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  • Title: Interobserver agreement of the Gross Motor Function Classification System in an ambulant population of children with cerebral palsy.
    Author: McDowell BC, Kerr C, Parkes J.
    Journal: Dev Med Child Neurol; 2007 Jul; 49(7):528-33. PubMed ID: 17593126.
    Abstract:
    Gross Motor Function Classification System (GMFCS) level was reported by three independent assessors in a population of children with cerebral palsy (CP) aged between 4 and 18 years (n=184; 112 males, 72 females; mean age 10y 10mo [SD 3y 7mo]). A software algorithm also provided a computed GMFCS level from a regional CP registry. Participants had clinical diagnoses of unilateral (n=94) and bilateral (n=84) spastic CP, ataxia (n=4), dyskinesia (n=1), and hypotonia (n=1), and could walk independently with or without the use of an aid (GMFCS Levels I-IV). Research physiotherapist (n=184) and parent/guardian data (n=178) were collected in a research environment. Data from the child's community physiotherapist (n=143) were obtained by postal questionnaire. Results, using the kappa statistic with linear weighting (kappa(1w)), showed good agreement between the parent/guardian and research physiotherapist (kappa(1w)=0.75) with more moderate levels of agreement between the clinical physiotherapist and researcher (kappa(1w)=0.64) and the clinical physiotherapist and parent/guardian (kappa(1w)=0.57). Agreement was consistently better for older children (>2y). This study has shown that agreement with parent report increases with therapists'experience of the GMFCS and knowledge of the child at the time of grading. Substantial agreement between a computed GMFCS and an experienced therapist (kappa(1w)=0.74) also demonstrates the potential for extrapolation of GMFCS rating from an existing CP registry, providing the latter has sufficient data on locomotor ability.
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