The Greek Version of Mini-Manual Ability Classification System (Mini-MACS): Translation and Reliability Study

INTRODUCTION

The Mini-Manual Ability Classification System (Mini-MACS) is an adaptation of the MACS for children with cerebral palsy (CP) aged 1-4 years, which classifies children's performance to handle objects that are relevant to their age and development. The availability of a reliable Mini-MACS in Greek would allow for using it safely and properly in the clinical and research context of Greece. Therefore, the purpose of this study was to translate the original English version into Greek and examine its test-retest and interrater reliability.

MATERIAL AND METHODS

The English Mini-MACS was translated into Greek using the "forward-backward" method. Sixty-three children with CP, Gross Motor Function Classification System (GMFCS) levels I-V, aged 12 -50 months were included in the reliability study. Test-retest and interrater reliability were assessed using the interclass correlation coefficient (ICC). The association between Mini-MACS and GMFCS level ratings was also assessed using Spearman's rho correlation coefficient (ρ).

RESULTS

The translated version was easy to understand and use. The Greek Mini-MACS was found to have excellent test-retest reliability (ICC > 0.96) for both parents and therapists, good interrater reliability (ICC=0.89) between therapists and parents, and moderate-to-strong correlation with the GMFCS (ρ = 0.56-0.64, p < 0.0001).

CONCLUSION

The Greek Mini-MACS constitutes a user-friendly and reliable scale for use in the Greek population.

Association between leisure activities and sleep disturbances among children with and without cerebral palsy

Background/Aims

Sleep disturbances are common among children with cerebral palsy, resulting in adverse consequences. Investigating the association between leisure activities and sleep disturbances could help to develop ways to promote their sleep quality. This study primarily aimed to investigate the association between leisure activities and sleep disturbances among children with and without cerebral palsy. The secondary aim was to study the prevalence of sleep disturbances and some of its associated factors.

Methods

A total of 75 children with cerebral palsy (study group) (mean age 10.0 ± 2.5 years) and 75 typically developing children (control group) (mean age 10.5 ± 2.9 years) were randomly selected to completed the Children's Assessment of Participation and Enjoyment. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children. Factors associated with sleep disturbances (age, gender, school attendance, bedroom sharing, type of cerebral palsy, motor functions, eating and drinking ability and communication functions) were statistically analysed and the prevalence of sleep disturbances was calculated.

Results

Overall frequency of leisure participation was strongly correlated with overall sleep disturbances (P<0.001) among both groups. The prevalence of overall sleep disturbances was 17.1% and 10.6% among the study and the control groups respectively. Eating and drinking ability and spastic quadriplegia emerged as the strongest predictors of overall negative scores on the Sleep Disturbance Scale for Children.

Conclusions

Greater participation in leisure activities is associated with better sleep. Occupational therapists are encouraged to consider this association when planning for occupation-based interventions aimed at enhancing occupational performance.

Measurement properties of the Gross Motor Function Classification System, Gross Motor Function Classification System-Expanded & Revised, Manual Ability Classification System, and Communication Function Classification System in cerebral palsy: a systematic review with meta-analysis

AIM

To systematically review and meta-analyse the measurement properties of the Gross Motor Function Classification System (GMFCS), Gross Motor Function Classification System-Expanded & Revised (GMFCS-E&R), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) in children with cerebral palsy (CP).

METHOD

Six databases were searched. Articles on the measurement properties of the GMFCS, GMFCS-E&R, MACS, and CFCS administered to children with CP were included. Quality was assessed by means of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The level and grading of evidence were defined for each measurement property.

RESULTS

Forty-four articles were included in the systematic review and 37 articles were included in the meta-analysis. The level (grading) of evidence was strong (positive) for reliability and construct validity. Content validity displayed an unknown level of evidence for the GMFCS, limited evidence (positive) for the MACS, and moderate evidence (positive) for the CFCS. There was moderate (positive) evidence for measurement error in the GMFCS and MACS. The level of evidence for responsiveness was unknown. No studies investigated cross-cultural validity.

INTERPRETATION

These instruments can be used by health care professionals and caregivers to quantify the constructs needed to measure ability in children with CP. Current high-quality evidence supports the use of these tools to classify ability in children with CP. Adopting the COSMIN guidelines, content, and cross-cultural validity should be investigated further. What this paper adds Strong evidence supports the reliability and construct validity of the GMFCS, GMFCS-E&R, MACS, and CFCS as functional classification systems in children with cerebral palsy. The GMFCS, GMFCS-E&R, MACS, and CFCS can be used by both health care professionals and caregivers. The GMFCS, GMFCS-E&R, MACS, and CFCS should not be used to detect change.

Predictive role of individual factors in the leisure preferences of children and adolescents with cerebral palsy: a cross-sectional study in Iran

Background/Aims

The participation of children and adolescents with cerebral palsy in leisure activities is associated with their preferences. A better understanding of their leisure preferences and the factors that influence them can help therapists to promote young patients' participation in leisure activities. The aim of this study was to describe the role of individual factors in the prediction of leisure preferences of children and adolescents with cerebral palsy in Iran.

Methods

A cross-sectional study design was used. A total of 152 children and adolescents with cerebral palsy were selected to complete the Preferences for Activities of Children questionnaire. Simple and multiple linear regression analyses were performed to assess the role of individual factors in the prediction of preferences for leisure activities.

Results

Individual factors played a significant role in the prediction of leisure preferences. Their influence on the preferences for recreational, physical and self-improvement domains (r2=0.215; 0.154; 0.127, respectively) were greater than for social and skill-based domains (r2=0.045; 0.052, respectively).

Conclusions

Preferences for physical activities need to be augmented while a high preference for social and recreational activities could be used to promote participation in leisure activities. Therapists and other healthcare professionals should consider individual factors relating to leisure preferences when devising therapeutic plans that aim to promote participation in leisure activities.

Effects of transcranial direct current stimulation combined with cognitive orientation to daily occupational performance in children with cerebral palsy: a protocol for a randomised controlled trial

Background/Aims

Children with hemiplegic cerebral palsy have limitations in activities requiring reach and manipulation of objects with their affected upper extremity. Transcranial direct current stimulation and the cognitive orientation to occupational performance approach are relatively new interventions that may lead to promising results for these children. This article describes the method of a randomised clinical trial that will compare the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with transcranial direct current stimulation and neurodevelopmental treatment.

Methods

A four-armed clinical trial with a sample size of 36 participants will be performed in Tehran. Participants will be randomly divided into four groups. Group A will receive neuro-developmental treatment with sham transcranial direct current stimulation, group B will receive neurodevelopmental treatment with transcranial direct current stimulation, group C will receive cognitive orientation to daily occupational performance with sham transcranial direct current stimulation, and group D will receive cognitive orientation to daily occupational performance with transcranial direct current stimulation. The examiner will be blind to the study and assessments will be done at baseline, after the end of the intervention and 1 month after the completion of the intervention (as follow up). Data analysis will be as repeated measure analysis of variance and intention to treat.

Conclusions

This article describes the protocol of a clinical trial that compares the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with the combination of transcranial direct current stimulation and neurodevelopmental treatment on upper extremity goals and functions of children with hemiplegic cerebral palsy.

Validity and reliability of the Persian version of the Eating and Drinking Ability Classification System

Background/Aims

The ability to eat and drink is the most important factor in health, survival and longevity. Children with cerebral palsy can suffer from severe dysphagia, which can lead to a high risk of aspiration and choking. As classifying eating and drinking ability in children with cerebral palsy is important in research and treatment, the aim of this study was to determine the cross-cultural validation and reliability of the Persian version of the Eating and Drinking Ability Classification System.

Methods

After translation procedures, the face validity, content validity, test–retest reliability and interrater reliability of the Eating and Drinking Ability Classification System were evaluated. In total, 130 parents of children with cerebral palsy and 34 therapists participated in the evaluation of the scale's reliability. The 73 boys and 57 girls with cerebral palsy were aged 3–20 years (mean age 4.4 years) and had various types of cerebral palsy. They were classified according to the Eating and Drinking Ability Classification System by both their parents and the therapists.

Results

The overall results indicated that the words and sentences used were simple, clear, understandable, relevant and necessary. The intraclass correlation coefficients for test–retest reliability for parents, occupational therapists and speech therapists were 0.98, 0.98 and 0.995, respectively. The interrater reliability between parents and occupational therapists was 0.96, between parents and speech therapists was 0.95, and between occupational therapists and speech therapists was 0.985.

Conclusions

The Persian version of the Eating and Drinking Ability Classification System seems to be valid and reliable. This system may be used to evaluate children with cerebral palsy.

Participation in leisure-time activities and the role of individual factors in children and adolescents with cerebral palsy

Background/Aims

This study evaluated the role of individual factors of children and adolescents with cerebral palsy in the prediction of leisure participation.

Methods

A cross-sectional study design was used. A group of children and adolescents with cerebral palsy were selected to complete the Children's Assessment of Participation and Enjoyment. Participants' cognitive levels were assessed based on the Study of Participation of Children with Cerebral Palsy Living in Europe estimated cognitive levels.

Findings

The models could best predict up to 31.8% of the variance in the participation rates, 28.4% of the variance in the frequency scores and 33.5% of the variance in the enjoyment scores of leisure domains. The type of cerebral palsy was one of the most significant predictive factors of leisure participation (β ranged from −0.177 to −0.525 for quadriplegia).

Conclusions

Therapists and rehabilitation specialists may consider individual factors to predict a proportion of leisure participation subscales before planning for interventions aimed at promoting the leisure participation of children and adolescents with cerebral palsy.

Cross-cultural psychometric properties of the Persian version of the Measure of Processes of Care for Service Providers questionnaire

Background

The Measure of Processes of Care is the most widely used tool for measuring family-centredness and perceptions of the care process. This study assessed the psychometric properties of the Persian language version of the Measure of Processes of Care for Service Providers questionnaire.

Methods

In a cross-sectional study, the Measure of Processes of Care for Service Providers questionnaire was translated three times based on a backward–forward method. The Persian version of the Measure of Processes of Care for Service Providers was used with 150 health providers in Iran. The Pearson correlation coefficient, Cronbach alpha and interclass correlation coefficient were used for reliability analysis. Content validity index and content validity ratio and confirmatory factor analysis was used for validity assessments.

Results

The test-retest correlation was higher than 0.95 and the interclass correlation coefficient was higher than 0.8 in all domains. The consistency coefficient was calculated as r=0.989 and the Cronbach alpha calculated as 0.994, which varied from 0.978 to 0.994. The content validity index average was 0.97, which varied from 0.90 to 0.99. Moreover, the content validity ratio average calculated 0.726 and ranged from 0.60 to 0.95. The goodness of fit index was acceptable as CMIN =χ2: 411.52, df; 280, P<0.001, CMIN/df; 1.47, root mean square error of approximation: 0.056; P value: 0.19, goodness of fit index and Tucker–Lewis index was 0.951 and 0.938 respectively.

Conclusion

The Persian translation of the Measure of Processes of Care for Service Providers questionnaire is a standard tool for assessing family-centred care with acceptable reliable and valid. It could be used in all health, clinical and rehabilitation centres to assess family-centred care in health care providers and can be an incentive to improve the quality of family-related services.

Reliability of the gross motor function classification system and the manual ability classification system in children with cerebral palsy in Tanzania

OBJECTIVES

Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) are broadly studied in high-income countries, but data concerning their functioning are lacking in developing countries. Therefore, we analyzed their reliability and sensitivity to change in children with cerebral palsy in Tanzania.

METHODS

GMFCS and MACS are two ordinal grading systems used to assess motor functions while observing children's performances. Forty-nine children were classified by two independent physiotherapy students at baseline, after one month and after one year. Reliability and sensitivity to change were analyzed using intraclass correlation coefficient (ICC), effect size (ES), standard response mean (SRM), standard error of measurement (SEM), and minimal detectable change (MDC).

RESULTS

Inter- (ICC = 0.97/0.95 for GMFCS/MACS) and intra-rater reliability (ICC = 0.98/0.96 GMFCS/MACS) were excellent. Sensitivity to change was small (ES = -0.14/0.11, SRM = -0.24;/0.24 GMFCS/MACS). SEM was 0.2 points, resulting in MDC = 0.5/0.7 for GMFCS/MACS, respectively.

CONCLUSIONS

GMFCS and MACS demonstrated excellent reliability, but not sensitivity to change.

Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System

AIM

To determine the stability of the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) over 1-year and 2-year intervals using a process for consensus classification between parents and therapists.

METHOD

Participants were 664 children with cerebral palsy (CP), 18 months to 12 years of age, one of their parents, and 90 therapists. Consensus between parents and therapists on level of function was ≥92% for the GMFCS, MACS, and CFCS. A linearly weighted kappa coefficient of ≥0.75 was the criterion for stability.

RESULTS

Kappa coefficients varied from 0.76 to 0.88 for the GMFCS, 0.59 to 0.73 for the MACS, and 0.57 to 0.77 for the CFCS. For children younger than 4 years of age, level of function did not change for 58.2% on the GMFCS, 30.3% on the MACS, and 39.3% on the CFCS. For children 4 years of age or older, level of function did not change for 72.3% on the GMFCS, 49.1% on the MACS, and 55% on the CFCS.

INTERPRETATION

The findings support repeated classification of children over time. The kappa coefficients for the GMFCS are attributed to descriptions of levels for each age band. Consensus classification facilitates discussion between parents and professionals that has implications for shared decision-making.

WHAT THIS PAPER ADDS

The findings support repeated classification of children over time. Stability was higher for the Gross Motor Function Classification System than the Manual Ability Classification System and Communication Function Classification System. The function of younger children was more likely to be reclassified. Percentage agreement between parents and therapists using consensus classification varied from 92% to 97%. The intraclass correlation coefficient overestimated stability compared with the weighted kappa coefficient.

Validation of Persian Caregivers' Report of Quality of Life questionnaire for adolescents with cerebral palsy

Background/Aims:

There is no tool in Persian to examine quality of life for adolescents with cerebral palsy based on their specific conditions. Therefore, the purpose of this study was to assess the psychometric properties of the Persian version of the caregivers' report of the Quality of Life questionnaire for adolescents with cerebral palsy (CP QOL).

Methods:

In this psychometric measurement study, the CP QOL (caregivers' report) was translated into Persian, and then its content validity, and construct validity were examined. A convenience sample of subjects including 82 parents of adolescents with cerebral palsy (13–18 years) were recruited for this study. Then, the relationship between the participants' quality of life and their level of gross motor and hand function was assessed.

Findings:

Internal consistency for all the questions of the questionnaire were high (0.78–0.92). There was also a significant and weak correlation between all domains of quality of life and the adolescents' gross motor function and manual abilities.

Conclusions:

The Persian version of the caregivers' report of the CP QOL-Teen has acceptable content validity. It is a useful tool for evaluating the quality of life of adolescents with cerebral palsy.

Effectiveness of cognitive orientation to (daily) occupational performance (CO-OP) on children with cerebral palsy: A mixed design

BACKGROUND

Cerebral palsy (CP) is the most common cause of physical disabilities during childhood. Therapeutic interventions mainly focus on impairment reduction to address motor-based difficulties. In contrast, Cognitive Orientation to daily Occupational Performance (CO-OP) is a cognitive approach, providing intervention at the level of activity and participation.

AIMS

This study aims to determine whether the CO-OP approach improves motor skills and achievement in motor-based occupational performance goals in children with CP.

METHODS AND PROCEDURES

In this mixed design research (i.e., a multiple baseline single case experimental design and a one-group pretest-posttest design), five children with CP participated in 12 CO-OP intervention sessions. Repeated measures of motor skills for the multiple baseline single case experimental design were taken using the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP); pre- and post-measures of parent/child perception of performance and satisfaction were identified using the Canadian Occupational Performance Measure (COPM); level of achievement was identified using Goal Attainment Scaling (GAS).

OUTCOMES AND RESULTS

According to the BOTMP results, all children were able to engage in the CO-OP intervention to improve motor performance. Significant differences after treatment were found in both performance and performance satisfaction ratings using the COPM as rated by parents and children. The GAS results showed progress in achievement levels for all children; all goals were achieved or exceeded.

CONCLUSIONS AND IMPLICATIONS

CO-OP intervention can be helpful in improving motor skills and achieving self-identified, motor-based goals in children with CP.

Reliability and Responsiveness of Upper Limb Motor Assessments for Children With Central Neuromotor Disorders

Background. To investigate the effectiveness of upper limb rehabilitation, sound measures of upper limb function, capacity, and performance are paramount. Objectives. This systematic review investigates reliability and responsiveness of upper limb measurement tools used in pediatric neurorehabilitation. Methods. A 2-tiered search was conducted up to July 2014. The first search identified upper limb motor assessments for 1- to 18-year-old children with neuromotor disorders. The second search examined the psychometric properties of the tools. Methodological quality was rated according to COSMIN guidelines, and results for each tool were assembled in a “best evidence synthesis.” Furthermore, we delineated whether tools were unimanual or bimanual tests and if they measured recovery or did not distinguish between physiological and compensatory movements. Results. The first search delivered 2546 hits. Of these, 110 articles on 51 upper limb assessment tools were included. The second search resulted in 58 studies on reliability, 11 on measurement error, and 10 on responsiveness. Best evidence synthesis revealed only 2 assessments with moderate positive evidence for reliability, whereas no evidence on measurement error and responsiveness was found. The Melbourne Assessment showed moderate positive evidence for interrater and a fair positive level of evidence for intrarater reliability. The Pediatric Motor Activity Log Revised revealed moderate positive evidence for test–retest reliability. Conclusions. There is a lack of high-quality studies about psychometric properties of upper limb measurement tools in children with neuromotor disorders. To date, upper limb rehabilitation trials in children and adolescents risk being biased by insensitive measurement tools lacking reliability.

The Communication Function Classification System: cultural adaptation, validity, and reliability of the Farsi version for patients with cerebral palsy

BACKGROUND

This study developed a Farsi language Communication Function Classification System and then tested its reliability and validity.

METHODS

Communication Function Classification System is designed to classify the communication functions of individuals with cerebral palsy. Up until now, there has been no instrument for assessment of this communication function in Iran. The English Communication Function Classification System was translated into Farsi and cross-culturally modified by a panel of experts. Professionals and parents then assessed the content validity of the modified version. A backtranslation of the Farsi version was confirmed by the developer of the English Communication Function Classification System. Face validity was assessed by therapists and parents of 10 patients. The Farsi Communication Function Classification System was administered to 152 individuals with cerebral palsy (age, 2 to 18 years; median age, 10 years; mean age, 9.9 years; standard deviation, 4.3 years). Inter-rater reliability was analyzed between parents, occupational therapists, and speech and language pathologists. The test-retest reliability was assessed for 75 patients with a 14 day interval between tests.

RESULTS

The inter-rater reliability of the Communication Function Classification System was 0.81 between speech and language pathologists and occupational therapists, 0.74 between parents and occupational therapists, and 0.88 between parents and speech and language pathologists. The test-retest reliability was 0.96 for occupational therapists, 0.98 for speech and language pathologists, and 0.94 for parents.

CONCLUSIONS

The findings suggest that the Farsi version of Communication Function Classification System is a reliable and valid measure that can be used in clinical settings to assess communication function in patients with cerebral palsy.

The Manual Ability Classification System: A Scoping Review

PURPOSE

To examine the use of the Manual Ability Classification System (MACS) and to identify gaps in the literature by conducting a thorough search of existing publications from 2006 to March 2013.

METHODS

An extensive literature search included 15 databases, using the search terms "Manual Ability Classification System" or "MACS" to retrieve relevant abstracts.

RESULTS

A total of 161 articles were identified for final inclusion. The review identified literature that supports the reliability, validity, and stability of the MACS.

CONCLUSIONS

The MACS could be considered as a standard classification for children with cerebral palsy on the basis of manual abilities. The MACS can be reliably used for children between 4 and 18 years and adults between 18 and 24 years. The use of the MACS is expected to increase; further work is required to explore the use of the MACS in clinical practice.