Pediatric Musculoskeletal Functional Health Questionnaire
Descriptive Information
- Title: POSNA Pediatric Musculo-skeletal Functional Health Questionnaire
- Dates of Publication and Revision: 1998
- Author (s): Daltroy, L.H., Liang, M.H., Fossel, A.H., & Goldberg, M.J.
- Source (publisher or distributor, address): Pediatric Outcomes Instrument Developmental Group. Pediatric Orthopaedic Society of North
- Costs (booklets, forms, kit): No Cost
- Purpose: used to assess functional health outcomes, consisting of health, pain, and ability to participate in normal daily activities, as well as vigorous activities, usually post orthopedic surgery.
- Type of Test (eg, screening, evaluative; interview, observation, checklist or inventory): Interview
- Target Population and Ages: Children and adolescents (2-18) with general health problems and specifically any problems related to bone and muscle conditions.
- Time Requirements – Administration and Scoring: Not specified, approximately 15 minutes to complete.
Test Administration
- Administration:
- Parent/Child Questionnaire: Parents report for children 2-10 years old. Parent/Adolescent Questionnaire: Parent or adolescent (11-18 years old) reports.
- Scoring
- Responses are scaled. Some items use a categorical response, other items are nominal responses indicated by circling “Yes” or “No”
- Some Items are scored on a 5-point scale, others are scored on a 4-point scale.
- Eight Scales are calculated for the Pediatric Parent/child/adolescent Outcomes Instrument. Most Items are scored on a 1 to 4 range with 1 indicating that the activity is “easy” or “able to do most of the time” and 4 indicating that the activity “can’t be done at all” or “none of the time.”
- There are 8 subscales: upper extremity and physical function scale; Transfer and Basic Mobility Scale; Sports/Physical Functioning Scale: Pain/Comfort Scale; Treatment Expectations Scale; Happiness Scale; Satisfaction with Symptoms Scale; and Global Functioning Scale.
- A minimum of 50% of the items in a scale must have a response for the scale score to be computed
- Higher raw score represents a higher level of disability (general information except Treatment expectations)
- Higher normative scores reflect better functioning
- Type of information, resulting from testing (e.g. standard scores, percentile ranks)
- Higher raw scores on each scale excluding the treatment expectations scale indicates higher disability. Higher normative scores indicate better health.
- A formula is provided and is used to compute a standardized score for each scale by using the raw score.
- The global scale is scored 0-100, populations mean of 50, and standard deviation of 10.
- Norms
- Environment for Testing: Not Specified
- Equipment and Materials Needed: None
- Examiner Qualifications: No specific training is needed although administer must provide clear instructions to the respondent regarding the reference time period and response categories
Psychometric Characteristics
- Evidence of Reliability
- Test-Retest: Reliability was examined with Pearson correlation coefficients.
- Parent test-retest ranging from .71 (POSNA happy & satisfied scale) to .97 (POSNA global scale).
- Child test-retest .76 (POSNA expectations scale) to .97 (transfers & mobility scale)
- Reliability between parent and child response were lower, ranging from .45 (POSNA expectations scale) and .50 (POSNA happy & satisfied scale) to .84 (POSNA global scale).
- T-test were used to analyze differences in responses between pairs of parents and adolescent test takers. Results were significant for all scales, but the mean differences were not large. In general adolescents rated themselves higher than their parents, but parents had a higher expectation for treatment than their child.
- Evidence of Validity
- Content Validity: Determined by choosing the items that rated high in importance to patients, parents, and experts and verified by pilot testing.
- Construct Validity: Physician ratings of global function, pain limitation on function, and severity of diagnosis were analyzed and correlated with similar POSNA parent and adolescent measures. The highest connection was found between physician ratings of global function and parent and adolescent ratings on the POSNA global scale, upper extremity function, physical function and sports, and transfers and mobility scales.
- Sensitivity/Responsiveness to change
- Sensitive to improvement over 9-month period among patients with moderate to severe diagnosis at baseline.
Summary Comments
- Strengths
- No cost
- No equipment needed
- Ability to assess overall health, pain, and ability to participate in ADLs through 8 subscales.
- Weaknesses
- Significant time might be required to score questionnaire
- Scoring can be confusing due to multiple sources for scoring that are listed
- Length of questionnaire can be extensive to some
- Clinical Applications
- Ability to subjectively address all concerns and aspects of musculoskeletal health in pediatrics including upper extremity and physical function scale; transfer and Basic Mobility Scale; Sports/Physical Functioning; Pain/Comfort; Treatment Expectations; Happiness; Satisfaction with Symptoms; and Global Function.
Reference:
Susan E. Klepper. Measures of Pediatric Function. Pediatric Function. Oct 2003. S5-S14.
Article Summary
Kelly A. Jeans et al. Comparison of Gait After Syme and Transtibial Amputation in Children: Factors That May Play a Role in Function. J Bone Joint Surg Am, 2014 Oct 01.
A syme amputation is commonly recommended in order to preserve limb length, avoid bone overgrowth, enable distal limb loading, and maximize efficiency and symmetry of gait. However with the introduction of advanced prosthetic foot designs that have the potential to greatly improve athletic performance, families have been requesting a shorter residual limb length to accommodate athletic feet in order to give their children the potential to participate in competitive sports.The purpose of this study was to compare the efficiency and symmetry of gait in children with a syme amputation to those with a transtibial amputation and the impact of the prosthetic foot on gait and pediatric outcomes data collection instrument.The Study population consisted of 64 children ranging in ages between 4 and 19 years old with unilateral amputations. One group consisted of 41 children with a syme amputation and one group consisting of 23 children with a transtibial amputation. All participants completed gait training at least six months before participating in study. Participants that were unable to walk without assistance due to neurological, improper fit of prosthesis or skin issues were not tested. Participants underwent gait analysis with a motion capture system at self-selected walking speed. Residual limb length was measured manually from the medial joint line to the end of the residual limb. The prostheses prescription, including the socket and foot component was recorded by the treating prosthetist. The outcome measures used was the Pediatric functional health questionnaire. Results for symes vs transtibial group included only slight differences among groups. Longer residual length might restrict the ability to fit a high-performance dynamic foot component although there is no true gait differences that would impact function. Decisions on whether to shorten the tibia in a syme amputation should be made on a case by case basis.
2 responses to “Pediatric Musculoskeletal Functional Health Questionnaire”
Leave a Reply
You must be logged in to post a comment.
Our group has a high functioning 4 year old. This looks promising to use for happiness as well as for physical activity functioning. Should the test be done with and without AFO’s if the patient uses the AFO’s to help correct toe walking?
This is a good choice for an article following our recent P&O module. I think it would be interesting to have the parent fill out a questionnaire as well as the adolescent to see how the answers compare. Feedback from the patient is so important when planning patient interventions.