MİNTAZE KEREM GÜNEL, Tülay TARSUSLU, AKMER MUTLU, AYŞE LİVANELİOĞLU

Investigation of interobserver reliability of the Gillette Functional Assessment Questionnaire in children with spastic diparetic cerebral palsy

Amaç: Beyin felçli (BF) çocuklarda ortopedik girişimler ve uzun süreli rehabilitasyon sonrasında yürümede fonksiyonel etkinliği değerlendirmede hasta yakınlarından alınan bilgiler oldukça önemlidir. Bu çalışmada, BF’li çocuklarda Gillette Fonksiyonel Yürüme Değerlendirme Anketi (FYDA) anne ve fizyoterapiste uygulanarak anketin gözlemciler arası güvenirliği değerlendirildi. Çalışma planı: Çalışmaya spastik diparetik BF’li 52 çocuk (22 kız, 30 erkek; ort. yaş 7.8±4.4; dağılım 4-12) ve anneleri alındı. Tüm olgular Kaba Motor Fonksiyon Sınıflama Sistemi’ne (KMFSS) göre seviye 1-3 idi. Çocukların bağımsız hareket seviyelerini belirlemek için Gillette FYDA hem annelere hem de fizyoterapiste uygulandı ve Gillette FYDA’nın gözlemciler arası güvenirliği hesaplandı. Çocukların motor performansını değerlendirmek için Kaba Motor Performans Ölçütü’nün (KMPÖ) ayakta durma ve yürüme-koşma-zıplama altbölümleri, fonksiyonel bağımsızlık düzeyini belirlemek için Çocuklar İçin Fonksiyonel Bağımsızlık Ölçümü’nün (WeeFIM) transfer ve lokomosyon altbölümleri kullanıldı. Anneler tarafından ve fizyoterapist tarafından yanıtlanan FYDA’nın KMFSS, KMPÖ ve WeeFIM değerlendirmeleriyle ilişkisi araştırıldı. Sonuçlar: Gillette FYDA için gözlemciler arası güvenirlik katsayısı 0.94 (%95 güven aralığı 0.898-0.966) bulundu. Annenin yanıtları ile fizyoterapistin yanıtları arasında güçlü bir ilişki gözlendi (r=0.882, p

Anahtar Kelimeler:

İhtiyaç tesbiti, Anketler, Yürüyüş şekli, Beyin felci, Özürlülük değerlendirmesi, Anneler, Sonuçların tekrarlanabilirliği, Gözlemci farklılığı, Yürüme

Spastik diparetik beyin felçli çocuklarda Gillette Fonksiyonel Yürüme Değerlendirme Anketi’nin gözlemciler arası güvenirliğinin araştırılması

Objectives: Information obtained from families is of particular importance in the evaluation of functional mobility skills of children with cerebral palsy (CP) after orthopedic interventions and long-term rehabilitation applications. This study was designed to evaluate the interobserver reliability of the Gillette Functional Assessment Questionnaire (FAQ) which was administered to the mothers and the physiotherapist for children with CP. Methods: The study included 52 spastic diparetic children with CP (22 girls, 30 boys; mean age 7.8±4.4 years; range 4 to 12 years) and their mothers. According to the Gross Motor Function Classification System (GMFCS), all the children were in level 1 to 3. The Gillette FAQ was administered to the mother and physiotherapist to determine the functional walking level of the child and the interobserver reliability of the FAQ was calculated. In addition, gross motor performance was evaluated by the standing and walking-running-jumping dimensions of the Gross Motor Performance Measure (GMPM), and functional independence level was evaluated by the transfer and locomotion dimensions of the Functional Independence Measure for Children (WeeFIM). Correlations were sought between the FAQ results of the physiotherapist and mothers and the GMFCS, GMPM, and WeeFIM. Results: The intraclass correlation coefficient for interobserver reliability of the Gillette FAQ was 0.94 (95% CI 0.898-0.966). A highly significant correlation was found between the responses of the mother and physiotherapist to the Gillette FAQ (r=0.882, p<0.01). The responses of the mother and physiotherapist to the Gillette FAQ showed a negative correlation with the GMFCS level, and positive correlations with the dimensions of the GMPM and WeeFIM studied (p<0.01). Conclusion: The Gillette FAQ can be used by the physiotherapists to determine the functional changes in spastic diparetic children with CP and can help clinicians derive important information from the families about functional walking of their children. a new comprehensive index of gait pathology. Gait Posture 2008;28:351-7. 16. Corry IS, Cosgrove AP, Duffy CM, McNeill S, Taylor TC, Graham HK. Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: a randomised prospective trial. J Pediatr Orthop 1998;18:304-11. 17. Maathuis KG, van der Schans CP, van Iperen A, Rietman HS, Geertzen JH. Gait in children with cerebral palsy: observer reliability of Physician Rating Scale and Edinburgh Visual Gait Analysis Interval Testing scale. J Pediatr Orthop 2005;25:268-72. 18. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214-23. 19. Boyce WF, Gowland C, Rosenbaum PL, Lane M, Plews N, Goldsmith CH, et al. The Gross Motor Performance Measure: validity and responsiveness of a measure of quality of movement. Phys Ther 1995;75:603-13. 20. Aybay C, Erkin G, Elhan AH, Sirzai H, Özel S. ADL assessment of nondisabled Turkish children with the WeeFIM instrument. Am J Phys Med Rehabil 2007;86: 176-82. 21. Ottenbacher KJ, Msall ME, Lyon NR, Duffy LC, Granger CV, Braun S. Interrater agreement and stability of the Functional Independence Measure for Children (WeeFIM): use in children with developmental disabilities. Arch Phys Med Rehabil 1997;78:1309-15. 22. Daltroy LH, Liang MH, Fossel AH, Goldberg MJ. The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. Pediatric Outcomes Instrument Development Group. Pediatric Orthopaedic Society of North America. J Pediatr Orthop 1998;18:561-71. 23. Viehweger E, Haumont T, de Lattre C, Presedo A, Filipetti P, Ilharreborde B, et al. Multidimensional outcome assessment in cerebral palsy: is it feasible and relevant? J Pediatr Orthop 2008;28:576-83. 24. Trost JP, Schwartz MH, Krach LE, Dunn ME, Novacheck TF. Comprehensive short-term outcome assessment of selective dorsal rhizotomy. Dev Med Child Neurol 2008;50:765-71. 25. Amichai T, Harries N, Dvir Z, Patish H, Copeliovitch L. The effects of femoral derotation osteotomy in children with cerebral palsy: an evaluation using energy cost and functional mobility. J Pediatr Orthop 2009;29:68-72. 26. Tervo RC, Azuma S, Stout J, Novacheck T. Correlation between physical functioning and gait measures in children with cerebral palsy. Dev Med Child Neurol 2002; 44:185-90.

Keywords:

Needs Assessment, Questionnaires, Gait, Cerebral Palsy, Disability Evaluation, Mothers, Reproducibility of Results, Observer Variation, Walking,

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1. Pirpiris M, Gates PE, McCarthy JJ, D’Astous J, Tylkowksi C, Sanders JO, et al. Function and well-being in ambulatory children with cerebral palsy. J Pediatr Orthop 2006;26:119-24.
2. Damiano DL, Laws E, Carmines DV, Abel MF. Relationship of spasticity to knee angular velocity and motion during gait in cerebral palsy. Gait Posture 2006;23:1-8.
3. Hagberg B, Hagberg G, Olow I. The changing panorama of cerebral palsy in Sweden 1954-1970. I. Analysis of the general changes. Acta Paediatr Scand 1975;64:187-92.
4. Novacheck TF, Stout JL, Tervo R. Reliability and validity of the Gillette Functional Assessment Questionnaire as an outcome measure in children with walking disabilities. J Pediatr Orthop 2000;20:75-81.
5. Cardoso ES, Rodrigues BM, Barroso M, Menezes CJ, Lucena RS, Nora DB, et al. Botulinum toxin type A for the treatment of the spastic equinus foot in cerebral palsy. Pediatr Neurol 2006;34:106-9.
6. Kerem M, Livanelioğlu A, Topçu M. Effects of Johnstone pressure splints combined with neurodevelopmental therapy on spasticity and cutaneous sensory inputs in spastic cerebral palsy. Dev Med Child Neurol 2001; 43:307-13.
7. Kerem-Günel M. Rehabilitation of children with cerebral palsy from a physiotherapist’s perspective. [Article in Turkish] Acta Orthop Traumatol Turc 2009;43:173-80.
8. Mutlu A, Krosschell K, Spira DG. Treadmill training with partial body-weight support in children with cerebral palsy: a systematic review. Dev Med Child Neurol 2009;51:268-75.
9. Sullivan E, Barnes D, Linton JL, Calmes J, Damiano D, Oeffinger D, et al. Relationships among functional outcome measures used for assessing children with ambulatory CP. Dev Med Child Neurol 2007;49:338-44.
10. Oeffinger D, Gorton G, Bagley A, Nicholson D, Barnes D, Calmes J, et al. Outcome assessments in children with cerebral palsy, part I: descriptive characteristics of GMFCS Levels I to III. Dev Med Child Neurol 2007;49:172-80.
11. Mutlu A, Livanelioğlu A, Günel MK. Reliability of Ashworth and Modified Ashworth scales in children with spastic cerebral palsy. BMC Musculoskelet Disord 2008; 9:44.
12. Günel MK, Mutlu A, Tarsuslu T, Livanelioğlu A. Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy. Eur J Pediatr 2009; 168:477-85.
13. Harvey A, Robin J, Morris ME, Graham HK, Baker R. A systematic review of measures of activity limitation for children with cerebral palsy. Dev Med Child Neurol 2008; 50:190-8.
14. Furlong W, Barr RD, Feeny D, Yandow S. Patient-focused measures of functional health status and health-related quality of life in pediatric orthopedics: a case study in measurement selection. Health Qual Life Outcomes 2005;3:3.
15. Schwartz MH, Rozumalski A. The Gait Deviation Index: