Classification of manual abilities in children with cerebral palsy under 5 years of age: how reliable is the Manual Ability Classification System?

OBJECTIVE

To assess the interobserver reliability of the Manual Ability Classification System (MACS) in young children (age 1-5 years) with cerebral palsy.

DESIGN

Interobserver reliability study.

SETTING

A cross-sectional study of a hospital-based population of children with cerebral palsy.

SUBJECTS

Thirty children, 18 boys and 12 girls between 1 and 5 years of age (mean age 2.5 years +/- 14.2 SD, Gross Motor Function Classification System level I-IV).

MEASURES

the children were classified by means of the MACS by two independent observers. Interobserver reliability was analysed using Cohen's kappa.

RESULTS

Overall interobserver reliability of the MACS for children aged 1-5 years was moderate, with a linear weighted kappa (kappa) of 0.62 (95% confidence interval (CI) 0.49-0.76). According to the generally accepted categories of agreement, reliability was moderate for children under 2 years of age (kappa = 0.55), and good for children between 2 and 5 years of age (kappa = 0.67).

CONCLUSION

Classification of manual ability of young children with cerebral palsy is possible between 2 and 5 years of age. For children younger than 2 years old, it should be done with caution. Further development of the MACS for children under 5 years of age is recommended with an emphasis on age-appropriate descriptions of manual abilities.