Pediatric Evaluation of Disability Inventory (PEDI)

Posted on: March 15, 2015 | By: kleamon | Filed under: Pediatric Evaluation of Disability Inventory (PEDI)

Pediatric Evaluation of Disability Inventory (PEDI)

Title: Pediatric Evaluation of Disability Inventory (PEDI) – 1st Edition, 1992

Revision: Pediatric Evaluation of Disability Inventory – Computer Adaptive Test (PEDI-CAT)  –  2nd edition, 2012

Author (s): Stephen M. Haley, Wendy J. Coster, Larry H. Ludlow, Jane T. Haltiwanger, Peter J. Andrellos

Publisher & Distributor: Pearson Clinical Assessment (PsychCorp)

Costs: Total Package $171.55

  • PEDI Manual $125.95
  • PEDI Scoring Forms (Pkg of 25) $45.60

Purpose: To assess functional capabilities and performance, monitor progress in functional performance, and evaluate therapeutic or rehabilitative progress.

Type of Test: The test is norm referenced, and can be used as a criterion-referenced measure of functional status.

Target Population and Ages: Children with disabilities between the ages of 6 months – 7 ½ years

  • Can be used in older children if their functional development is delayed.

Time Requirements: 45-60 minutes for administration and scoring

  • Experienced clinicians familiar with the test: 30-45 minutes

 

TEST ADMINISTRATION

Administration: Administered by parent report, administration by professional judgment, and administration combination of methods.

Scoring: The raw scores from the 3 functional domains are added and converted using the manual, values range from 0-100.

  • Self-care: 73 functional skills / 8 Caregiver assistance  / 8 Modifications
  • Mobility: 59 functional skills / 7 Caregiver assistance /  7 Modifications
  • Social function: 65 functional skills / 5 Caregiver assistance / 5 Modifications

Function skill scale (Capability):

  • 0 = Unable, or limited in capability, to perform item in most situations
  • 1 = Capable of performing item in most situations or item has been previously mastered by and functional skills have progressed beyond this level

Caregiver Assistance Scale (Level of independence):

  • 0 = Total assist
  • 1 = Max assist
  • 2 = Mod assist
  • 3 = Min assist
  • 4 = Supervision
  • 5 = Independent

Modification Scale:

  • N= No modifications
  • C= Child oriented modifications
  • R= Rehabilitation equipment
  • E= Extensive Modification

MCID: ~11 Points

Type of information, resulting from testing: Higher scores indicate lesser degree of disability (higher functional level).

  • Standard and scaled performance scores can be calculated
  • No results were found that indicated a particular data set represented the presences of a specific impairment or disability.

Environment for Testing: In a closed and controlled environment

Equipment and Materials Needed: Paper, pencil, manual and scoring form

Examiner Qualifications: By physical therapist, occupational therapist, other health care professionals, and teachers, and parent/caregiver report.

Psychometric Characteristics:

  • Sensitivity to change: > .8 (effect size & standard response mean), Higher responsiveness to changes in motor ability with children younger than 4 yo.

Standardization/normative data: The PEDI is standardized on a normative sample of n=412 children of the same age group without any functional disabilities.

Evidence of Reliability:

  • Internal consistency of Scales: demonstrated an excellent internal consistency within 3 functional skill scales: self-care (n=.99), mobility (n=.97), Social function (n=.98) and 3 caregiver assistance scales: self-care (n=.97), mobility(n=.95), social function (n=.95)
  • Intra-Respondent Reliability: ICC=0.95 -.99
    • Reliability increased when the same person interviews the child
  • Inter-Respondent Reliability: ICC=0.64 – 0.74

Evidence of Validity:

  • Construct Validity: High correspondences with mean scale scores and the child’s age with both functional skills and caregiver assistance scales.
    • Functional behavior is correlated with age: functional independence implies the highest skill level has been obtained in that area.

Discriminative: PEDI modifications and functional skill scales are better at predicting a status with a P-value ranging from <0.001 to P=0.38

  • Measures indicate that the PEDI places children in the correct age classifications based on the scores obtained from each sub-scale measure.

Predictive: The PEDI not only assess capabilities but assesses performances and allows for the degree of functional limitations and childhood disability to be assessed rather than one or the other. Has a good predictive value at determining status and is a better predictor of group status than the Battelle or the WEEFIM.

 

SUMMARY COMMENTS

Strengths:

  • Minimal training
  • Low cost to administer
  • Covers components of ICF: activity & participation
  • Focus is placed more on performance and capabilities rather than impairment
  • Each scale can be used separately or in combination with the others
  • It has been translated in to multiple languages demonstrating similar results

Weaknesses:

  • Time consuming
  • Floor and ceiling effects
  • More accurate when used on children between 6months – 7 ½ years, but may be utilized for older children who experience functional delays.

 

CLINICAL APPLICATIONS

This assessment looks at a lot of multiple aspects of a child’s life.  It is designed for young children with a range of functional impairments.  This assessment evaluates children with disability for their functional skills in several different areas including: mobility, self-care, and social functioning.  The PEDI can assist pediatric professionals with establishing adequate functional goals related to ADL’s, mobility as well as other functional impairments.  The PEDI can help detect delays or functional impairments/deficits as well as monitor the progress of a pediatric patient by providing valid and reliable objective measures.   This outcome measure can be utilized across multiple venues including: inpatient, outpatient, and acute care settings; with a good responsiveness with differing therapeutic approaches including hippotherapy, aquatic therapy, Constrain induced movement therapy, pharmacological, and surgical interventions .

 

 

References:

  1. Haley SM, Coster WI, Kao YC, et al. Lessons from use of the Pediatric Evaluation of Disability Inventory: where do we go from here?. Pediatr Phys Ther. 2010;22(1):69-75.
  2. http://www.docstoc.com/docs/82488252/Kuiken_PEDI
  3. http://www.pearsonclinical.com/childhood/products/100000505/pediatric-evaluation-of-disability-inventory-pedi.html
  4. http://otforchildrenassessmentportfolio.blogspot.com/2013/04/pediatric-evaluation-of-disability.html
  5. Vos-Vromans DCWM, Ketelaar M, and Gorter JW. Responsiveness of evaluative measures for children with cerebral palsy: The Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory. Disability and Rehabilitation. 2005; 27(20): 1245 – 1252.
  6. Berg M, Jahnsen R, Frøslie K, Hussain A. Reliability of the pediatric evaluation of disability inventory (PEDI). Physical & Occupational Therapy in Pediatrics. 2004;24:61-77

 

Sensitivity to Functional Improvements of GMFM-88, GMFM-66, and PEDI Mobility Scores in Young Children with Cerebral Palsy.

The purpose of this article was to determine how effective the GMFM-88’s total score, PEDI mobility score and the GMFM-66 score compared to the findings of the score GMFM-88 Goal total score when assessing age and severity in children with Cerebral Palsy.  The subjects consisted of 64 children between the ages of 21 – 84 months old diagnosed with CP who had the ability to follow verbal commands, and who did not undergo a muscle-lengthening surgery or Botox injection within the last 6 months.  Children were provided physical therapy by the same 2 assistants, 3x week for 30minutes each visit for a period of 6 months; during which each child participated in both a K-GMFM and the PEDI mobility assessment.  The specific intervention that was implemented by the therapist was not provided in the article.  The results of the study indicated that the GMFM-88 goal total provided the most responsive measure regardless of the functional severity.  Sensitivity to detect functional changes over time indicated that the GMFM-88 Goal total detected large changes, followed by the PEDI mobility scale and GMFM-88 with a medium effect size, and the GMFM-66 with a small effect size. According to Previous studies referenced by the article the PEDI and GMFM demonstrate a greater responsiveness to change in motor ability over time when utilized with Children under the age of 4 years old. In conclusion the GMFM-88 goal total had highest sensitivity to functional change regardless of severity, age in comparison to the other outcome measures utilized.

I thought this was an interesting article. The only issue I have with this study was that only 1 domain of the PEDI was utilized in the research.  The PEDI has 3 domains assessing multiple aspects of function, mobility, and self-care.  These measures, in my opinion, provides a greater measure to assess functional change across a larger magnitude of activities, with the focus of multiple ICF aspects rather than just looking at the mobility portion of it.

Reference:

Ko J. Sensitivity to functional improvements of GMFM-88, GMFM-66, and PEDI mobility scores in young children with cerebral palsy. Percept Mot Skills. 2014;119(1):305-19.

 

 

 

 

 

 

 

 

 

 

 

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