Mutlu Akmer, Akmese Pelin Pistav, Gunel Mintaze Kerem, Karahan Sevilay, Livanelioglu Ayse
Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
Int J Rehabil Res. 2010 Dec;33(4):319-24. doi: 10.1097/MRR.0b013e32833abe71.
Our purpose in this study was to evaluate performance and capacity as defined by Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) from the 'activity limitation' perspective of International Classification of Functioning,Disability, and Health (ICF) and to investigate the relationship between the two classification systems in different subtypes of cerebral palsy (CP). This prospective cross-sectional study was performed on 448 children with CP ranging from 4 to 15 years of age. Activity limitations were studied with the GMFCS for gross motor function and MACS for manual ability. The Spearman's correlation coefficient, contingency coefficient, and Cramer's V coefficient were used to assess the strength and significance of the association betweenGMFCS and MACS. The overall agreement between GMFCS and MACS was found to be 41%. The agreement was 42% in spastic children, 40% in dyskinetic children, 50% in ataxic children, and 28% in mixed type children. The overall j value was j=0.235 (P<0.001). The κ coefficient was 0.252 in spastic children, 0.245 in dyskinetic children, 0.318 in ataxic children, and 0.023 in mixed type children. All the κ coefficients except the value for the mixed type were found to be significant. The usage of two different classification systems, GMFCS and MACS, to describe the capacity and performance in children with CP as defined by the ICF provides an easy and quick classification tool for indicating 'activity limitations' of ICF in children with CP. The next step in research should be to highlight the other domains such as participation restrictions in these children.
我们开展本研究的目的是，从国际功能、残疾和健康分类（ICF）的“活动受限”角度，评估由粗大运动功能分类系统（GMFCS）和手动能力分类系统（MACS）所定义的表现和能力，并探究这两种分类系统在不同亚型脑瘫（CP）中的关系。这项前瞻性横断面研究针对448名4至15岁的脑瘫患儿开展。采用GMFCS研究粗大运动功能方面的活动受限情况，采用MACS研究手动能力方面的活动受限情况。使用Spearman相关系数、列联系数和Cramer's V系数评估GMFCS与MACS之间关联的强度和显著性。结果发现，GMFCS与MACS之间的总体一致性为41%。在痉挛型患儿中一致性为42%，在运动障碍型患儿中为40%，在共济失调型患儿中为50%，在混合型患儿中为28%。总体j值为j = 0.235（P<0.001）。痉挛型患儿的κ系数为0.252，运动障碍型患儿为0.245，共济失调型患儿为0.318，混合型患儿为0.023。除混合型外，所有κ系数均具有显著性。使用GMFCS和MACS这两种不同的分类系统来描述ICF所定义的脑瘫患儿的能力和表现，为指明ICF在脑瘫患儿中的“活动受限”情况提供了一种简便快捷的分类工具。下一步研究应着重关注这些患儿的其他领域，如参与限制。
