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Stability of the Manual Ability Classification System in young children with cerebral palsy
Author(s) -
Burgess Andrea,
Boyd Roslyn,
Ziviani Jenny,
Chatfield Mark D,
Ware Robert S,
Sakzewski Leanne
Publication year - 2019
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14143
Subject(s) - cerebral palsy , population , pediatrics , medicine , prospective cohort study , physical therapy , surgery , environmental health
Aim To examine the stability over time of the Manual Ability Classification System ( MACS ) levels in children with cerebral palsy ( CP ) aged 18 to 60 months. Method This was a prospective longitudinal population‐based study of 252 Australian children (160 males [63%] 92 females [37%]; mean age [ SD ] 41.7mo [14], range 17.2mo–69.2mo) with CP . Children were classified at 18 months ( n =70), 24 months ( n =131), 30 months ( n =173), 36 months ( n =209), 48 months ( n =226), and 60 months ( n =221) of age. Stability of the MACS was examined using the proportion of specific positive agreement and transition proportions, which are measures of agreement. Results There were 1030 unique observations, with each of the 252 participants seen between two and six occasions (median=4). Average specific positive agreement over the study period was 76% for MACS level I, 67% for level II , 50% for level III , 51% for level IV , and 83% for level V. MACS levels I and V have the highest degree of stability, while levels III and IV have the lowest. We show how this may be explained by the proportion of children in each MACS level. Interpretation Using measures of agreement rather than measures of reliability provides accurate information when measuring stability over time of an ordinal classification system. The relative stability of MACS levels can be explained by the proportion of children in each level. What this paper adds Children classified in Manual Ability Classification System (MACS) levels III and IV change levels at next assessment about 50% of the time. Children should be assessed with the MACS regularly, particularly those in levels III and IV. Stability within ordinal classification level categories can be predicted using a measurement error model. Transition proportions or specific agreement is recommended for reporting stability of ordinal classification systems.