School of Physical Therapy, Western University, London, ON, Canada.
CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.
Dev Med Child Neurol. 2019 Apr;61(4):469-476. doi: 10.1111/dmcn.14080. Epub 2018 Oct 23.
First, to describe the impact of health conditions on daily activities over time in children with cerebral palsy (CP) and to create age-specific reference centiles. Second, to determine the amount of change typical over a 1-year period, across Gross Motor Function Classification System (GMFCS) levels.
A prospective, cohort design, with five assessments over 2 years, involved 708 children with a confirmed diagnosis of CP participating in the On Track Study (396 males, 312 females; mean age 6y [SD 2y 7mo]; range 18mo-12y at first assessment; 32.1% in GMFCS level I, 22.7% in GMFCS level II, 11.2% in GMFCS level III, 18.2% in GMFCS level IV, 15.7% in GMFCS level V). The impact of health conditions on daily activities was assessed using the Child Health Conditions Questionnaire. Data were analyzed using mixed-effects models and quantile regression.
Linear longitudinal trajectories describe the relatively stable impact of health conditions over time for each functional level for children aged 2 years to 12 years, with the lowest scores (least impact) in GMFCS level I and the highest scores (highest impact) in GMFCS level V. Centiles were created for children in each GMFCS level. A system to interpret the magnitude of change over time in centiles was developed.
Longitudinal trajectories of co-occurring health conditions assist with understanding children's prognoses. Centiles assist in understanding a child's experience relative to children in similar GMFCS levels. Guidelines are provided to determine if children are progressing 'as expected', 'better than expected' or 'more poorly than expected' in regard to the impact of health conditions on daily activities.
For children with cerebral palsy, the mean impact of health conditions on daily activities is relatively stable. Significant intraindividual and interindividual variability for the impact of health conditions exists, which complicates prognosis. Centiles enable interpretation of the impact of health conditions relative to Gross Motor Function Classification System level.
首先，描述脑瘫（CP）患儿随时间推移健康状况对日常活动的影响，并制定特定年龄的参考百分位数。其次，确定特定时间段内 GMFCS 各水平的典型变化量。
前瞻性队列设计，2 年内进行 5 次评估，共有 708 名确诊 CP 患儿参加 On Track 研究（男 396 例，女 312 例；平均年龄 6 岁[标准差 2 岁 7 个月]；首次评估时年龄范围为 18 个月至 12 岁；32.1%为 GMFCS I 级，22.7%为 GMFCS II 级，11.2%为 GMFCS III 级，18.2%为 GMFCS IV 级，15.7%为 GMFCS V 级）。使用儿童健康状况问卷评估健康状况对日常活动的影响。采用混合效应模型和分位数回归分析数据。
对于 2 岁至 12 岁的每个功能水平，线性纵向轨迹描述了健康状况随时间的相对稳定影响，GMFCS I 级得分最低（影响最小），GMFCS V 级得分最高（影响最大）。为每个 GMFCS 级别的儿童创建了百分位数。制定了一个用于解释随时间变化的百分位数变化幅度的系统。
共病健康状况的纵向轨迹有助于了解儿童的预后。百分位数有助于了解儿童相对于类似 GMFCS 水平的儿童的体验。提供了指南以确定儿童在健康状况对日常活动的影响方面是“按预期进展”、“进展优于预期”还是“进展差于预期”。
对于脑瘫患儿，健康状况对日常活动的影响均值相对稳定。健康状况的影响存在显著的个体内和个体间变异性，这使预后复杂化。百分位数使健康状况的影响相对于粗大运动功能分类系统水平的解释成为可能。
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