Jahnsen Reidun Birgitta, Weedon-Fekjar Harald, Myklebust Gerd, Storvold Gunfrid Vinje
Norwegian Quality and Surveillance Registry of Cerebral Palsy, Oslo University Hospital, 0424 Oslo, Norway.
Institute of Health and Society, University of Oslo, 0313 Oslo, Norway.
J Clin Med. 2024 Dec 31;14(1):178. doi: 10.3390/jcm14010178.
Cerebral palsy is a complex lifespan disability caused by a lesion to the immature brain. Evaluation of interventions for children with cerebral palsy requires valid and reliable outcome measures. Motor development curves and reference percentiles for The Gross Motor Function Measure (GMFM-66) are valuable tools for following, predicting, comparing, and evaluating changes in gross motor skills. The aims of this study were to create motor development curves with reference percentiles based on Norwegian data and compare them with published counterparts for Canadian children aged 2-21 years. Prospective population-based cohort data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) for 1206 children with 3612 GMFM-66 tests between 0.5 and 17.3 years of age. Median development by Gross Motor Function Classification System (GMFCS) levels was estimated using a generalized additive regression model with smoothed parameters for location, scale, and shape (based on the R GAMLSS library). To adjust for repeated individual measurements, we report the median curve of 100 random samples with only one observation per observed child. The Norwegian motor development curves for GMFCS levels I-IV increase up to 7 years of age before flattening off, while GMFCS level V curves are relatively flat. Overall, both motor development curves and GMFM-66 percentiles are very similar to Canadian counterparts. The existing Canadian reference curves are valid also for Norway, working well for both clinical and research applications. However, Norwegian percentiles can be used from an earlier age.
脑瘫是一种由未成熟大脑损伤导致的复杂的终身残疾。对脑瘫患儿干预措施的评估需要有效且可靠的结果指标。粗大运动功能测量（GMFM - 66）的运动发育曲线和参考百分位数是跟踪、预测、比较和评估粗大运动技能变化的宝贵工具。本研究的目的是基于挪威数据创建带有参考百分位数的运动发育曲线，并将其与已发表的加拿大2至21岁儿童的相应曲线进行比较。来自挪威脑瘫质量与监测登记处（NorCP）的前瞻性基于人群的队列数据，涉及1206名儿童，在0.5至17.3岁之间进行了3612次GMFM - 66测试。使用具有位置、尺度和形状平滑参数的广义相加回归模型（基于R语言的GAMLSS库）估计按粗大运动功能分类系统（GMFCS）水平划分的中位发育情况。为了调整重复的个体测量，我们报告了100个随机样本的中位曲线，每个观察到的儿童仅一个观察值。GMFCS I - IV级的挪威运动发育曲线在7岁之前上升，之后趋于平稳，而GMFCS V级曲线相对较平。总体而言，运动发育曲线和GMFM - 66百分位数与加拿大的相应曲线非常相似。现有的加拿大参考曲线对挪威也有效，在临床和研究应用中都表现良好。然而，挪威的百分位数可以从更早的年龄开始使用。
