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

Quality of upper extremity skills and disability inventory via manual ability classification in children with neonatal brachial plexus palsy

PURPOSE

The aim of study was to investigate the relationship between upper extremity skill quality and disability inventory according to manual ability classification system in children with neonatal brachial plexus palsy (NBPP).

MATERIALS AND METHODS

Children with NBPP were included between the ages of 4-7.5 years. Children were classified in Manual Ability Classification System (MACS). Upper extremity skill quality was evaluated with Quality of Upper Extremity Skills Test (QUEST), disability status was assessed with Pediatric Evaluation of Disability Inventory (PEDI).

RESULTS

Total of 63 children (girls:31/boys:32), and mean age was 6.32 ± 1.73 years. 37 (58.73%) of children were at MACS Level-2. According to MACS classification, significant differences were noted in PEDI scores (p = 0.001), dissociated movements (p = 0.016) and grasp (p = 0.002) domains of QUEST. However, no significant differences between QUEST total scores (p = 0.079). PEDI (ROC; AuC = 0.762) and QUEST total score (ROC; AuC = 0.714) were sensitive to difference between groups across MACS in children with NBPP.

CONCLUSION

The PEDI and QUEST are sensitive in distinguishing the disability of children with NBPP at different MACS levels. Assessment of children with NBPP is not limited to functionality, disability, and quality of movement, it is multidimensional. Outcomes measures studies of movement's quality in children with NBPP are needed.

Evaluation of daily and social participation of children with Cerebral Palsy across different age groups with a focus on the 'F'-words: Function, family, fitness, fun, friends and future

BACKGROUND

The impact of disability differs across cultures. This study aimed to determine the predictors of participation in children with cerebral palsy (CP) in Turkey, based on the six F-words.

METHODS

Cross-sectional study exploring participation profiles of 450 children with CP, aged between 2 and 18 years. Pediatric Evaluation of Disability Inventory (PEDI) evaluated functional skills, and Assessment of Life Habits (LIFE-H) version 3.0 assessed daily and social participation. Hierarchical linear regression models were done to determine the predictors of participation in daily activities (PDA) and social roles (PSR) in three age groups (2-4, 5-13 and 14-18 years) based on the 6 F-words (mobility of PEDI for 'fitness'; four classification systems and self-care of PEDI for 'functioning'; social functions of PEDI for 'friends'; demographic information by parents for 'family'; the recreation of LIFE-H for 'fun'; and different stages of development for 'future').

RESULTS

The most important predictors for total PDA by age group were: self-care (p = 0.012) of PEDI in 2-4 y; self-care (p = 0.001) and mobility (p = 0.005) of PEDI in 5-13 y; GMFCS (p = 0.006) and mobility (p = 0.002) of PEDI in 14-18 y. Significant predictors for PSR differed by age group: self-care (p = 0.001) of PEDI in 2-4 y; self-care (p = 0.023) and mobility (p = 0.006) of PEDI in 5-13 y; and GMFCS (p = 0.004) and MACS (p = 0.003) in 14-18 y.

CONCLUSIONS

Six F-words of function and fitness focussed on self-care in younger children with an increasing emphasis on mobility and ability levels according to age. Therefore, rehabilitation for different aspects of the functional levels is needed to improve participation in life across the six F-words framework; plus take into consideration context, age-differences, family's expectations, life requirements, environmental needs, and cultural differences.

Psychometric properties of the Viking Speech Scale-Turkish version for children with cerebral palsy aged 4-18 years based on live and video-based observation

BACKGROUND

Speech is the most common method of communication. Video-based clinical communication evaluation is a requirement for children with speech-language impairments living in rural areas, and those who have limited mobility.

AIMS

To determine the validity and reliability of the Turkish version of the Viking Speech Scale (VSS-T) via live and video-based observation for children with cerebral palsy (CP) aged 4-18 years.

METHODS & PROCEDURES

A total of 142 children (mean age 8.18 ± 3.98 years; 68 female) with CP were included in this study. Their motor, communication, visual and eating-drinking function levels and comorbidities (dental, swallowing, cognitive impairments and epilepsy) were recorded. The Intelligibility in Context Scale (ICS), the Pediatric Evaluation of Disability Inventory-Social Function (PEDI-SF), and the Functional Independence Measure for Children-Communication (WeeFIM-C) were assessed to examine the concurrent validity of the VSS-T. The interrater reliability of the VSS-T was analysed between parents, physical therapists, and speech and language therapists from live and video-based observation. Intra-rater reliability was calculated from ratings made from live and video-based observations taken 3 weeks apart.

OUTCOMES & RESULTS

The VSS-T was strongly related to the ICS (r = -0.830), PEDI-SF (r = -0.819), WeeFIM-C (r = -0.643), other functional classifications (r > 0.432), and the comorbidities (Cramer's V > 0.284, p < 0.001). Good to excellent interrater reliability (κ_w ≥ 0.838) and intra-rater reliability (intraclass correlation coefficient (ICC) = 0.848-0.995) were found between parents and therapists.

CONCLUSIONS & IMPLICATIONS

Speech and language therapists, physical therapists, and parents can use the VSS-T as a valid and reliable classification system to describe speech intelligibility of 4-18-year-old children with CP. Both live and video-based observations can be used to administer the VSS-T.

WHAT THIS PAPER ADDS

What is already known on the subject The English version of the VSS has been shown to be a valid and reliable tool used to classify the speech of children with CP aged 4-13 years. The scale can be administered by means of live observation of the child or based on clinicians' notes on the case by parents, SLTs, physiotherapists and paediatricians. What this paper adds to existing knowledge The VSS-T is valid and reliable for children with CP aged 4-18 years. Video-based observation is a suitable method for evaluating the VSS-T levels. The VSS-T has a moderate association with the CFCS. What are the potential or actual clinical implications of this work? The VSS-T is a valid and reliable method of categorizing the severity of motor speech impairment for Turkish children with CP in clinical research studies, registry systems or epidemiological studies. Both experienced and inexperienced therapists can use either live or video-based observation methods to administer the VSS-T. This study extended the validity and reliability of the scale in children with CP aged up to 18 years. The VSS-T is also associated with the Visual Functional Classification System (VFCS), which has been recently developed for describing the visual abilities of children with CP in daily life. In addition, the VSS-T is associated with the presence of dental, swallowing, cognitive problems and epilepsy.

How does treadmill training contribute to botulinum toxin application plus routine physical therapy in ambulatory children with spastic bilateral cerebral palsy? A randomized controlled trial

BACKGROUND

In spite of treadmill training and multilevel botulinum toxin (BoNT-A) injection being the two most commonly used treatment methods in pediatric rehabilitation management, there was no study investigating the effect of treadmill training after BoNT-A injection in children with cerebral palsy (CP).

AIM

The aim of this study was to investigate the effect of treadmill training in addition to routine physical therapy after BoNT-A injection in ambulatory children with spastic bilateral CP on lower extremity muscle strength, selective motor control, and mobility.

METHODS

A total of 30 spastic bilateral children with CP classified level II-III by the Gross Motor Function Classification System were randomly assigned the study and control groups. Both groups continued routine physical therapy treatments after multilevel BoNT-A injection into lower extremities, while the study group additionally underwent 8 weeks of treadmill training (20 min, two sessions per week). Handheld dynamometer, selective control assessment of lower extremity, temporospatial evaluation of gait, and Pediatric Evaluation of Disability Inventory were assessed before and after 8 weeks.

RESULTS

In both groups, hip, knee, and ankle muscle strength increased at the end of 8 weeks (p < 0.05); however, in the study group, hip flexor/extensor muscle strength (p < 0.05, ES ≥ 0.50), selective motor control of ankle (p < 0.01, ES = 1.17), walking speed (p < 0.01, ES = 2.60), step lengths (p < 0.01, ES = 1.32), and mobility (p < 0.01, ES = 1.37) increased significantly compared to those of the control group.

CONCLUSIONS

Treadmill training in addition to routine physical therapy after BoNT-A injection is beneficial for hip muscle strength, ankle selective motor control, walking quality, and functional mobility in the short term.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03580174.

A cross-sectional study determining the relationship between eating and drinking skills and functional independence levels of patients with cerebral palsy

Background/Aim: In cerebral palsy (CP), drinking/eating disorders are considered common. To evaluate these disorders, a very detailed and lengthy evaluation is required. Few tools are available to identify children who need to be evaluated. This study determined whether the functional independence level of children with CP is sufficient to predict their drinking/eating skills and to determine the relationship between this functional level and these skills. Methods: A total of 105 children with CP aged 4–8 years participated in a cross-sectional study in our outpatient clinic. Functional classification was assigned using the Gross Motor Function Classification System and Manuel Ability Classification System (GMFCS and MACS, respectively). For a functional assessment of daily life, the Pediatric Evaluation of Disability Inventory (PEDI) was performed by asking a relative of the child. The Eating and Drinking Abilities Classification System (EDACS) level was added to the study after asking the caregivers of the patients for eating/drinking evaluations. Results: According to the current results, we found a negative correlation between EDACS and PEDI scores. As the EDACS grade increased, the PEDI subscale and total scores decreased in a statistically significant manner (P < 0.001), while the GMFCS and MACS scale increased statistically (P < 0.001). As the PEDI subscale and total scores increased, the levels of GMFCS and MACS decreased statistically significantly (P < 0.001). Conclusions: The performances of children with CP in terms of activities of daily living are closely related to their performance in eating/drinking activities. If children are independent in their mobility, social functions, and daily self-care, they are also more independent in terms of eating/drinking.

The psychometric properties of Turkish version of the Modified Paediatric Mini Mental Scale

BACKGROUND

Children with neurological diseases suffer from neurocognitive problems due to both the disease and the treatment processes. Therefore, it is necessary that a battery can be used to determine and track the cognitive function of these children. The aim of this study is to establish the Turkish version of the Modified Paediatric Mini Mental Scale (MPMMS), ensure its cultural adaptation, and test the validity and reliability of the Turkish version of the MPMMS.

METHODS

Sixty-five children with the neurological condition were enrolled in this methodological study. The subjects' age, height, weight, and body mass index were recorded. The MPMMS and the social function subscale of the Paediatric Evaluation of Disability Inventory (PEDI) were used to assess the participants' cognitive function. The construct validity of the questionnaire was determined by the correlation between the MPMMS and the social function subscale of the PEDI. Cronbach's alpha was calculated to determine internal consistency. To determine test-retest reliability, 32 children were assessed 7-14 days after the initial assessment, and the intraclass correlation coefficient (ICC) was calculated.

RESULTS

The mean age of the participants was 9.26 ± 3.87 years. A very strong significant correlation was found between the MPMMS and social function subscale of the PEDI (r = 0.935, p = 0.000). The internal consistency of the MPMMS was excellent (Cronbach's alpha = 0.932).

CONCLUSIONS

The Turkish version of the MPMMS has excellent validity and reliability and can be used by professionals in various health care settings to determine children's cognitive abilities.

Effect of the cognitive orientation to daily occupational performance (CO-OP) approach for children with cerebral palsy: A randomized controlled trial

PURPOSE

The study aimed to examine the effects of "Cognitive Orientation to daily Occupational Performance" (CO-OP) approach in terms of performance and satisfaction as well as functional status in children with cerebral palsy (CP) receiving neurodevelopmental treatment (NDT) and determine the parents' satisfaction level.

METHODS

Thirty-two children with CP were randomized to experimental (n = 16) or control (n = 16) groups, with n = 2 dropouts. Therapy was applied twice a week for five weeks. The experimental group received a CO-OP plus NDT, while the control group received only NDT.

RESULTS

No baseline differences existed, except for years of schooling, which was higher in the experimental group. After treatment, there were statistically significant and clinically meaningful improvements in occupational performance and function, favouring children who received 5-weeks of CO-OP plus NDT over NDT alone (p < 0.05).

CONCLUSION

CO-OP is expected to be beneficial if incorporated into CP rehabilitation.

Validity and test-retest reliability of the Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI-UG) in children and youth with cerebral palsy

BACKGROUND

Validity of the Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI-UG) was previously investigated on typically developing children. This study aimed to investigate the validity, test-retest reliability and minimal detectable change (MDC) of the PEDI-UG in children and youth (C&Y) with cerebral palsy (CP).

METHOD

A cross-sectional study design with 118 C&Y with CP (44.7% girls) aged 10 months-22.5 years were included in the study; 37 of them completed the PEDI-UG twice to investigate test-retest reliability, determined by calculating the intraclass correlation coefficient (ICC). Additionally, data from 249 typically developing children were used for differential item functioning (DIF) analysis. The validity of the PEDI-UG was investigated by Rasch analysis. The Kruskal-Wallis test and Spearman's correlation coefficient were calculated to investigate associations between PEDI-UG scores and external classification systems.

RESULTS

The principal component analysis of residuals indicated unidimensionality in all domains. The ICC values were excellent (0.98-0.99), and the MDCs were less than 6 and 13 (on a 0-100 scale) for the functional skills and caregiver assistance parts, respectively. The four-category caregiver assistance rating scale fulfilled the criteria for the analysis of rating scale functioning. In total, 78 of 189 items in the functional skills domain and two items in the caregiver assistance domain demonstrated DIF between C&Y with CP and TD children. The Kruskal-Wallis test (p < 0.05) and Spearman's correlation (coefficients of -0.93 to -0.78) supported the validity of PEDI-UG.

CONCLUSION

The current diagnose-specific version of PEDI-UG demonstrates evidence for validity as a measure of ability in C&Y with CP in Uganda and other similar settings, being a promising tool for use in clinical practice and research. Conversion tables and MDC values are provided to facilitate clinical adoption of the measure.

An investigation of the psychometric properties of the Turkish adaptation of the activity limitations in cerebral palsy questionnaire

PURPOSE

To translate the ACTIVLIM-CP questionnaire, developed to assess global activity performance in children with Cerebral Palsy (CP), into Turkish and to investigate its psychometric properties.

METHODS

Eighty-nine children with CP, aged between 2 and 18 years (mean age: 10.08 ± 4.94 years), were included in the study. Internal consistency was measured by Cronbach's alpha and test-retest reliability was assessed using intraclass correlation coefficient (ICC). Convergent validity was evaluated through the pattern of correlations between the ACTIVLIM-CP with PEDI, ABILOCO-Kids, ABILHAND-Kids, and Wee-FIM scores. Known-group comparisons were made according to epilepsy existence and ambulation level measured by Gross Motor Function Classification System (GMFCS).

RESULTS

Internal consistency was excellent (Cronbach's α = 0.990), and the ICC for the test-retest reliability was 0.990. There was a very strong correlation between ACTIVLIM-CP and ABILHAND-Kids (r = 0.946), WeeFIM (r = 0.900), PEDI Functional Skills and Caregiver Assistance scores (r = 0.954, r = 0.937, respectively), and ABILOCO-Kids (r = 0.817) (p < 0.001) score. ACTIVLIM-CP score was lower in children with epilepsy (p = 0.001) and in the high-level group according to GMFCS (p < 0.001).

CONCLUSION

The Turkish adaptation of ACTIVLIM-CP is a valid and reliable scale for measuring activity limitations in children with CP and is compatible with other scales evaluating activity limitations.

CLINICAL TRIAL NUMBER

NCT05184244IMPLICATIONS FOR REHABILITATIONActivity limitation measurements are crucial and necessary to determine the global activity performance of children with CP.ACTIVLIM-CP was translated and culturally adapted to Turkish and showed good psychometric properties.ACTIVLIM-CP is a valid and reliable tool to evaluate activity performance in children with CP.

Cross-cultural adaptation and reliability of the Arabic version of Children’s Hand-use Experience Questionnaire (CHEQ)

Background

Validated outcome measures are essential for assessment and treatment of children with disabilities. The Children’s Hand-use Experience Questionnaire (CHEQ) was developed and validated for use in Western countries for children with unilateral hand dysfunction. This study aimed to perform a cross-cultural adaptation and investigate reliability for the Arabic CHEQ.

Methods

Translation and cross-cultural adaptation were performed in four phases: (i) forward-translation and reconciliation with feedback from parents and typically developing children from Jordan (n = 14); (ii) backward-translation and review; (iii) cognitive debriefing with parents and/or their children with unilateral hand dysfunction (n = 17); and (iv) review and proofreading. In the psychometric analyses, 161 children from Jordan (mean age [SD] 10y 8 m [5y 8 m]; 88 males) participated. Internal consistency was evaluated with Cronbach’s alpha. Test-retest reliability was evaluated in 39 children with intraclass correlation coefficient (ICC) and weighted kappa (κ).

Results

Synonyms of four words were added to accommodate for different Arabic dialects. On average, 93% of children with unilateral hand dysfunction and their parents understood the CHEQ items. One response alternative, ‘Get help’, to the opening question was unclear for 70% of the respondents and need further explanation. Two items about using a knife and fork were difficult to comprehend and culturally irrelevant. High internal consistency was demonstrated (Cronbach’s alphas 0.94- 0.97) and moderate to excellent ICC (0.77–0.93). For 18 individual items, κ indicated poor to good agreement (κ between 0.28 and 0.66).

Conclusions

After the suggested minor adjustments, the Arabic CHEQ will be comprehensible, culturally relevant and reliable for assessing children with unilateral hand dysfunction in Jordan.

Exploring Effects of the HEP (Homeostasis-Enrichment-Plasticity) Approach as a Comprehensive Therapy Intervention for an Infant with Cerebral Palsy: A Case Report

Cerebral palsy (CP) is a common non-progressive neurodevelopmental disorder which causes developmental disabilities in children. Varied interventions for CP exist to address medical and physical needs but with limited effectiveness evidence. Environmental enrichment (EE) is an animal model intervention for many neurodevelopmental disorders, including CP, with considerable positive effects. This case report defines the Homeostasis-Enrichment-Plasticity (HEP) approach, which is based upon principles of EE and ecological theories of development and describes its use to promote the developmental and functional skills of an infant with CP. Parent interviews and assessment data were completed before and after intervention. For the interested parameters data was gathered by developmental history, systematic observation of behaviors in the clinical setting and at home, Beck Anxiety Inventory (BAI), Infant-Toddler Symptom Checklist, the Sensory Profile Infant/Toddler, Peabody Developmental Motor Scales-2, Gross Motor Function Measurement-88 (GMFM-88), the Gross Motor Function Classification System (GMFCS), and Pediatric Evaluation of Disability Inventory (PEDI). The HEP approach intervention was implemented one time per week for 12 months. Following the HEP approach intervention, self-regulation and sensory processing scores improved. GMFM-88 total score improved from 45/264 to 123/264. The Peabody found all gross motor (54–110), fine motor (65–117), and total motor quotient (119–227) scores improved after intervention. Post-intervention observations showed obvious gross motor progress with movement from GMFCS Level IV to Level I. Performance on the Functional Skills Scales and Caregiver Assistance Scales of PEDI also demonstrated notable improvements. BAI scores revealed low anxiety scores for both the mother (13/63 points) and father (14/63) before intervention. These scores did not change after intervention. A definition and detailed description of the HEP approach intervention is presented here for the first time. The case report demonstrated preliminary evidence for the effectiveness of the HEP approach on self-regulation, sensory processing, motor development, functional skills, and caregiver assistance with an infant with CP. Additional studies are needed to validate the findings.

Construct-concurrent validity and reliability of the European Child Environment Questionnaire (ECEQ) in a sample of Turkish children with cerebral palsy

PURPOSE

To investigate the construct-concurrent validity and reliability of the Turkish version of the European Child Environment Questionnaire (ECEQ-T) in children with cerebral palsy (CP).

METHODS

Mean age 9.53 ± 4.45 years 306 children with CP and their parents participated in the study. While construct validity was assessed using confirmatory factor analysis, concurrent validity was investigated using the correlation between ECEQ-T and Pediatric Evaluation of Disability Inventory (PEDI) with Spearman's correlation analysis. For test-retest reliability, ECEQ-T was administered twice to 65 parents with an interval of two weeks. Cronbach's alpha (α) and Intraclass Correlation Coefficient (ICC) were used for reliability.

RESULTS

Construct validity (RMSEA > 0.080; GFI ≥ 0.90) and concurrent validity (r: -0.533 to -0.293; p < 0.05) were confirmed as acceptable. Eight items were dropped out as they did not fit the model and finally ECEQ-T contains 54 items in three domains. High Cronbach's α and ICC values were found (Cronbach α_PE: 0.960/ICC_PE: 0.959, Cronbach α_SS: 0.955/ICC_SS: 0.954), Cronbach α_A: 0.822/ICC_A: 0.802, Cronbach α_T: 0.957/ICC_T: 0.955).

CONCLUSION

ECEQ-T has demonstrated good psychometric properties and can be used as a reliable and valid measure to assess environmental factors. We believe that ECEQ-T is a useful and detailed questionnaire to determine barriers-facilitators for increasing activity and participation in Turkish children with CP.IMPLICATIONS FOR REHABILITATIONThe Turkish version of ECEQ has acceptable construct validity and moderate concurrent validity for evaluating environmental factors in children with cerebral palsy.The Turkish version of ECEQ provides valuable information, which could be helpful to guide public health services and government policies in order to optimize the participation of children with CP.Environmental factors may play an important role in activity and participation in children with cerebral palsy. Turkish version of the ECEQ can be used for evaluating the environmental factors to determine barriers of activity and participation.

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.

Administration of the German Pediatric Evaluation of Disability Inventory (PEDI-G) Using the Mode of Observation in Children Undergoing Inpatient Rehabilitation: A Reliability and Validity Study

Aims: To investigate inter-rater reliability, concurrent validity, and feasibility of the German Pediatric Evaluation of Disability Inventory (PEDI-G) using the mode of observation in a Swiss inpatient rehabilitation setting with the Functional Independence Measure for Children (WeeFIM®) as criterion.Methods: Cross-sectional clinimetric study including 36 children and adolescents with median age 10.8 (quartiles 8.7, 13.0) years with neurological/neuro-orthopedic disorders. Data were collected by healthcare professionals through observation. Analyses were performed using intraclass correlation coefficients (ICC_2,1), standard error of measurement (SEM_Agreement), Bland-Altman plots, Cohen's Kappa κ, percentage agreement, and correlations.Results: Excellent inter-rater reliability (ICCs_2,1 ≥ 0.97), small SEMs and acceptable limits of agreement for the Functional Skills Scale (FSS) and Caregiver Assistance Scale (CAS) were found. No systematic differences between raters existed. Cohen's Kappa for inter-rater agreement of the Modifications Scale (MS) ranged from poor to strong (-0.06 ≤ κ ≤0.85). Excellent concurrent validity for FSS and CAS with the WeeFIM^® (ρ  ≥ 0.96), and excellent correlations of FSS and CAS with each other (ρ  ≥ 0.98) were identified.Conclusion: The German PEDI-G seems to be a reliable and valid, but time-consuming tool when applied in an inpatient setting using observation.

Cross-cultural adaptation, validity, and reliability of the Turkish version of Assistance to Participate Scale

BACKGROUND

The Assistance to Participate Scale is a questionnaire to evaluate activity participation of children with developmental disabilities. The purpose of this study was to determine the validity and reliability of the Turkish version of the Assistance to Participate Scale.

METHODS

Ninety-eight mothers' children with developmental disabilities were included in this study. The Assistance to Participate Scale, Pediatric Quality of Life Inventory, and Pediatric Evaluation of Disability Inventory were applied to all subjects. To evaluate reliability, Cronbach's alpha coefficient, minimal detectable change (MDC) with standard error of measurement (SEM), and intraclass correlation coefficient (ICC) for test-retest were used. The relationship between Assistance to Participate Scale, Pediatric Quality of Life Inventory, and Pediatric Evaluation of Disability Inventory was investigated, and exploratory and confirmatory factor analysis were used for construct validity.

RESULTS

Cronbach's alpha value of the scale was found.93, demonstrating that this value has excellent internal consistency. Test-retest reliability was found 0.99 (ICC 95% CI [0.995, 0.998]; SEM:0.57, MDC:1.58). For construct validity, the correlations between Assistance to Participate Scale, Pediatric Quality of Life Inventory, and Pediatric Evaluation of Disability Inventory total scores and items were significant (p < .001). Factor analysis showed that the questionnaire had unidimensional and the explained variance was 0.84%.

CONCLUSIONS

The Turkish version of the Assistance to Participate Scale is valid and reliable scale for children with developmental disabilities.

Psychometric properties of the German Version of the Pediatric Evaluation of Disability Inventory (PEDI-G): A factor analysis

BACKGROUND

Activities of daily living (ADL) are crucial for children because they enable them to participate in everyday life. For the evaluation of children`s ADL performance, health professionals such as occupational therapists use standardized ADL assessments. To implement assessments into practice it is important that the score generated from an assessment can be viewed as a unidimensional measure.

AIM

To investigate the factor structure of the German Pediatric Evaluation of Disability Inventory (PEDI-G) in a sample of typically developing children and children with an impairment.

MATERIAL AND METHODS

An exploratory factor analysis (EFA) with factor rotation was performed to assess the factor structure for the PEDI-G domains (self-care, mobility and social function) of the Functional Skills Scale and the Caregiver Assistance Scale.

RESULTS

262 children (118 (45%) girls and 144 (55%) boys) participated in this study. Their mean age (SD) was 4 years (SD 1.91). Results suggest that the PEDI domains of the Functional Skills Scale and the Caregivers Assistance Scale can be used as unidimensional measures to evaluate child`s ability to perform activities of daily living.

CONCLUSION

The results of this study support the use of the PEDI-G for research and practice in Austria, Germany and Switzerland.

The Uganda version of the Pediatric Evaluation of Disability Inventory (PEDI). Part I: Cross-cultural adaptation

BACKGROUND

The Pediatric Evaluation of Disability Inventory (PEDI) was developed and standardized to measure functional performance in American children. So far, no published study has examined the use of the PEDI in sub-Saharan Africa. This study describes the adaptation, translation, and validation process undertaken to develop a culturally relevant PEDI for Uganda (PEDI-UG).

METHOD

The cross-cultural adaptation and translation of the PEDI was performed in a series of steps. A project manager and a technical advisory group were involved in all steps of adaptation, translation, cognitive debriefing, and revision. Translation and back-translation between English and Luganda were performed by professional translators. Cognitive debriefing of two subsequent adapted revisions was performed by a field-testing team on a total of 75 caregivers of children aged 6 months to 7.5 years.

RESULTS

The PEDI-UG was established in both English (the official language) and Luganda (a local language) and comprises 185 items. Revisions entailed deleting irrelevant items, modifying wording, inserting new items, and incorporating local examples while retaining the meaning of the original PEDI. Item statements were rephrased as questions. Seven new items were inserted and 19 items deleted. To accommodate major differences in living conditions between rural and urban areas, 10 alternative items were provided.

CONCLUSIONS

The PEDI-UG is to be used to measure functional limitations in both clinical practice and research, in order to assess and evaluate rehabilitative procedures in children with developmental delay and disability in Uganda. In this study, we take the first step by translating and adapting the original PEDI version to the culture and life conditions in both rural and urban Uganda. In subsequent studies, the tool's psychometric properties will be examined, and the tool will be tested in children with developmental delay and disability.

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.

Effects of inspiratory muscle training in children with cerebral palsy: a randomized controlled trial

BACKGROUND

Respiratory muscle weakness and its relation to other impairments in children with cerebral palsy (CP) have been shown in the latest studies. The effects of inspiratory muscle training (IMT) in this population have not been comprehensively investigated so far.

OBJECTIVES

To investigate the effects of IMT on trunk control, pulmonary functions, respiratory muscle strength, daily living activities, exercise capacity and quality of life in children with CP.

METHODS

This was a prospective-randomized controlled trial. Twenty-five children with CP were randomly assigned to the treatment (n=13) or the control group (n=12). The treatment group received IMT at 30% of maximal inspiratory pressure (MIP) and the control group received sham therapy (5% of MIP) for 6 weeks. Also, both groups received routine conventional physical therapy (stretching, strengthening, and functional exercises, etc.) for 6 weeks. The primary outcome measure was trunk control. Secondary outcome measures were pulmonary function, respiratory muscle strength, daily living activities, functional exercise capacity and quality of life.

RESULTS

The treatment group had better outcome for trunk control (3.87, 95% CI 3.72-4.02). Also, respiratory muscle strength, daily living activities, functional exercise capacity and quality of life were significantly improved in the treatment group compared with controls. No improvements were observed in the pulmonary function test scores between the groups.

CONCLUSION

Inspiratory muscle training improves trunk control, respiratory muscle strength, daily living activities, functional exercise capacity and quality of life in children with CP and it can be included in the physiotherapy and rehabilitation programs.

Cross-cultural validity of the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G)-a Rasch model application

AIM

The aim of this study was to evaluate the cross-cultural validity of the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G) when used in Austria, Germany and Switzerland.

METHOD

A total of 118 girls and 144 boys participated in this study; 198 of the children (75.6%) had a developmental disability and 64 (24.4%) were without a known disability. The mean age was four years (range 11 months to 10 years and six months, SD 1.91). Item goodness of fit, differential item functioning (DIF) and differential test functioning (DTF) were evaluated by use of a Rasch model.

RESULTS

Twenty-four (11.6%) out of 206 items of the Functional Skills Scale and one (5%) out of 20 items of the Caregiver Assistance Scale demonstrated misfit according to the Rasch model. Thirty-four (16.5%) out of 206 items of the Functional Skills Scale and no item from the Caregiver Assistance Scale demonstrated DIF. Almost half (46%) of the items demonstrating misfit also demonstrated DIF, indicating an association between them. The DIF by country only demonstrated a minimal impact on the person measures of the PEDI-G.

INTERPRETATION

Even though some items did not meet the statistical and clinical criteria set, the PEDI-G can be used, on a preliminary basis as a valid tool to measure activities of daily living of children with and without a disability in these countries. Further larger studies are needed to evaluate more psychometric item properties of the PEDI-G in relation to context.

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.

Physical therapy for a child with sudden-onset choreoathetosis: a case report

PURPOSE

This case report describes the physical therapy examination, intervention, and outcomes for a 5-year-old girl who developed choreoathetosis following mitral valve repair.

CASE DESCRIPTION

This child was admitted to an inpatient short-term rehabilitation program with marked choreoathetosis and dependence for all functional mobility. She received physical therapy twice a day for 5 weeks. Physical therapy intervention included therapeutic exercise emphasizing stabilization and closed chain exercises, aquatic therapy, and functional training to improve gross motor skills and mobility. Tests and measures included the Selective Control Assessment of the Lower Extremity, 66-item Gross Motor Function Measure, and Pediatric Evaluation of Disability Inventory.

OUTCOMES

At discharge, this child demonstrated improvements in her Selective Control Assessment of the Lower Extremity, Gross Motor Function Measure, and Pediatric Evaluation of Disability Inventory scores. She was independent in all functional mobility tasks.

SUMMARY

This case study describes physical therapy tests and measures, intervention, and positive outcomes for a child with sudden-onset choreoathetosis.

Computer adaptive test performance in children with and without disabilities: prospective field study of the PEDI-CAT

PURPOSE

To examine the discriminant validity, test-retest reliability, administration time and acceptability of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT).

METHODS

A sample of 102 parents of children 3 through 20 years of age with (n = 50) and without (n = 52) disabilities was recruited for this prospective field study. A sub-sample (n = 25) also completed the PEDI-CAT a second time within one month. Parents completed 15 items in each of the four PEDI-CAT domains (daily activities, mobility, social/cognitive, responsibility) using a laptop computer. Following completion, parents answered a four-question user evaluation survey.

RESULTS

PEDI-CAT scores based on parent responses differentiated between groups of children with and without disabilities in all four domains. Test-retest reliability estimates were high (ICC = 0.96-0.99) for all four domains. The mean time to complete 60 items for the full sample (n = 102) was 12.66 minutes (SD = 4.47). Parents reported favorable reactions to the PEDI-CAT.

CONCLUSIONS

The PEDI-CAT offers a valid and reliable assessment acceptable to parents.

Pediatric Evaluation of Disability Inventory: a cross-cultural comparison of daily function between Taiwanese and American children

The study described the psychometric properties of the Pediatric Evaluation of Disability Inventory (PEDI) when used in Taiwanese normally developing children and illustrated the ethnic differences in determining capacity and independence in daily function between Taiwanese and American children. The Chinese version of the PEDI (PEDI-C) was administered to Taiwanese parents of 494 normally developing children and 110 children with developmental disabilities (DD). The scores of Taiwanese population were compared with the American counterparts using independent samples t-test. The PEDI-C had demonstrated good psychometric properties when used in Chinese-speaking population. The results revealed that internal consistency and inter-rater reliability was high. The unidimensionality of each domain was supported by Mokken analysis. The standardized factor scores of the PEDI-C differentiated children with DD from normally developing children. Group differences existed in various areas of daily function between Taiwanese and American children. Taiwanese children were less capable and needed more assistance in self-care and social function of daily living, especially after 4 years of age. Taiwanese and American children had similar capacity and performance in mobility. The identified discrepancy could serve as a guide of child-rearing for parents and for clinicians working with clients from different cultural backgrounds in a culturally diverse society.

Item bank development for a revised pediatric evaluation of disability inventory (PEDI)

The Pediatric Evaluation of Disability Inventory (PEDI) is a useful clinical and research assessment, but it has limitations in content, age range, and efficiency. The purpose of this article is to describe the development of the item bank for a new computer adaptive testing version of the PEDI (PEDI-CAT). An expanded item set and response options were reviewed by clinician experts and examined at parent and clinician focus groups. Eleven parents participated in 32 cognitive interviews to examine content, format, and comprehension of items and responses. A set of 76 self-care, 78 mobility, and 64 social function items with pictures and a four-point "Difficulty" scale were developed. The PEDI's Caregiver Assistance scale was replaced by a "Responsibility Scale" with 53 items. Content validity was established incorporating input from clinicians and parents. The new item bank covers a broad range of functional activities for children of all ages and abilities.

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.