Pediatric Evaluation of Disability Inventory (PEDI)
There have been no updates made to the PEDI-CAT since the last reviewed article on March 7, 2018.
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
Steinhart S, Kornitzer E, Baron AB, Wever C, Shoshan L, Katz-Leurer M. Independence in self-care activities in children with myelomeningocele: exploring factors based on the International Classification of Function model. Disability and Rehabilitation. 2016;40(1):62-68. doi:10.1080/09638288.2016.1243158
Purpose: The aim of this article was to use the ICF-model to evaluate the independence level of children with MMC. The PEDI being a clinically valid and reliable test was used to evaluate the independence level for the participants and to take into consideration environmental factors associated with the children involved in the study.
Study Population: 113 total participants (aged 3-18 years; ~50% female) of a recruited sample from a multi-disciplinary outpatient clinic part of a hospital in Jerusalem, Israel. 62% of participants were complete paraplegics (thoracic or high lumbar lesion), 29% partial paraplegics (low lumbar lesions), 16% were sacral. Children with Arnold Chiari malformation accounted for 87% of the total population total, 88.5% had hydrocephalus (excessive CSF in intercranial space), and of those with hydrocephalus, 85% had a shunt installed.
Methods: Participants were excluded from study if additional diagnoses that impaired their function or cognition significantly. Mental retardation is an example of the cognitive diagnoses that would exclude a participant. Consent from the parents were obtained prior to any assessments were made.
Outcome Measures: The self-care domain of the PEDI was used to assess independence in self-care of the participants. This test was used due to the reliability and validity found in the age range of this population, as well as with assessing the level of independence in children with myelomeningocele. The functional mobility scale (FMS) was used for mobility. It was used due to it accounting for a range of assistive devices that the participant might use.
Results: The PEDI score for children with hydrocephalus was a mean of 10.7 points lower when compared to participants that did not have hydrocephalus. The PEDI caregiver scores were also a mean of 9.2 points lower in those participants with hydrocephalus at the time of this study. Environmental factors were expected to play a part in the scoring of the PEDI, however no associations were made between the independence level and different environmental factors. Participants were of different religious affiliations, however were mostly from a low socioeconomic level and parents of children had lower levels of education compared to general population. Age tends to be the most important aspect of functional independence, as with age comes experience and repetitiveness of tasks.
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: For most children with MMC, alternative or adaptive equipment is used for bowel and bladder management. Due to the difficulty and timeliness it takes to adjust the equipment, it may cause the patient to be less independent in the scoring on the PEDI. This would cause lower scores on the PEDI placing them in a category that may not be indicative of their functional assessment overall and lower the sensitivity of the PEDI in children with MMC. Activity and participation were not intricately measured due to time constraints in this clinic.
Conclusion: Age is the predominating factor for independence levels in children with MMC. Environmental factors do not play as much of a role as age does. This is important due to the fact that regardless of what level of socioeconomic status of the individual or family, they are much more likely to progress in independence with age. It is important to continuously encourage good behavior focus on other aspects that can assist with independence in self-care activities such as cognitive function.
3 responses to “Pediatric Evaluation of Disability Inventory (PEDI)”
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Great Review! I am impressed that you were able to identify the shortcomings of the PEDI in assessing children with MMC due to the difficulty and timeliness of managing their adaptive equipment during bowel and bladder functions. With age comes experience and strength which will help in the management of adaptive equipment. This was helpful information and shows me the importance of adaptive equipment training when working with children with MMC.
Interesting how hydrocephalus impacts function! Nice review!!
Thank you for this review! I am curious about how activity and participation would be measured in this population for future research. It would be interesting to see how both elements change with age and when compared to typical age-related activities.