Tests & Measures: A Resource for Pediatric Physical Therapy Practitioners

Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT)

There have been no updates made to the PEDI-CAT since the last reviewed article on March 6, 2017.

 

PEDI-CAT for Windows= $89.00

PEDI-CAT for iPad= $399.00

(PEDI-CAT 1.4.0 Manual is included with purchase.)

 

Category: Evaluative

 

Article reviewed

Shore, B., Allar, B., Miller, P., Matheney, T., Snyder, B. and Fragala-Pinkham, M. (2017). Evaluating the Discriminant Validity of the Pediatric Evaluation of Disability Inventory: Computer Adaptive Test in Children With Cerebral Palsy. Physical Therapy, 97(6), pp.669-676.

 

Purpose: The aim was to investigate the discriminant validity of the PEDI-CAT according to GMFCS and MACS levels in a group of children/adolescents with Cerebral Palsy. Discriminant validity determines whether two measures that should not be related are actually not related.

 

Study Population: 101 total participants [54 boys, 47 girls] of a convenience sample from a multi-discipline CP clinic at a tertiary-level pediatric children’s hospital; Mean age was 11 years, 11 months. English and Spanish – speaking parents of children and adolescents between 6 and 20 years old, confirmed diagnosis of CP (GMFCS I-IV) and consistent primary caregiver present during the clinic visit. 59 participants were identified as ambulatory (GMFCS levels I-III) and 42 as non-ambulatory (GMFCS levels IV-V). 26 participants were identified as manually independent (MACS level I-II) and 36 as manually dependent (MACS levels III-IV).

 

Methods: Participants were excluded from study if neuromuscular diagnosis was unclear, if they had recently undergone a surgical procedure (less than 6 months) or if they had a recent botulinum toxin A administration (less than 3 months). The participant’s parents or caregivers completed the PEDI-CAT using an iPad (in English or Spanish) with the aid of a trained research assistant. Demographic information recorded was race, sex, ethnicity, level of education(child and parent), socioeconomic status and type of caregiver completing the form. The treating physician assigned each participant a Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) score.

 

Outcome Measures: PEDI-CAT is utilized as a computer adapted platform with an item blank of 276 items that include the domains of Daily Activities, Mobility, Social/Cognitive and Responsibility. These 4 domains can be used separately or in combination with the other domains. There are 2 versions of the PEDI-CAT; speedy version which administers 15 items in each domain and Content-balanced version which administers 30 items with a minimum of 4 items from each content area of that domain. In this study, the speedy PEDI-CAT was used, with the total testing time lasting around 12 minutes on average.

 

Results: All four PEDI-CAT domain scores were able to discriminate amon GMFCS and MACS levels. Area’s under the ROC curve ((AUC’s)=0.98 and 0.97) Mobility and Daily Activities domains showed excellent discriminant validity distinguishing between ambulatory and non-ambulatory. The Daily activities domain also exhibited excellent discriminant validity distinguishing between independent and dependent hand function ((AUC)= 0.93).

 

Strengths: The study was able to create a large sample size (n= 101), with a variety of levels of GMFCS and MACS levels. This study was able to focus on school aged children and determine validity in relation to GMFCS and MACS levels.

 

Limitations: The study was not powered to detect differences across individual GMFCS and MACS levels. Instead it looked across broad functional levels of ambulatory versus non-ambulatory and independent versus dependent hand function. PEDI-CAT is designed for children and adolescents from birth through 20 years, where this study chose to focus on school-age children in this study. The population of this study had selection bias with caregivers who chose to participate in the study and all were primarily Caucasian, middle-income parents from similar socioeconomic backgrounds. All of the participants did not have a MACS classification, but it was found that there were no differences in PEDI-CAT scores between those with or without MACS levels.

 

Conclusion: The results of this study were able to demonstrate across gross and fine motor functional levels, that the PEDI-CAT is a valid outcome instrument for measuring functional abilities in children with CP. The author states that the next step in testing the PEDI-CAT should examine the responsiveness of the measure to surgical and rehabilitation interventions for children with CP, since this was an exclusion factor for this study. In this population they would need to determine the Minimal Detectable change (MDC) and Minimal Clinically Important Difference (MCID) for each domain. Future studies also need to involve testing the concurrent validity of the PEDI-CAT in CP with other measures such as the Functional Mobility Scale, Caregivers Priorities and Child Health Index of Life with Disabilities, and the Peds-QL (CP Module). Along with concurrent validity, future work needs to examine additional construct validity and responsiveness of the PEDI-CAT in children with CP.