Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Dev Med Child Neurol. 2011 Nov;53(11):1007-12. doi: 10.1111/j.1469-8749.2011.04044.x.
The aim of this study was to describe the distribution of motor severity levels and temporal trends in an Australian population cohort and to review the distribution of Gross Motor Function Classification System (GMFCS) levels across cerebral palsy (CP) registries worldwide.
Data were extracted from the Victorian Cerebral Palsy Register for 3312 individuals (1852 males, 1460 females; mean age 21y 2mo [SD 9 y 6 mo]) with non-postneonatally acquired CP, born between 1970 and 2003. The proportions of each motor severity level were calculated and logistic regression analyses were used to assess trends over time. A systematic review of the literature was undertaken and GMFCS data were extracted based on previously devised criteria. The proportions were plotted and the degree of heterogeneity was assessed for each level.
Population data from Victoria suggested a proportional increase in mild motor impairment (GMFCS levels I/II) from 54% of all cases of CP in the 1970s to 61% in the 2000s. For nine CP registries worldwide, the mean proportions of each GMFCS level, from level I to V, were 34.2%, 25.6%, 11.5%, 13.7%, and 15.6% respectively. There was substantial heterogeneity between registries for all levels except level III.
Despite the usefulness and reported reliability of the GMFCS, substantial variability was found in the distribution of GMFCS levels between population registries, particularly between levels I and II, suggesting greater classification uncertainty between these levels. Further research would be useful to determine whether routine collection of extra clinical information may facilitate more reliable classification.
本研究旨在描述澳大利亚人群队列中运动严重程度水平的分布情况，并综述全球脑瘫注册研究中粗大运动功能分级系统（GMFCS）水平的分布情况。
从维多利亚脑瘫注册处提取了 3312 名（1852 名男性，1460 名女性；平均年龄 21 岁 2 个月[标准差 9 岁 6 个月]）非晚发型获得性脑瘫患者的数据，这些患者出生于 1970 年至 2003 年之间。计算了每个运动严重程度水平的比例，并进行逻辑回归分析以评估随时间的趋势。进行了系统综述，并根据先前制定的标准提取 GMFCS 数据。绘制了各水平的比例图，并评估了其异质性程度。
维多利亚的人群数据表明，轻度运动障碍（GMFCS 水平 I/II）的比例从 70 年代所有脑瘫病例的 54%增加到 2000 年代的 61%。对于全球 9 个脑瘫注册研究，每个 GMFCS 水平（从 I 级到 V 级）的平均比例分别为 34.2%、25.6%、11.5%、13.7%和 15.6%。除了 III 级之外，所有水平的注册研究之间都存在很大的异质性。
尽管 GMFCS 具有实用性和报道的可靠性，但在人群注册研究中 GMFCS 水平的分布存在很大的变异性，特别是在 I 级和 II 级之间，这表明在这些水平之间存在更大的分类不确定性。进一步的研究将有助于确定是否常规收集额外的临床信息可以促进更可靠的分类。
