Expanded and Revised; Gross Motor Function Measure-66; Gross Motor Function Measure-88; LSU; MANOVA; Outcome and process assessment (health care); Rehabilitation; Reproducibility of results; STS; TUDS; TUG; Timed Up & Go; Timed Up and Down Stairs; cerebral palsy; lateral step-up; multivariate analysis of variance; sit-to-stand.