Application of the Gross Motor Function Measure in children with conditions other than cerebral palsy: A systematic review.

The purpose of this study was to describe the test-retest reliability of the Gross Motor Function Measure (GMFM) in children with cerebral palsy. The GMFM was administered twice, within a one-week time period, to twenty-one children with cerebral palsy. The time of day, therapists, and evaluation setting were held constant. Intra-class correlations ranged from .76 to 1.00. The data suggest that the GMFM is consistent in the measurement of gross motor skills and that children with cerebral palsy exhibit stable gross motor skills during repeat measurement. This information will be helpful in future analysis of treatment efficacy using the GMFM as an outcome measure.

The purpose of this study was to describe the test-retest reliability of the Gross Motor Function Measure (GMFM) in children with cerebral palsy. The GMFM was administered twice, within a one-week time period, to twenty-one children with cerebral palsy. The time of day, therapists, and evaluation setting were held constant. Intra-class correlations ranged from .76 to 1.00. The data suggest that the GMFM is consistent in the measurement of gross motor skills and that children with cerebral palsy exhibit stable gross motor skills during repeat measurement. This information will be helpful in future analysis of treatment efficacy using the GMFM as an outcome measure.

AimTo investigate the application and evaluate the measurement properties of the Gross Motor Function Measure (GMFM) in children with conditions other than cerebral palsy (CP).MethodA systematic review was conducted using five electronic databases to identify studies that used the GMFM in children with conditions other than CP. Methodological quality and measurement properties were evaluated using established standards for assessing outcome measures.ResultsWe identified 210 studies across various paediatric conditions. Measurement property studies examined eight conditions: acquired brain injury, spinal muscular atrophy, Fukuyama congenital muscular dystrophy, Down syndrome, osteogenesis imperfecta, acute lymphoblastic leukaemia (ALL), leukodystrophy, and Pompe disease. Evidence quality was generally low to very low owing to small sample sizes and methodological limitations. Reliability showed sufficient ratings across most conditions. Content validity was examined only for ALL and demonstrated sufficient ratings. Responsiveness and construct validity showed variable results across conditions. Clinical application analysis revealed inadequate methodological reporting and widespread use without appropriate validation.InterpretationGMFM validation for conditions other than CP remains insufficient despite widespread use. Content validity verification and enhanced methodological rigor are critically needed. Clinicians should interpret results cautiously until robust validation is established.

ABSTRACTThe aim was to develop a Challenge Module (CM) as a proposed adjunct to the Gross Motor Function Measure for children with cerebral palsy who have high-level motor function. Items were generated in a physiotherapist (PT) focus group. Item reduction was based on PTs’ ratings of item importance and safety via online surveys. The proposed CM items were pilot-tested with children in Gross Motor Function Classification System Level I. The focus group identified 35 items for consideration. The first item-reduction survey (n = 86 PT respondents) resulted in 20 items. A second survey yielded two additional items. Seven pilot-test participants (6–14 years) had a CM total mean score of 74.5% (SD = 19.4). Three easy items were subsequently removed and two items combined. Of seven additional items suggested by the children during testing, two were accepted in a third item-reduction survey. The final result was a 20-item CM to evaluate advanced motor skills. The CM requires refinement through Rasch scaling and formal validation.

The efficacy of interventions for cerebral palsy (CP) has been frequently investigated with inconclusive results and motor function measured by the Gross Motor Function Measure (GMFM-66) is common. In this observational analysis, we quantify the GMFM-66 change scores of the second and third year of a multimodal rehabilitation program (interval rehabilitation including home-based, vibration-assisted training) in children with CP. The study was a retrospective analysis of children with CP (2-13 years) participating for a second (n = 262) and third year (n = 86) in the rehabilitation program with GMFM-66 scores at start (M0), after 4 months (M4) of intensive training, and after 8 months of follow-up (M12). A method was previously developed to differentiate between possible treatment effects and expected development under standard of care for GMFM-66 scores using Cohen's d effect size (ES; size of difference). After the treatment phase of 4 months (M4) in the second year, 125 of 262 children were responder (ES ≥ 0.2) and 137 children nonresponder (ES < 0.2); mean ES for nonresponder was -0.212 (trivial) and for responder 0.836 (large). After M4 in the third year, 43 children of 86 were responder (ES = 0.881 [large]) and 43 nonresponder (ES = -0.124 [trivial]). Repeated rehabilitation shows a large additional treatment effect to standard of care in 50% of children which is likely due to the intervention, because in the follow-up period (standard of care), no additional treatment effect was observed and the children followed their expected development.

To develop an algorithmic approach to identify item sets of the 66-item version of the Gross Motor Function Measure (GMFM-66) to be administered to individual children, and to examine the validity of the algorithm for obtaining a GMFM-66 score. An algorithmic approach was used to identify item sets of the GMFM-66 (GMFM-66-IS) using data from 95 males and 79 females with cerebral palsy (CP; mean age 14y 7mo, SD 1y 8mo, range 12y 7mo to 17y 8mo). The GMFM-66-IS scores were then validated using combined data from three Dutch studies involving 134 males and 92 females with CP (mean age 7y, SD 4y 6mo, range 1y 4mo to 13y 8mo), representing all levels of the Gross Motor Function Classification System. The final algorithm contains three decision items from the GMFM-66 that determine which one of four item sets to administer. The GMFM-66-IS has excellent agreement with the full GMFM-66 both at a single assessment (intraclass correlation coefficient [ICC]=0.994, 95% confidence intervals [CI] 0.993-0.996) and across repeat assessments (ICC=0.92, 95% CI 0.89-0.95). The GMFM-66-IS is a promising alternative to the full GMFM-66. Users should be consistent in their choice of measure (GMFM-66 or GMFM-66-IS) on repeat testing and clearly identify which method was used.

The aim of this study was to compare the pattern of motor dysfunction in Hong Kong Chinese children with spastic diplegic and the athetoid type of cerebral palsy (CP) by the Gross Motor Function Measure (GMFM). The GMFM was first tested on its content validity in differentiating the items suitable for testing on upper and lower limb function, followed by test-retest and inter-rater reliability studies, before it was used in a within-subject experiment comparing upper and lower gross motor function in two types of CP, respectively. Children with spastic diplegia (n=18) and with athetosis (n=19) were recruited from three pre-school centres, schools for physically handicapped children and centres of the Hong Kong Spastic Association in Hong Kong. The GMFM, a standardized outcome measure of the motor function in children with CP, was used in comparing mean scores of motor tasks involving upper limbs and those not involving upper limbs in the athetoid and spastic cerebral palsied children. The scores were significantly higher for the children in the spastic diplegic group, but there was no significant difference in the performance of static and dynamic motor tasks of the GMFM between the children in the two groups.

This study examined the reliability, validity, and responsiveness to change of measurements obtained with a 66-item version of the Gross Motor Function Measure (GMFM-66) developed using Rasch analysis. The validity of measurements obtained with the GMFM-66 was assessed by examining the hierarchy of items and the GMFM-66 scores for different groups of children from a stratified random community-based sample of 537 children with cerebral palsy (CP). A subset of 228 children who had been reassessed at 12 months was used to test the hypothesis that children who are young (<5 years of age) and have "mild" CP will demonstrate greater change in GMFM-66 scores than children who are older ((5 years of age) and whose CP is more severe. Data from an additional 19 children with CP who were assessed twice, one week apart, were used to examine test-retest reliability. The overall changes in GMFM-66 scores over 12 months and a time ( severity ( age interaction supported our hypotheses. Test-retest reliability was high (intraclass correlation coefficient=.99). This study demonstrated that the GMFM-66 has good psychometric properties. By providing a hierarchical structure and interval scaling, the GMFM-66 can provide a better understanding of motor development for children with CP than the 88 item GMFM and can improve the scoring and interpretation of data obtained with the GMFM.

Background and Purpose The purpose of this study was to investigate difference of the gross motor function between cerebral palsy children who lived in sheltered house and those who lived home. Subject and Methods This study was a survey research Design. Participants were 19 children living G sheltered housing and 19 children living Seosan city, Dangjin province, and Yesan province. Data were collected from the 21th of February to the 11th of April, 2005. Data were analyzed by SPSS/WIN program. Results This study showed that there is significant difference of average age between sheltered group and home group. In the Gross Motor Function Measure (GMFM) result, there is significantly difference of item “B”(p&lt;.05).

The aim of the study was to monitor the changes over an eight-month period in gross motor performance of a group of children with different types of cerebral palsy (CP) using the GMFM (Gross Motor Function Measure). Fifty children aged between 12 and 79 months and undergoing active physical therapy (twice a week) participated in the study. The children were evaluated three times at four-month intervals (baseline, four, and 8 months later) with the GMFM test under standardized conditions. Children with quadriplegia (n = 24), hemiplegia (n = 16), and diplegia (n = 10) showed significant improvement of their gross motor function over the eight-month period (mean GMFM total change score = 6.2%; 4.2%, and 7.0%, respectively) and there was no difference in the rate of change across types. The mean GMFM scores of the children with quadriplegia were always significantly lower than corresponding scores of the two other groups (p < 0.001). Results indicate that, irrespective of the type of CP, the GMFM is sensitive to changes in motor performance of children over time.

Evaluating the Responsiveness of 2 Versions of the Gross Motor Function Measure for Children With Cerebral Palsy

OBJECTIVE: To test the intra- and interrater reliability of the Brazilian Portuguese versionof the 66-item Gross Motor Function Measure (GMFM-66).METHOD: The sample included 48 children with cerebral palsy (CP), ranging from 2-17 yearsold, classified at levels I to IV of the Gross Motor Function ClassificationSystem (GMFCS) and four child rehabilitation examiners. A main examiner evaluatedall children using the GMFM-66 and video-recorded the assessments. The otherexaminers watched the video recordings and scored them independently for theassessment of interrater reliability. For the intrarater reliability evaluation,the main examiner watched the video recordings one month after the evaluation andre-scored each child. We calculated reliability by using intraclass correlationcoefficients (ICC) with their respective 95% confidence intervals.RESULTS: Excellent test reliability was documented. The intrarater reliability of thetotal sample was ICC=0.99 (95% CI 0.98-0.99), and the interrater reliability wasICC=0.97 (95% CI 0.95-0.98). The reliability across GMFCS levels ranged fromICC=0.92 (95% CI 0.72-0.98) to ICC=0.99 (95% CI 0.99-0.99); the lowest value wasthe interrater reliability for the GMFCS IV group. Reliability in the five GMFMdimensions varied from ICC=0.95 (95% CI 0.93-0.97) to ICC=0.99 (95% CI0.99-0.99).CONCLUSION: The Brazilian Portuguese version of the GMFM-66 showed excellent intra- andinterrater reliability when used in Brazilian children with CP levels GMFCS I toIV.

The Gross Motor Function Measure (GMFM) is a criterion-referenced evaluative measure designed to detect change over time for children diagnosed with cerebral palsy (CP). Reliability of this measure has not been tested for children with osteogenesis imperfecta (OI). The purpose of this study was to determine the intra- and interrater reliabilities of the GMFM for use with children diagnosed with OI. One physical therapist administered and scored the GMFM for 19 children with OI who were followed at the Shriners Hospital for Children. The assessments were videotaped, then viewed and scored by five physical therapists, including the author, at least six weeks later. Intra- and interrater reliabilities were assessed using intraclass correlation coefficients (ICCs). Kappa statistics were calculated for items demonstrating more disagreement than the majority. The ICCs for intrarater reliability of the five dimensions and total score were 0.99. The ICCs for interrater reliability were 0.98 for the lying and rolling dimension and 0.99 for the other dimensions and total score. Kappa statistics for items demonstrating more disagreement than the majority ranged from 0.552 to 1.00. This study provides evidence of the reliability of the GMFM for children with OI when scored by pediatric physical therapists familiar with the measure. The videotape provided a consistent situation because each therapist did not directly interact with each child, but rather rated a videotaped session of the child's performance.

Purpose: The Gross Motor Function Measure (GMFM) is a criterion-referenced evaluative measure designed to detect change over time for children diagnosed with cerebral palsy (CP). Reliability of this measure has not been tested for children with osteogenesis imperfecta (OI). The purpose of this study was to determine the intra- and interrater reliabilities of the GMFM for use with children diagnosed with OI. Method: One physical therapist administered and scored the GMFM for 19 children with OI who were followed at the Shriners Hospital for Children. The assessments were videotaped, then viewed and scored by five physical therapists, including the author, at least six weeks later. Intra- and interrater reliabilities were assessed using intraclass correlation coefficients (ICCs). Kappa statistics were calculated for items demonstrating more disagreement than the majority. Results: The ICCs for intrarater reliability of the five dimensions and total score were 0.99. The ICCs for interrater reliability were 0.98 for the lying and rolling dimension and 0.99 for the other dimensions and total score. Kappa statistics for items demonstrating more disagreement than the majority ranged from 0.552 to 1.00. Conclusions: This study provides evidence of the reliability of the GMFM for children with OI when scored by pediatric physical therapists familiar with the measure. The videotape provided a consistent situation because each therapist did not directly interact with each child, but rather rated a videotaped session of the child's performance.

Pediatric Physical Therapy is the first and only peer-reviewed journal devoted to this discipline. The Journal provides a forum for scientific and professional exchange among researchers and practitioners throughout the world that represent subspecialties of the discipline, including early intervention, neonatology, pediatric sports and fitness, school physical therapy, acute care for seriously ill children, and the prevention of primary and secondary conditions that lead to disabling conditions. Official Journal of APTA Pediatrics, an Academy of the American Physical Therapy Association, The Dutch Association for Pediatric Physical Therapy, Physiotherapia Paediatrica, The New Zealand Society of Physiotherapists Pediatric Special Interest Group, and The Pediatric Division of the Canadian Physiotherapy Association.