Self‐care performance in children with cerebral palsy: a longitudinal study
Andrea Burgess, Roslyn N. Boyd, Mark D. Chatfield, Jenny Ziviani, Leanne Sakzewski
Abstract
Aim To investigate self‐care developmental trajectories in children with cerebral palsy (CP) across all functional ability levels, according to Manual Ability Classification System (MACS) levels. Method This was a prospective longitudinal population‐based study of 71 children aged from 2 years 6 months to 12 years, with CP (47 [66%] males, 24 [34%] females). Pediatric Evaluation of Disability Inventory (PEDI) measures were taken at 2 years 6 months, 3, 4, and 5 years, and the PEDI ‐ Computer Adaptive Test (PEDI‐CAT) between 8 and 12 years. At 8 to 12 years, children were classified in MACS levels I (21; 30%), II (22; 31%), III (16; 23%), IV (6; 8%), and V (6; 8%). Longitudinal analysis of the PEDI Functional Skills Scale self‐care and PEDI‐CAT daily activities domains used the published linking equation, and multilevel mixed‐effects regression modelling with interaction between age and MACS. Results Between 5 and 12 years of age, children classified in MACS levels I to III continued to show progress in self‐care development (PEDI‐CAT scaled scores estimated change per year: I, 0.72; II, 0.49; III, 0.48). Children classified in MACS level IV showed an upward non‐significant trend between 5 and 8 to 12 years (estimated change 0.42; 95% confidence interval [CI] −0.04 to 0.88). Children in MACS level V showed a decline in self‐care (estimated change: −0.65; 95% CI −1.16 to −0.14). Interpretation Self‐care development attained by 8 to 12 years of age was related to the severity of manual ability impairment. Application of the linking equation from PEDI to PEDI‐CAT is somewhat uncertain at the extreme lower end of the scale. Our study supports recommendations for items to be added to the PEDI‐CAT to address floor effect. What this paper adds Manual Ability Classification System (MACS) levels are most appropriate to use in models predicting self‐care performance. Children classified in MACS levels I to III showed steady rates of improvement in self‐care. Children in MACS level IV showed an upward trend of improvement in self‐care. Children in MACS level V showed a decline in self‐care. Manual ability and self‐care are closely linked in children with cerebral palsy across childhood.