Category: Measurement; Pediatric Rehabilitation; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : To examine the ability of the UE-CP-PRO computer adaptive test (CAT) to detect functional change in a cohort of children with cerebral palsy (CP) undergoing upper extremity (UE) orthopedic surgery to improve function.
Design : Repeated measures design with assessments administered at pre-operative baseline, and three post-operative follow-up visits at 6, 12, and 24 months.
Setting : Multi-site at Shriners Hospitals for Children: Philadelphia, Montreal, Chicago, Sacramento, Houston, St. Louis, Greenville, Portland, and Tampa.
Participants (or Animals, Specimens, Cadavers) : Convenience sample (N=97, age 2-20 years) based on the following criteria: confirmed CP; undergoing UE surgery for functional improvement; parent/caregiver spoke English/Spanish. Exclusion criteria: Other diagnoses (e.g., pediatric stroke); surgery for reasons other than functional improvement (e.g., positioning, cosmesis); receiving Botox® injections without surgery.
Interventions : All participants underwent UE musculoskeletal surgery (2009-2013). Because the intent of this study was not to determine the effectiveness of surgery, children were enrolled if the surgery was performed to improve physical function of the UE. 93% of participants had a combination of surgical procedures on multiple joints under the same anesthetic; the most common procedures were thumb adductor release with/without z-plasty, tendon lengthenings (wrist, finger, thumb flexors; biceps, first dorsal interossei, and pronator teres), and transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis.
Main Outcome Measure(s) : UE-CP-PRO-CAT, Pediatric Outcomes Data Collection Instrument (PODCI-UE), ABILHAND-Kids, and Box and Blocks Test were administered. Mean, standard deviation, effect size (ES) and standardized response mean (SRM) values for each measure, at each time interval, and each level of the Manual Ability Classification System (MACS) were calculated and compared. Minimal detectable change at the 90% confidence level (MDC90) was determined.
The ES (0.40) and SRM (0.53) for the UE-CP-PRO-CAT at baseline to 6 months were moderate and significantly greater than the PODCI-UE (ES=0.18; SRM=0.25). The ES and SRM for legacy measures were not significantly greater than the UE-CP-PRO-CAT at any time period. From baseline to 6 months, UE-CP-PRO-CAT detected a large significant improvement for MACS level-II (SRM=0.70; ES=0.70). The MDC90 for UE-CP-PRO-CAT was 5.20.
Conclusions : The UE-CP-PRO-CAT was significantly better in detecting change in UE function in the first 6 months post-surgery and comparable to other measures at 12 and 24 months.