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Interobserver agreement of the Gross Motor Function Classification System in an ambulant population of children with cerebral palsy
Author(s) -
McDowell Brona C,
Kerr Claire,
Parkes Jackie
Publication year - 2007
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/j.1469-8749.2007.00528.x
Subject(s) - gross motor function classification system , cerebral palsy , physical therapy , kappa , medicine , population , spastic , cohen's kappa , pediatrics , physical medicine and rehabilitation , psychology , environmental health , philosophy , linguistics , machine learning , computer science
Gross Motor Function Classification System (GMFCS) level was reported by three independent assessors in a population of children with cerebral palsy (CP) aged between 4 and 18 years ( n =184; 112 males, 72 females; mean age 10y 10mo [SD 3y 7mo]). A software algorithm also provided a computed GMFCS level from a regional CP registry. Participants had clinical diagnoses of unilateral ( n =94) and bilateral ( n =84) spastic CP, ataxia ( n =4), dyskinesia ( n =1), and hypotonia ( n =1), and could walk independently with or without the use of an aid (GMFCS Levels I‐IV). Research physiotherapist ( n =184) and parent/guardian data ( n =178) were collected in a research environment. Data from the child's community physiotherapist ( n =143) were obtained by postal questionnaire. Results, using the kappa statistic with linear weighting (κ 1w ), showed good agreement between the parent/guardian and research physiotherapist (κ 1w =0.75) with more moderate levels of agreement between the clinical physiotherapist and researcher (κ 1w =0.64) and the clinical physiotherapist and parent/guardian (κ 1w =0.57). Agreement was consistently better for older children (>2y). This study has shown that agreement with parent report increases with therapists’experience of the GMFCS and knowledge of the child at the time of grading. Substantial agreement between a computed GMFCS and an experienced therapist (κ 1w =0.74) also demonstrates the potential for extrapolation of GMFCS rating from an existing CP registry, providing the latter has sufficient data on locomotor ability.