Date Presented 04/06/19
The psychometric properties examined in this research study will enable evidence-informed decision making for OTs to select robust assessment tools when working with children with cerebral palsy. This study reports on the significantly better ability of the Upper-Extremity Cerebral Palsy Profile of Health and Function Computerized Adaptive Test in detecting a change in UE function of children with cerebral palsy when compared to other measures.
Primary Author and Speaker: Namrata Grampurohit
Contributing Authors: Mary Slavin, Pengsheng Ni, Alan Jette, MaryJane Mulcahey
PURPOSE: The Cerebral Palsy Profile of Health and Function (CP-PRO) computerized adaptive tests are quality of life measures developed specifically for use in children with cerebral palsy (Haley et al., 2009; Tucker et al., 2009). Prior to using an outcome measure in research or clinical practice, it is important to determine the ability of the measure to detect change. This study examines the ability of the Upper Extremity (UE) CP-PRO computerized adaptive test to detect a change in function following UE surgery, as compared to legacy measures, including the Pediatric Outcomes Data Collection Instrument (PODCI) and ABILHAND-Kids, and a performance measure, the Box and Blocks test.
DESIGN: The repeated measures quasi-experimental design was utilized for this multicenter study and recruited children and youth with cerebral palsy who had UE musculoskeletal surgery from 2009 to 2013. The children were included if they had a confirmed diagnosis of cerebral palsy and parent or caregiver spoke English or Spanish and was willing to complete the assessments. The children were excluded if they had surgery for reasons other than functional improvements and were receiving Botox® injections without surgery.
METHODS: Children with cerebral palsy completed the UE CP-PRO computerized adaptive test, PODCI-UE, ABILHAND-Kids, and Box and Blocks test measures preoperatively (97 children) and at three postoperative intervals: 6-month (80 children), 12-month (73 children), and 24-month (52 children). Mean, standard deviation, effect size, and standardized response mean values for each measure, at each time interval, and each level of the Manual Ability Classification System were calculated and compared. Finally, minimal detectable change at the 90% confidence level was determined.
RESULTS: The effect size (0.40) and standardized response mean (0.53) for the UE CP-PRO computerized adaptive test at baseline to 6 months were moderate and significantly greater than the PODCI-UE (effect size=0.18; standardized response mean=0.25). The effect size and standardized response mean for legacy and performance measures were not significantly greater than the UE CP-PRO computerized adaptive test at any time period. From baseline to 6 months, UE CP-PRO CAT detected a large significant improvement for Manual Ability Classification System level-II (standardized response mean=0.70; effect size=0.70). The minimal detectable change for UE CP-PRO computerized adaptive test was 5.20.
CONCLUSIONS: The UE CP-PRO computerized adaptive test is significantly better in detecting a change in UE function in the first six months after UE musculoskeletal surgery in children with cerebral palsy and comparable to other measures at 12 and 24 months. The results of this study can impact the selection of assessment tools by occupational therapy practitioners when working with children with cerebral palsy.
References
Haley, S. M., Fragala-Pinkham, M. A., Dumas, H. M., Ni, P., Gorton, G. E., Watson, K., … Tucker, C. A. (2009). Evaluation of an Item Bank for a Computerized Adaptive Test of Activity in Children With Cerebral Palsy. Physical Therapy, 89(6), 589–600. http://doi.org/10.2522/ptj.20090007
Tucker, C. A., Montpetit, K., Bilodeau, N., Dumas, H. M., Fragala-Pinkham, M. A., Watson, K., … Haley, S. M (2009) Development of a parent-report computer-adaptive test to assess physical functioning in children with cerebral palsy II: upper-extremity skills. Developmental Medicine & Child Neurology. 51(9):725-31. doi:10.1111/j.1469-8749.2009.03267.x
