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ABSTRACT: The aim of this article was to determine item measurement properties of a set of items selected from the Gillette Functional Assessment Questionnaire (FAQ) and the Pediatric Outcome Data Collection Instrument (PODCI) using Rasch analysis, and to explore relationships between the FAQ/PODCI combined set of items, FAQ walking scale level, Gross Motor Function Classification System (GMFCS) levels, and the Gait Deviation Index on a common measurement scale.
Rasch analysis was performed on data from a retrospective chart review of parent-reported FAQ and PODCI data from 485 individuals (273 males; 212 females; mean age 9 y 10 mo, SD 3 y 10 mo) who underwent first-time three-dimensional gait analysis. Of the 485 individuals, 289 had a diagnosis of cerebral palsy (104 GMFCS level I, 97 GMFCS level II, 69 GMFCS level III, and 19 GMFCS level IV). Rasch-based person abilities and item difficulties based on subgroups defined by the FAQ walking scale level, Gait Deviation Index, and the GMFCS level were compared.
The FAQ/PODCI item set demonstrated necessary Rasch characteristics to support its use as a combined measurement scale. Item groupings at similar difficulty levels were consistent with the mean person abilities of subgroups based on FAQ walking scale level, Gait Deviation Index, and GMFCS level.
Rasch-derived person ability scores from the FAQ/PODCI combined item set are consistent with clinical measures. Rasch analysis provides insights that may improve interpretation of the difficulty of motor functions for children with disabilities.
Developmental Medicine & Child Neurology 03/2012; 54(5):443-50. · 2.92 Impact Factor
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ABSTRACT: Aim To determine dimensionality and item-level properties of the Gillette Functional Assessment Questionnaire (FAQ) 22-item skill set using factor and Rasch analyses.Method A retrospective review of parent-reported FAQ 22-item skill set data was conducted of 485 individuals (273 males, 212 females; mean age 9y 10mo, SD 3y 10mo), including 289 with cerebral palsy and 196 with a variety of other neuromusculoskeletal conditions with orthopedic impairments. Factor analyses to validate unidimensionality of the skill set and Rasch analyses to determine relative item difficulty, item and test level information, and content coverage of the item set were performed. Differential item functioning analysis of sub-groups based on sex, diagnosis grouping, and age was conducted. Precision of score estimates for the item set was analyzed.Results The FAQ 22-item skill set demonstrates unidimensional structure and good item fit statistics. No floor or ceiling effects were noted. Differential item functioning (DIF) based on age was noted for seven items, four items showed diagnosis group-related DIF, and one item sex-related DIF. Precision was adequate in the mid-range range of abilities.Interpretation Based on this analysis, the FAQ 22-item skill set is a hierarchical set of interval scaled items suitable for measuring locomotor skill ability in children.
Developmental Medicine & Child Neurology 02/2011; 53(3):250 - 255. · 2.92 Impact Factor
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ABSTRACT: To determine dimensionality and item-level properties of the Gillette Functional Assessment Questionnaire (FAQ) 22-item skill set using factor and Rasch analyses.
A retrospective review of parent-reported FAQ 22-item skill set data was conducted of 485 individuals (273 males, 212 females; mean age 9 y 10 mo, SD 3 y 10 mo), including 289 with cerebral palsy and 196 with a variety of other neuromusculoskeletal conditions with orthopedic impairments. Factor analyses to validate unidimensionality of the skill set and Rasch analyses to determine relative item difficulty, item and test level information, and content coverage of the item set were performed. Differential item functioning analysis of sub-groups based on sex, diagnosis grouping, and age was conducted. Precision of score estimates for the item set was analyzed.
The FAQ 22-item skill set demonstrates unidimensional structure and good item fit statistics. No floor or ceiling effects were noted. Differential item functioning (DIF) based on age was noted for seven items, four items showed diagnosis group-related DIF, and one item sex-related DIF. Precision was adequate in the mid-range range of abilities.
Based on this analysis, the FAQ 22-item skill set is a hierarchical set of interval scaled items suitable for measuring locomotor skill ability in children.
Developmental Medicine & Child Neurology 11/2010; 53(3):250-5. · 2.92 Impact Factor
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ABSTRACT: Aim Children and adolescents highly value their ability to participate in relevant daily life and recreational activities. The Activities Scale for Kids–performance (ASKp) instrument measures the frequency of performance of 30 common childhood activities, and has been shown to be valid and reliable. A revised and expanded 38-item ASKp (ASKp38) version has been reported in recent literature and is currently used in clinical research. The aim of this paper is to assess the factor structure and item-level statistics of the ASKp38.Method Our study used factor analyses and Rasch analyses to determine the item-set dimensionality and to calculate item-level statistics respectively, for existing ASKp38 data from 200 children (104 males; 96 females; mean age 12y 7mo; SD 2y 8mo; range 6–20y) with physical disabilities. The children had a variety of physical impairments including cerebral palsy (n=105; range 8–13y), limb salvage (n=18; range 11–20y), arthrogryposis (n=13; 6–17y), and other, including individuals with spina bifida and spinal cord injury (n=64; 8–19y).Results A two-factor model, with components of activities of daily living and play, most optimally fit the data. Item-fit statistics based on this two-factor model demonstrated adequate fit and content coverage.Interpretation The ASKp38 appears to consist of two factors, defined as (1) activities of daily living and (2) play, and may be used to measure the frequency of activity performance on two corresponding subscales.
Developmental Medicine & Child Neurology 10/2010; 53(2):161 - 166. · 2.92 Impact Factor
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ABSTRACT: Children and adolescents highly value their ability to participate in relevant daily life and recreational activities. The Activities Scale for Kids-performance (ASKp) instrument measures the frequency of performance of 30 common childhood activities, and has been shown to be valid and reliable. A revised and expanded 38-item ASKp (ASKp38) version has been reported in recent literature and is currently used in clinical research. The aim of this paper is to assess the factor structure and item-level statistics of the ASKp38.
Our study used factor analyses and Rasch analyses to determine the item-set dimensionality and to calculate item-level statistics respectively, for existing ASKp38 data from 200 children (104 males; 96 females; mean age 12y 7mo; SD 2y 8mo; range 6-20y) with physical disabilities. The children had a variety of physical impairments including cerebral palsy (n = 105; range 8-13 y), limb salvage (n = 18; range 11-20y), arthrogryposis (n = 13; 6-17y), and other, including individuals with spina bifida and spinal cord injury (n = 64; 8-19 y).
A two-factor model, with components of activities of daily living and play, most optimally fit the data. Item-fit statistics based on this two-factor model demonstrated adequate fit and content coverage.
The ASKp38 appears to consist of two factors, defined as (1) activities of daily living and (2) play, and may be used to measure the frequency of activity performance on two corresponding subscales.
Developmental Medicine & Child Neurology 10/2010; 53(2):161-6. · 2.92 Impact Factor
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ABSTRACT: Children with brachial plexus birth palsy (BPBP) may undergo shoulder external rotation tendon transfers (ERTT) to improve function. In terms of outcome measurements, and according to the World Health Organization International Classification of Functioning, Disability, and Health model, ERTT reduces impairment as measured by range of motion (ROM), but has not been shown to improve activity and participation. Furthermore, correlation between these outcome measures has not been established. The Pediatric Outcomes Data Collection Instrument (PODCI) is a well-validated musculoskeletal health questionnaire that addresses activity and participation components of function. The aim of this study is to determine whether PODCI scores improve after ERTT, and whether this improvement correlates with improvement in ROM.
A total of 23 children with a mean age of 6.3 years (range, 4.4-12.8 years) with BPBP and standard indications for ERTT underwent preoperative and 1-year postoperative shoulder ROM measurements, and parental completion of the PODCI. Change in ROM was compared with change in PODCI scores to determine if these were correlated.
Average range of active shoulder abduction improved 35 degrees (P < 0.001), and average range of active external rotation improved 41 degrees (P < 0.001). The PODCI scores for Upper Extremity Function, Sports Function, and Global Function improved (12 points [P < 0.001], 4 points [P = 0.04], and 6 points [P = 0.001], respectively). Improvement in ROM did not correlate with improvement in PODCI scores. However, postoperative peak active abduction correlated strongly with postoperative PODCI scores for Upper Extremity Function, and Global Function (rs = 0.712 [P < 0.001], rs = 0.735 [P < 0.001], respectively), and moderately with Transfers and Basic Mobility and Sports Function scores (rs = 0.496 [P=0.016], rs = 0.449 [P = 0.032], respectively).
For children with BPBP, ERTT is associated with reduced impairment and improved activity and participation. Maximum postoperative abduction is positively associated with PODCI scores, but change in ROM is not. Further study is needed to determine if ceiling effects or other factors account for the lack of correlation between these outcome measures.
Level of evidence IV, case series.
Journal of Pediatric Orthopaedics 03/2008; 28(2):259-64. · 1.16 Impact Factor
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ABSTRACT: Kinematic studies of abnormal upper extremity (UE) motion provide the unique and valuable perspective of motion analysis during simulated functional tasks. However, they require comparison with healthy control data. Obtaining this control data usually entails testing a healthy population, which can be costly and time consuming, requiring separate subject inclusion criteria, recruitment, and institutional review board approval. The kinematics of the unimpaired UE in people with unilateral impairment have not been analyzed and documented. The purpose of this study was to compare UE motion during activities of daily living in the contralateral unimpaired arm of subjects with brachial plexus birth palsy (BPBP) with an age-matched control population.
The contralateral arms of 40 subjects with unilateral BPBP were compared with the arms of 15 healthy subjects using an established 3-dimensional upper extremity motion analysis protocol.
There were no significant differences between the 2 arms on 17 of 19 motion parameters. The 2 differences that were statistically significant (P < 0.05) were not clinically meaningful.
The contralateral arms of children with unilateral BPBP can be used as controls for future upper extremity motion analysis studies of this population, and further recruitment of age-matched controls is not necessary for comparison with 5- to 8-year-old children with BPBP.
Journal of Pediatric Orthopaedics 09/2007; 27(6):709-11. · 1.16 Impact Factor
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ABSTRACT: As many as half of children with unilateral congenital transverse forearm total deficiency (UCTFTD) choose not to wear a prosthesis. In a multicenter study, 489 children and young adults aged 2 to 20 years with UCTFTD and their parents were tested for satisfaction, quality of life, and function. One hundred sixty-eight (34%) of those tested had chosen not to wear a prosthesis. Subjects and parents were asked the open-ended question What are the reasons for not wearing a prosthesis? and were allowed to give more than one response. Of the 135 subjects who had chosen not to wear a prosthesis and who responded to the question, the reason most frequently (53%) given was that the prosthesis did not help function. Forty-nine percent reported they stopped wearing it because the prosthesis was uncomfortable. Currently, upper-extremity prosthetic management for children with UCTFTD is a matter of controversy, with some clinicians advocating the need for prostheses to accomplish bilateral hand tasks, particularly in the scheme of normal development. Responses from children who do not wear a prosthesis may aid practitioners in re-evaluating the prosthetic role and potentially improve prosthetic options.
JPO Journal of Prosthetics and Orthotics 03/2007; 19(2):51-54.
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Anita M Bagley,
George Gorton,
Donna Oeffinger,
Douglas Barnes,
Janine Calmes,
Diane Nicholson,
Diane Damiano,
Mark Abel,
Richard Kryscio,
Sarah Rogers,
Chester Tylkowski
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ABSTRACT: Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to III, participated in this prospective multicenter, cross-sectional study. All tools were completed by parents and participants when appropriate. Effect size indices (ESIs) for parametric variables and odds ratios for non-parametric data quantified the magnitude of differences across GMFCS levels. Binary logistic regression models determined discrimination, and receiver operating characteristic curves addressed sensitivity and specificity. Between Levels I and II, the most discriminatory tools were Gross Motor Function Measure (GMFM-66), velocity, and WeeFIM Mobility. Between Levels II and III, the most discriminatory tools were GMFM Dimension E, Pediatric Functional Independence Measure (WeeFIM) Self-Care and Mobility, cadence, and Gillette Functional Assessment Questionnaire Question 1. Large ESIs were noted for Parent and Child reports of Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function, Parent report of PODCI Global Function, GMFM Dimension E, and GMFM-66 across all GMFCS level comparisons. The least discriminatory tools were the Quality of Life and cognition measures; however, these are important in comprehensive assessments of treatment effects.
Developmental Medicine & Child Neurology 03/2007; 49(3):181-6. · 2.92 Impact Factor
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ABSTRACT: Children with unilateral congenital below-the-elbow deficiency present a dilemma to clinicians. Parents want the child to have a prosthesis and, because it seems that the deficiency will cause functional problems, one is customarily prescribed for infants. Use of the prosthesis is then encouraged throughout childhood. However, these children frequently abandon the prosthesis. There are no evidence-based guidelines regarding prescription of prostheses or standard methods for assessing use and function.
A multicenter outcomes study was done to assess the quality of life and function of 489 children with a unilateral congenital below-the-elbow deficiency; 321 wore a prosthesis, and 168 did not. The Unilateral Below-the-Elbow Test (UBET) was designed, validated, and administered to these children along with several outcomes measures, including the Pediatric Outcomes Data Collection Instrument (PODCI), the Pediatric Quality of Life Inventory (PedsQL), and the Prosthetic Upper Extremity Functional Index (PUFI).
Use of a prosthesis was not associated with any clinically relevant differences in PODCI or PedsQL scores. Non-wearers performed either the same as or better than wearers on the UBET. When queried (with use of the PUFI) about performance of various tasks, non-wearers scored themselves higher than wearers. Children with a unilateral congenital below-the-elbow deficiency scored the same as or higher than the general population on the PedsQL. They scored significantly lower than the general population on the PODCI Upper Extremity Physical Function Domain and higher on the Happiness Domain, but the differences were small.
Prostheses may help with social acceptance or may be useful as tools for specialized activities, but they do not appear to improve function or quality of life, which are nearly normal for children with unilateral congenital below-the-elbow deficiency regardless of whether they wear a prosthesis. These findings call into question the standard practices of fitting infants with prostheses and encouraging young children to wear the prosthesis.
The Journal of Bone and Joint Surgery 12/2006; 88(11):2356-65. · 3.27 Impact Factor
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ABSTRACT: The Unilateral Below Elbow Test (UBET) was developed to evaluate function in bimanual activities for both the prosthesis wearer and non-wearer. Nine tasks were chosen for each of four age-specific categories defined by development stages of hand function (2-4y, 5-7y, 8-10y, and 11-21y). Two scales, Completion of Task and Method of Use, were designed to rate performance. To measure reliability, four occupational therapists scored samples of videotaped UBET performances. For Completion of Task, an interval scale, agreement in scoring was measured with interclass correlation coefficients (ICC; n=9; five females, four males). For Method of Use, a nominal scale, chance-adjusted association was calculated with Cohen's kappa coefficients (interobserver n=198; 111 females, 87 males; intraobserver n=93; 56 females, 37 males). For Completion of Task, the average ICC was 0.87 for the prosthesis-on condition, and 0.85 for the prosthesis-off condition. ICCs exceeded 0.80 for eight out of nine tasks for the two older age groups, but for only five out of nine tasks in the younger age groups. Higher inter- and intraobserver kappa coefficients for Method of Use resulted when scoring children with their prostheses on versus off. The oldest age group had lower kappa values than the other three groups. The UBET is recommended for the functional evaluation of Completion of Task in children with unilateral congenital below elbow deficiency with and without their prostheses. Method of Use scoring can evaluate individuals for directed therapy interventions or prosthetic training.
Developmental Medicine & Child Neurology 08/2006; 48(7):569-75. · 2.92 Impact Factor
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ABSTRACT: The purpose of this study was to determine whether the Pediatric Outcomes Data Collection Instrument (PODCI) measures differences in function between children with brachial plexus birth palsy (BPBP) who are candidates for shoulder tendon surgery and age-matched controls. The PODCI was administered prospectively to 23 children with BPBP who were candidates for shoulder tendon surgery. Their results were compared with published PODCI data for control subjects, and factors associated with function within the BPBP cohort were determined. Children in the BPBP cohort had significantly lower PODCI scores in upper extremity function, sports, and global function than control subjects. Limited active shoulder external rotation was significantly associated with lower functional scores. The PODCI measures diminished upper extremity function in children with BPBP who are candidates for shoulder tendon surgery, thereby showing promise as a tool for measuring baseline function and postoperative functional gains for children with BPBP.
Journal of Pediatric Orthopaedics 25(3):400-4. · 1.16 Impact Factor
