Linder-Lucht Michaela, Othmer Verena, Walther Michael, Vry Julia, Michaelis Ulla, Stein Sabine, Weissenmayer Heike, Korinthenberg Rudolf, Mall Volker
Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Mathildenstrasse 1, D-79106 Freiburg, Germany.
Pediatrics. 2007 Oct;120(4):e880-6. doi: 10.1542/peds.2006-2258.
Motor function recovery is a key goal during rehabilitation of children and adolescents with traumatic brain injury. To evaluate how well treatment strategies improve motor function, we need validated outcome measures that are responsive to change in pediatric patients with traumatic brain injury. The Gross Motor Function Measure has demonstrated excellent psychometric properties in children with cerebral palsy and Down syndrome, yet its responsiveness in patients with pediatric traumatic brain injury has not been proven irrefutably. Our aim was to validate the Gross Motor Function Measure for this patient group.
Seventy-three patients (mean age: 11.4 years; range: 0.8-18.9 years) with moderate-to-severe traumatic brain injury were recruited in 12 rehabilitation centers and assessed twice with the Gross Motor Function Measure-88 over 4 to 6 weeks. As an external standard, we used judgements of change made independently by parents, physiotherapists, and 2 video assessors who were not familiar with the patients. We formulated and statistically investigated a priori hypotheses of how Gross Motor Function Measure change scores would correlate with those judgements of change. Both Gross Motor Function Measure versions, the original Gross Motor Function Measure-88 and the more recently developed Gross Motor Function Measure-66, were evaluated.
Both Gross Motor Function Measure change scores correlated significantly with all of the clinical judgements of change. The degree of correlation that we postulated, that the Gross Motor Function Measure change score would correlate highest with the video rating followed by physiotherapists and parents, was fully confirmed by the Gross Motor Function Measure-88 and largely confirmed by the Gross Motor Function Measure-66. Both Gross Motor Function Measure versions revealed convincing discriminative capability. Test-retest reliability was excellent.
We demonstrate convincing evidence of responsiveness and validity to support the use of both Gross Motor Function Measure versions as evaluative measures of gross motor function in children and adolescents with traumatic brain injury.
运动功能恢复是创伤性脑损伤儿童和青少年康复期间的关键目标。为了评估治疗策略对运动功能的改善程度，我们需要有效的结局指标来反映创伤性脑损伤儿科患者的变化情况。粗大运动功能测量量表在脑瘫和唐氏综合征患儿中已显示出良好的心理测量特性，但其在创伤性脑损伤儿科患者中的反应性尚未得到确凿证实。我们的目的是验证该量表在这一患者群体中的有效性。
在12个康复中心招募了73例中重度创伤性脑损伤患者（平均年龄：11.4岁；范围：0.8 - 18.9岁），并在4至6周内使用粗大运动功能测量量表-88进行了两次评估。作为外部标准，我们采用了家长、物理治疗师以及2名不熟悉患者的视频评估员独立做出的变化判断。我们制定并对粗大运动功能测量量表变化分数与这些变化判断之间相关性的先验假设进行了统计学研究。对粗大运动功能测量量表的两个版本，即原始的粗大运动功能测量量表-88和最近开发的粗大运动功能测量量表-66都进行了评估。
两个粗大运动功能测量量表的变化分数与所有临床变化判断均显著相关。我们假设的粗大运动功能测量量表变化分数与视频评分相关性最高，其次是物理治疗师和家长的相关性程度，在粗大运动功能测量量表-88中得到了充分证实，在粗大运动功能测量量表-66中也基本得到证实。两个粗大运动功能测量量表版本均显示出令人信服的区分能力。重测信度极佳。
我们提供了令人信服的证据证明反应性和有效性，以支持将两个粗大运动功能测量量表版本用作创伤性脑损伤儿童和青少年粗大运动功能的评估指标。
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