The American Paediatric Evaluation of Disability Inventory (PEDI). Applicability of PEDI in Sweden for children aged 2.0-6.9 years

Are the American normative standard scores applicable to the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G)?

BACKGROUND

The Pediatric Evaluation of Disability Inventory (PEDI) is an assessment to evaluate children's performance in activities of daily living.

AIMS

The study investigated if the normative standard scores of the PEDI are applicable to the German version of the PEDI (PEDI-G) in Germany, Austria and Switzerland, and whether there are differences in the applicability of the PEDI-G between the three countries.

MATERIALS AND METHODS

75 children with normal development (35 girls, 40 boys) from Germany (n = 17), Austria (n = 16), and Switzerland (n = 42) aged between 0.9 month and 7.3 years (SD = 2.03) participated in the study. Descriptive statistics, independent samples t-tests, univariate analyses of variance (ANOVA) and post hoc Tukey tests were applied.

RESULTS

No significant differences were identified. However, the German-speaking sample showed higher scores for the domain social function in both scales and in the Caregiver Assistance Scale self-care. Lower scores were identified in the Functional Skills Scale mobility.

CONCLUSIONS AND SIGNIFICANCE

The results support that the normative standard scores of the PEDI are applicable to the PEDI-G and for Austria, Germany and Switzerland, as no significant differences between the countries were identified. However, the generalizability of the results is limited due to sample size and recruitment procedures.

Efficacy of the Small Step Program in a Randomized Controlled Trial for Infants under 12 Months Old at Risk of Cerebral Palsy (CP) and Other Neurological Disorders

The objective was to evaluate the effects of the Small Step Program on general development in children at risk of cerebral palsy (CP) or other neurodevelopmental disorders. A randomized controlled trial compared Small Step with Standard Care in infants recruited at 4–9 months of corrected age (CA). The 35-week intervention targeted mobility, hand use, and communication during distinct periods. The Peabody Developmental Motor Scales^2ed (PDMS-2) was the primary outcome measure. For statistical analysis, a general linear model used PDMS-2 as the main outcome variable, together with a set of independent variables. Thirty-nine infants were randomized to Small Step (n = 19, age 6.3 months CA (1.62 SD)) or Standard Care (n = 20, age 6.7 months CA (1.96 SD)). Administering PDMS-2 at end of treatment identified no group effect, but an interaction between group and PDMS-2 at baseline was found (p < 0.02). Development was associated with baseline assessments in the Standard Care group, while infants in the Small Step group developed independent of the baseline level, implying that Small Step helped the most affected children to catch up by the end of treatment. This result was sustained at 2 years of age for PDMS-2 and the PEDI mobility scale.

The Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI-UG). Part II: Psychometric properties

BACKGROUND

The Pediatric Evaluation of Disability Inventory (PEDI) has been recommended as a gold standard in paediatric rehabilitation. A Ugandan version of PEDI (PEDI-UG) has been developed by culturally adapting and translating the original PEDI. The aim of this study was to investigate the psychometric properties of the PEDI-UG in Ugandan children by testing the instrument's rating scale functioning, internal structure, and test-retest reliability.

METHODS

Two hundred forty-nine Ugandan children (125 girls) aged 6 months to 7.5 years (Mean = 3.4, SD = 1.9) with typical development were tested using the PEDI-UG. Forty-nine children were tested twice to assess test-retest reliability. Validity was investigated by Rasch analysis and reliability by intraclass correlation coefficient.

RESULTS

The PEDI-UG domains showed good unidimensionality based on principal component analysis of residuals. Most activities (95%) showed acceptable fit to the Rasch model. Six misfit items were deleted from the Functional Skills scales and one from the Caregiver Assistance scales. The category steps on the Caregiver Assistance scales' rating scale were reversed but functioned well when changed from a 6-point to 4-point rating scale. The reliability was excellent; intraclass correlation coefficient was 0.87-0.92 for the domains of the Functional Skills scales and 0.86-0.88 for the domains of the Caregiver Assistance scales.

CONCLUSION

The PEDI-UG has good to excellent psychometric properties and provides a valid measure of the functional performance of typically developing children from the age of 6 months to 7.5 years in Uganda. Further analysis of all items, including misfit and deleted items, in children with functional disability is recommended.

Efficacy of the small step program in a randomised controlled trial for infants below age 12 months with clinical signs of CP; a study protocol

Background

Children with cerebral palsy (CP) have life-long motor disorders, and they are typically subjected to extensive treatment throughout their childhood. Despite this, there is a lack of evidence supporting the effectiveness of early interventions aiming at improving motor function, activity, and participation in daily life. The study will evaluate the effectiveness of the newly developed Small Step Program, which is introduced to children at risk of developing CP during their first year of life. The intervention is based upon theories of early learning-induced brain plasticity and comprises important components of evidence-based intervention approaches used with older children with CP.

Method and design

A two-group randomised control trial will be conducted. Invited infants at risk of developing CP due to a neonatal event affecting the brain will be randomised to either the Small Step Program or to usual care. They will be recruited from Astrid Lindgren Children’s Hospital at regular check-up and included at age 3–8 months. The Small Step Program was designed to provide individualized, goal directed, and intensive intervention focusing on hand use, mobility, and communication in the child’s own home environment and carried out by their parents who have been trained and coached by therapists. The primary endpoint will be approximately 35 weeks after the start of the intervention, and the secondary endpoint will be at 2 years of age. The primary outcome measure will be the Peabody Developmental Motor Scale (second edition). Secondary assessments will measure and describe the children’s general and specific development and brain pathology. In addition, the parents’ perspective of the program will be evaluated. General linear models will be used to compare outcomes between groups.

Discussion

This paper presents the background and rationale for developing the Small-Step Program and the design and protocol of a randomized controlled trial. The aim of the Small Step Program is to influence development by enabling children to function on a higher level than if not treated by the program and to evaluate whether the program will affect parent’s ability to cope with stress and anxiety related to having a child at risk of developing CP.

Trial registration

ClinicalTrials.gov Identifier NCT02166801. Registered June 12, 2014.

Analysis of PEDI Normative Data Between Spain and the United States

PURPOSE

To analyze the applicability of the Pediatric Evaluation of Disability Inventory (PEDI) to the Spanish population, and to assess the influence of demographic variables on the functional performance of the child.

METHOD

The Spanish version of the PEDI was administered via interview representing a sample of 199 children without disability. The applicability of the PEDI was analyzed with the Welch t test and differences between the variables were analyzed using single-factor analysis of variance.

RESULTS

Significant differences in overall and domain-specific performance were found between Spanish and American samples. The Spanish sample's average score was lower than the American sample. Differences in performance within the Spanish sample were found by age, sex, and rural/urban living environment.

CONCLUSIONS

The normative values of the PEDI should be applied with caution in the Spanish population until further data are available; however, the PEDI remains a useful instrument for monitoring functional change.

Normative Scores for the Pediatric Evaluation of Disability Inventory in Norway

AIM

The aim of this study was to develop clinically useful normative scores for the Pediatric Evaluation of Disability Inventory (PEDI) for children in Norway, and provide information on the relative difficulty level of individual test items.

METHODS

Using PEDI protocols from 224 Norwegian children without disability, we computed and scrutinized the normative scores for their representativeness, and compared them with scores from 313 children in the original US PEDI sample. Item functioning was compared using Rasch model-based differential item functioning (DIF) analyses and comparisons of item mastery.

RESULTS

The normative scores yielded consistent and regular results. The mean scores for each age group in the Norwegian sample were lower than in their US counterparts, and age mean plots ran parallel. However, this difference may be misleading for clinical use, as item comparisons revealed differences in both higher and lower directions between the samples for about a third of all items. Estimates of relative item difficulty for children in Norway were developed.

CONCLUSIONS

Identifying potential differences when using an instrument in another culture is important to avoid a risk of over- or underestimating a child's capability. In addition, item response patterns are required to make national normative scores clinically useful.

Inter-Rater and Test-Retest Reliability of the German Pediatric Evaluation of Disability Inventory (PEDI-G)

ABSTRACT Activities of daily living (ADL) of children are widely assessed with the Pediatric Evaluation Disability Inventory (PEDI). This study examined test-retest and inter-rater reliability of the German PEDI (PEDI-G). During the adaptation of the PEDI nine items were added. In total, 117 parents of 53 children without and 64 children with a diagnosed physical disability from Austria, Germany, and Switzerland participated. Reliability was examined by intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable difference (SDD) for the Functional Skill Scale with and without added items and the Caregiver Assistance Scale. Cohen`s Kappa was used to calculate the reliability of the Modification Scale. All ICC's for test-retest and inter-rater reliability were above 0.75, indicating good to very good reliability. The SDD varied from 0.83-5.58 across PEDI domains and scales. For the Modification Scale, Cohen's weighted kappa varied from 0.25 to 1.00 indicating sufficient reliability for some but not all items. Our findings indicate that the Functional Skill Scale and the Caregiver Assistance Scale of the PEDI-G are reliable scales that can be used to evaluate ADLs of children with and without physical disability.

Assessment on self-care, mobility and social function of children with spina bifida in Turkey

The aim of the study was to investigate the functional performance in children with spina bifida, using the Pediatric Evaluation of Disability Inventory (PEDI) to look into capacity of twenty-eight children with spina bifida with lesions at different levels in different dimensions of self-care, mobility and social function. Mean age of the patients was 3.5 ± 2.3 (1-10) years. In the muscle test carried out, 13 patients (44.8%) had no movements including pelvic elevation in lower extremity muscles and they were at level 5. Sixteen patients (54%) were non-ambulatory according to the Hoofer ambulation classification. Raw and scale scores in the self-care, mobility and social function domains both in the functional skill scale and in the caregiver scale were found to be lower compared to the data of the normal population. A statistically significant correlation was observed in the self-care values of the Functional Skills Scales and the Caregiver Assistance Scale measurements, which was positive for age and negative for Functional Ambulation Scale and muscle test (P < 0.05). A positive relation was found between the Functional Skills Scales-mobility area and age while a negative relation was observed between Functional Ambulation Scale and muscle test (P < 0.005). A negative relation was also found between Caregiver Assistance Scale-mobility and Functional Ambulation Scale and muscle test (P < 0.005). In our study, the functional performance of the children was found to be low. Low-level lesions, encouraging muscular strength and independence in mobility are all very important factors for functional independence.

Hand function in children with radial longitudinal deficiency

Background

In children with hypoplasia or aplasia of the radius (radial longitudinal deficiency) manual activity limitations may be caused by several factors; a short and bowed forearm, radial deviation of the wrist, a non-functional or absent thumb, limited range of motion in the fingers and impaired grip strength. The present study investigates the relation between these variables and activity and participation in children with radial dysplasia.

Methods

Twenty children, age 4–17 years, with radial longitudinal dysplasia Bayne type II-IV were examined with focus on the International Classification of Functioning and Health, version for Children and Youth (ICF-CY) context. Body function/structure was evaluated by measures of range of motion, grip strength, sensibility and radiographic parameters. Activity was examined by Box and Block Test and Assisting Hand Assessment (AHA). Participation was assessed by Children’s Hand-use Experience Questionnaire (CHEQ). Statistical correlations between assessments of body function/structure and activity as well as participation were examined.

Results

The mean total active motion of wrist (49.6°) and digits (447°) were less than norms. The mean hand forearm angle was 34° radially. Ulnar length ranged from 40 to 80% of age-related norms. Grip strength (mean 2.7 kg) and Box and Block Test (mean 33.8 blocks/minute) were considerably lower than for age-related norms. The mean score for the AHA was 55.9 and for CHEQ Grasp efficiency 69.3. The AHA had significant relationship with the total range of motion of digits (p = 0.042). Self-experienced time of performance (CHEQ Time) had significant relationship with total active motion of wrist (p = 0.043). Hand forearm angle did not show any significant relationship with Box and Block Test, AHA or CHEQ.

Conclusion

In radial longitudinal deficiency total range of motion of digits and wrist may be of more cardinal importance to the child’s activity and participation than the angulation of the wrist.

Relationship between gross motor function and daily functional skill in children with cerebral palsy

Objective

To investigate the relationship between gross motor function and daily functional skill in children with cerebral palsy (CP) and to explore how this relationship is moderated by the Gross Motor Function Classification System, Bimanual Fine Motor Function (BFMF), neuromotor types, and limb distribution of CP.

Methods

A cross-sectional survey of 112 children with CP (range, 4 years to 7 years and 7 months) was performed. Gross motor function was assessed with the Gross Motor Function Measure-66 (GMFM-66) and functional skill was assessed with the Pediatric Evaluation of Disability Inventory-Functional Skills Scale (PEDI-FSS).

Results

GMFM-66 scores explained 49.7%, 67.4%, and 26.1% of variance in the PEDI-FSS scores in the self-care, mobility, and social function domains, respectively. Significant moderation by the distribution of palsy and BFMF classification levels II, III, and IV was found in the relationship between GMFM-66 and PEDI-FSS self-care. Further significant moderation by the distribution of palsy was also observable in the relationship between GMFM-66 and PEDI-FSS mobility.

Conclusion

These findings suggest that limb distribution and hand function must be considered when evaluating gross motor function and functional skills in children with CP, especially in unilateral CP.

Applicability of pediatric evaluation of disability inventory in norway

The Pediatric Evaluation of Disability Inventory (PEDI) is an instrument for evaluating functional performance in disabled children aged 6 months to 7.5 years. PEDI measures both performance and caregiver assistance in three domains: self-care, mobility and social function. The purpose of this study was to investigate the applicability of the American normative reference values of PEDI, to describe ability among Norwegian children. This was investigated in a sample of 52 non-disabled Norwegian children in the age range 1.0-5.9 years. The Norwegian sample scored significantly lower than the American reference values for Functional Skills; self-care (mean 39; p <0.001), Care-giver Assistance; self-care (mean 43; p <0.001), and Functional Skills; mobility (mean 43, p <0.001). For caregiver assistance, mobility, and for functional skills and caregiver assistance, social function, there was good agreement between observations in the Norwegian sample and PEDI reference values. The result calls for a larger study, from which Norwegian reference values for PEDI can be derived.

Self-care and mobility skills in children with cerebral palsy, related to their manual ability and gross motor function classifications

AIM

The aim of this study was to investigate the acquisition of self-care and mobility skills in children with cerebral palsy (CP) in relation to their manual ability and gross motor function.

METHOD

Data from the Pediatric Evaluation of Disability Inventory (PEDI) self-care and mobility functional skill scales, the Manual Ability Classification System (MACS), and the Gross Motor Function Classification System (GMFCS) were collected from 195 children with CP (73 females, 122 males; mean age 8 y 1 mo; SD 3 y 11 mo; range 3-15 y); 51% had spastic bilateral CP, 36% spastic unilateral CP, 8% dyskinetic CP, and 3% ataxic CP. The percentage of children classified as MACS levels I to V was 28%, 34%, 17%, 7%, and 14% respectively, and classified as GMFCS levels I to V was 46%, 16%, 15%, 11%, and 12% respectively.

RESULTS

Children classified as MACS and GMFCS levels I or II scored higher than children in MACS and GMFCS levels III to V on both the self-care and mobility domains of the PEDI, with significant differences between all classification levels (p<0.001). The stepwise multiple regression analysis verified that MACS was the strongest predictor of self-care skills (66%) and that GMFCS was the strongest predictor of mobility skills (76%). A strong correlation between age and self-care ability was found among children classified as MACS level I or II and between age and mobility among children classified as GMFCS level I. Many of these children achieved independence, but at a later age than typically developing children. Children at other MACS and GMFCS levels demonstrated minimal progress with age.

INTERPRETATION

Knowledge of a child's MACS and GMFCS level can be useful when discussing expectations of, and goals for, the development of functional skills.

Applicability and intrarespondent reliability of the pediatric evaluation of disability inventory in a random Danish sample

PURPOSE

To examine the applicability of US reference data from the Pediatric Evaluation of Disability Inventory (PEDI) in a random Danish sample and to assess intrarespondent reliability.

METHODS

The PEDI was administered as a mailed questionnaire that was completed by the parents. Linear regression models and comparisons of item difficulty were performed in the data analysis. Intraclass correlation coefficients were used in the intrarespondent analysis.

RESULTS

US and Danish children differed on 3 of the 6 subscales of the PEDI. Danish children had significantly lower scores on the caregiver assistance subscales (self-care and mobility) and significantly higher scores on the functional skills subscale (social function). Item difficulty was found to be comparable (r = 0.82-0.97) on all 6 subscales. Intrarespondent reliability was good (intraclass correlation coefficient = 0.62-0.97).

CONCLUSION

The PEDI reference values seem partly applicable in a Danish population. In a Danish rehabilitation setting, interpreting PEDI scores with regard to detecting functional delays must be done cautiously.

Lessons from use of the Pediatric Evaluation of Disability Inventory: where do we go from here?

PURPOSE

The purpose of this article is to review the innovations, applications, and effect of the original Pediatric Evaluation of Disability Inventory (PEDI) published in 1992 and to describe planned revisions.

SUMMARY OF KEY POINTS

During the past decade, the PEDI has helped to shift thinking from a developmental to a functional focus. Using the PEDI, researchers and clinicians worldwide have highlighted variations in functional skill acquisition in clinical populations, the importance of recognizing cultural differences, and the value of documenting functional progress in relation to interventions.

CONCLUSIONS

The PEDI has had a rich tradition in helping to document functional development. New methods are proposed for the next generation of the PEDI by using item banks and computer adaptive testing.

RECOMMENDATIONS FOR CLINICAL PRACTICE

The computer adaptive testing feature and the revised and expanded content of the new PEDI will enable therapists to more efficiently assess children's functioning to a broader age group of children.

Validity and reliability of the Turkish translation of the Pediatric Evaluation of Disability Inventory (PEDI)

PURPOSE

To investigate the validity and reliability of the Turkish translation of the original Pediatric Evaluation of Disability Inventory (PEDI).

METHOD

On May 2003, we received permission from Boston University to translate and use the PEDI for Research purposes. PEDI Functional Skills scale and Caregiver Assistance scale was administered by physiatrists to 573 healthy Turkish children (295 males and 278 females; the age range: 7 months to 7(1/2) years) in two different healthcare centres in Ankara. The Turkish translation of the PEDI was again administered to 102 children after five days in order to assess test-retest reliability. Intraclass correlation coefficients (ICC) and Cronbach's alphas (alpha) were calculated. The test-retest reliability was assessed by Spearman's correlation coefficient. Internal construct validity was assessed by using Rasch unidimensional measurement model.

RESULTS

High Cronbach's alpha coefficients (> or =0.98), high ICC values (> or =0.96) and high Spearman correlation coefficients (> or =0.86) were found. The internal construct validity was confirmed by good fit to the Rasch measurement model. The fit statistics conducted in the study was acceptable, except for some items.

CONCLUSIONS

The Turkish translation of the PEDI is valid and reliable for the Turkish child population. We believe that PEDI is a detailed and useful instrument for the evaluation of efficiency of pediatric rehabilitation programme.

Évaluation des amputés

INTRODUCTION

Review of the literature about evaluation of amputees.

MATERIALS AND METHODS

A search of the Medline and Reedoc databases with the key words lower limb amputee, upper limb amputee, evaluation of lower limb amputee, evaluation of upper limb amputee, survey of lower limb amputee, survey of upper limb and the same words in French for reports on the evaluation of amputees.

RESULTS

Evaluations of amputees differ according to the level of amputation (lower or upper limb) and age (adult or child). They concern standing balance, walking (lower limb) and the mono- or bimanual prehensile capacities with or without prostheses in daily living activities and leisure (upper limb) as well as quality of life, personal satisfaction, psychological impact and, in particular, coping strategies.

DISCUSSION

For lower-limb amputees, tools to evaluate include scales of deambulation, of which few are valid in French, and global scales (on locomotor capacities, quality of life and satisfaction), which have been recently validated, but only one of them is valid in French. For upper-limb amputees, specific and valid tools are not available for adults; however, for children some functional capacity scales in daily activities have been validated and take into account psychomotor development. None of these tools are valid in French, and their use is scattered and limited to validation studies.

CONCLUSION

Only a few tools to evaluate amputees are valid in French for adults, and they concern lower-limb amputees only. Validating some of these tools in French is necessary.

Applicability of the pediatric evaluation of disability inventory in Slovenia

In the process of developmental (re)habilitation, determination of the functional abilities of an individual is an important step. For that we need appropriate measurement instruments. Because we do not have such measurement instruments in Slovenia, we chose the Pediatric Evaluation of Disability Inventory (PEDI), translated it, and applied it in daily practice to assess its usefulness and applicability. The purpose of the study was to find out whether the functional abilities of the population of Slovene children evaluated with the Pediatric Evaluation of Disability Inventory is comparable to the American normative data. We also wanted to assess the possible influence of gender, parent education, community size, and the presence of siblings on children's functional abilities. The Pediatric Evaluation of Disability Inventory was administered in the form of a structured interview to the parents of 147 healthy children in three age groups (0.5-1 year, 3-3.5 years, and 5-5.5 years) in different health care centers in Slovenia. Data analysis showed significant differences in functional skills and caregiver assistance scale scores when comparing the Slovene sample with the American normative data, particularly in the youngest age group. Slovene children were found consistently to be different (scoring either higher or lower) from American children at comparable ages in several functional skills and caregiver assistance scales. The analysis also confirmed the importance of gender and the presence of siblings for gaining higher scores on some of the functional skills and caregiver assistance scales. The level of parent education did not prove to have a significant impact on the results. Our results suggest that the American normative data are not completely appropriate for reference purposes in Slovenia. The results are in agreement with the findings of other studies, demonstrating the importance of ascertaining intercultural differences. We believe that adaptation and norming of the Slovene version of the Pediatric Evaluation of Disability Inventory are necessary before using the instrument in clinical practice in our country.

Factors of significance for mobility in children with myelomeningocele

AIM

To investigate neurological impairment, hand function and cognitive function in a group of children with myelomeningocele, in order to identify factors of significance for independent mobility and the physical assistance required for mobility in daily activities.

METHODS

The study material comprised 32 children, aged 6-11 y and without mental retardation. Mobility was assessed with the Pediatric Evaluation of Disability Inventory, scored as caregiver assistance. Statistical differences and correlations between the caregiver assistance scores and the selected variables were analysed.

RESULTS

Nine children scored independent mobility. The independent children had better hand coordination (p = 0.004) and walking ability (p = 0.01), lower cele levels (p = 0.011), higher performance IQ (p = 0.027), better visuospatial function (p = 0.029) and executive function (p = 0.037) than the others. The caregiver assistance scores were lower for both the children with early and severe symptoms of brainstem dysfunction and the children with scoliosis. Statistically significant correlations were found between the need for caregiver assistance and reduced walking ability, high cele level, poor hand strength and coordination, visuospatial function, executive function and performance IQ. In the subgroup of children who needed a wheelchair or walking aids, hand strength was the only variable significantly correlated with caregiver assistance (r(s) = 0.703, p = 0.000).

CONCLUSION

Most of the children were dependent on others in daily activities. Impaired hand function and cognitive function were significant for mobility, and this has implications for the therapy programme in children with myelomeningocele.

Reliability of the Dutch Pediatric Evaluation of Disability Inventory (PEDI)

OBJECTIVE

To evaluate the reliability of the Dutch version of the Pediatric Evaluation of Disability Inventory (PEDI), an instrument for measuring functional status (capability and performance in self-care, mobility and social function) of young children using parent interviews.

DESIGN

Inter-interviewer reliability was studied after scoring audiotaped interviews by a second researcher. For test-retest reliability the same parent was interviewed twice within three weeks; in inter-respondent reliability both parents of a child were interviewed independently within a few days. On item level, percentage identical scores were computed, and on scale level intraclass correlation coefficients (ICC) and Cronbach's alphas were calculated.

SUBJECTS

Parents of 63 nondisabled and 53 disabled (various diagnosis) children aged between 7 and 88 months were interviewed.

RESULTS

On scale level, all ICCs were above 0.90 and Cronbach's alpha was 0.89 for the self-care domain, 0.74 for the mobility domain and 0.87 for the social function domain. On item level for the Functional Skills Scale, the mean percentage identical scores varied from 89 to 99, and for the Caregiver Assistance Scale from 54 to 90. Different scores between interviewers resulted partially from ambiguous interpretation of the item and/or the explanation.

CONCLUSIONS

Although small adaptations have to be made, the psychometric properties of the Dutch PEDI are found to be good.