Hanna Steven E, Bartlett Doreen J, Rivard Lisa M, Russell Dianne J
Department of Clinical Epidemiology and Biostatistics, and Investigator, CanChild Centre for Childhood Disability Research, School of Rehabilitation Science, McMaster University, IAHS 408, Hamilton, Ontario, Canada L8S 1C7.
Phys Ther. 2008 May;88(5):596-607. doi: 10.2522/ptj.20070314. Epub 2008 Mar 13.
Physical therapists frequently use the 66-item Gross Motor Function Measure (GMFM-66) with the Gross Motor Function Classification System (GMFCS) to examine gross motor function in children with cerebral palsy (CP). Until now, reference percentiles for this measure were not available. The aim of this study was to improve the clinical utility of this gross motor measure by developing cross-sectional reference percentiles for the GMFM-66 within levels of the GMFCS.
A total of 1,940 motor measurements from 650 children with CP were used to develop percentiles. These observations were taken from a subsample, stratified by age and GMFCS, of those in a longitudinal cohort study reported in 2002. A standard LMS (skewness-median-coefficient of variation) method was used to develop cross-sectional reference percentiles.
Reference curves were created for the GMFM-66 by age and GMFCS level, plotted at the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles. The variability of change in children's percentiles over a 1-year interval also was investigated.
The reference percentiles extend the clinical utility of the GMFM-66 and GMFCS by providing for appropriate normative interpretation of GMFM-66 scores within GMFCS levels. When interpreting change in percentiles over time, therapists must carefully consider the large variability in change that is typical among children with CP. The use of percentiles should be supplemented by interpretation of the raw scores to understand change in function as well as relative standing.
物理治疗师经常使用包含66个条目的粗大运动功能测量量表（GMFM - 66）以及粗大运动功能分类系统（GMFCS）来评估脑瘫（CP）患儿的粗大运动功能。到目前为止，该测量量表的参考百分位数尚无可用数据。本研究的目的是通过制定GMFCS各水平内GMFM - 66的横断面参考百分位数，提高这种粗大运动测量方法的临床实用性。
共使用了来自650名CP患儿的1940次运动测量数据来制定百分位数。这些观察数据取自2002年报告的一项纵向队列研究中按年龄和GMFCS分层的子样本。采用标准的LMS（偏度 - 中位数 - 变异系数）方法来制定横断面参考百分位数。
按年龄和GMFCS水平为GMFM - 66创建了参考曲线，并绘制了第3、5、10、25、50、75、90、95和97百分位数。还研究了儿童百分位数在1年间隔内变化的变异性。
参考百分位数通过在GMFCS各水平内为GMFM - 66分数提供适当的规范性解释，扩展了GMFM - 66和GMFCS的临床实用性。在解释百分位数随时间的变化时，治疗师必须仔细考虑CP患儿中典型的变化的大的变异性。百分位数的使用应辅以原始分数的解释，以了解功能变化以及相对位置。
