McCormick Anna, Brien Marie, Plourde Joelle, Wood Ellen, Rosenbaum Peter, McLean Jennifer
Children's Hospital of Eastern Ontario, Canada.
Dev Med Child Neurol. 2007 Apr;49(4):265-9. doi: 10.1111/j.1469-8749.2007.00265.x.
To determine the stability of Gross Motor Function Classification System (GMFCS) levels between approximately 12 years of age and adulthood (i.e. > 16y) using a matched chart review. Adult health records from the Ottawa Rehabilitation Centre were matched with childhood health records from the Ottawa Children's Treatment Centre (OCTC). Health records were available for 103 adults (52 males, 51 females) with cerebral palsy (CP; age range 17-38y; mean age 22y [SD 4y]) who had also been seen at the OCTC at a mean age of 12 years (SD 1y). GMFCS levels as adults were: Level I, n= 10; Level II, n= 24; Level III, n= 21; Level IV, n= 30; and Level V, n= 18. Adult participants were classified using the GMFCS at the time they were last seen by a rehabilitation specialist, sometime between June 2002 and June 2005. Corresponding paediatric charts were reviewed and classified by two independent raters blinded to the adult GMFCS levels. GMFCS levels around age 12 were: Level I, n= 20; Level II, n= 13; Level III, n= 22; Level IV, n= 35; and Level V, n= 13. Interrater reliability for childhood health records was determined with a quadratic weighted kappa and was 0.978. Stability of GMFCS levels was also assessed using the quadratic weighted kappa and was 0.895. The positive predictive value of the GMFCS at 12 years of age to predict walking without mobility aids by adulthood is 0.88. If the child is a wheelchair user at around age 12 years, the positive predictive value is 0.96 that the individual will still be a wheelchair user as an adult. This study supports previous findings that interrater reliability when using the GMFCS is very high. It also shows that the GMFCS level observed around the age of 12 years is highly predictive of adult motor function. This provides important information for individuals with CP, their families, and care providers as they plan for future care needs and rehabilitation intervention.
通过匹配图表回顾，确定大约12岁至成年期（即>16岁）之间粗大运动功能分类系统（GMFCS）水平的稳定性。渥太华康复中心的成人健康记录与渥太华儿童治疗中心（OCTC）的儿童健康记录进行匹配。共有103名患有脑瘫（CP）的成年人（52名男性，51名女性）的健康记录可供使用（年龄范围17 - 38岁；平均年龄22岁[标准差4岁]），他们在OCTC就诊时的平均年龄为12岁（标准差1岁）。成年后的GMFCS水平为：I级，n = 10；II级，n = 24；III级，n = 21；IV级，n = 30；V级，n = 18。成年参与者在2002年6月至2005年6月期间最后一次接受康复专家诊治时使用GMFCS进行分类。两名对成年GMFCS水平不知情的独立评估者对相应的儿科图表进行回顾和分类。12岁左右的GMFCS水平为：I级，n = 20；II级，n = 13；III级，n = 22；IV级，n = 35；V级，n = 13。儿童健康记录的评估者间信度通过二次加权kappa系数确定，为0.978。GMFCS水平的稳定性也使用二次加权kappa系数进行评估，为0.895。12岁时GMFCS预测成年后无需移动辅助器具行走的阳性预测值为0.88。如果儿童在12岁左右是轮椅使用者，该个体成年后仍为轮椅使用者的阳性预测值为0.96。本研究支持了先前的研究结果，即使用GMFCS时评估者间信度非常高。研究还表明，12岁左右观察到的GMFCS水平对成人运动功能具有高度预测性。这为患有CP的个体、他们的家庭以及护理提供者在规划未来护理需求和康复干预时提供了重要信息。
