Clusters of daily functioning and classification levels: Agreement of information in children with cerebral palsy

Purpose: To analyze the agreement between gross motor and hand function levels and clusters of functional performance in children with cerebral palsy (CP).

Method}: The sample consisted of 129 children with CP aged 4 to 13~years. Children's gross motor and hand function were classified with the Gross Motor Classification System (GMFCS) and Manual Ability Classification System (MACS). Their daily functioning on self-care and mobility was assessed with the Pediatric Evaluation of Disability Inventory (PEDI). Cluster analyses grouped children with similar repertoires on self-care and mobility skills using the agglomerative hierarchical technique. The associations across self-care and mobility clusters with daily living skills were tested with Chi-Square tests. The level of agreement was quantified with the Kappa coefficient.

Results: Four groupings of children's functional skills in self-care (R $^{2}=$ 0.92) and mobility (R $^{2}=$ 0.95) were identified. These groupings were associated with hand function (χ $ ^{2}=$ 145.43; p< 0.001) and mobility levels (χ $ ^{2}=$ 198.13; p< 0.001), respectively. The agreement between MACS and self-care skills was 61.7% (Kappa=0.47; p< 0.001) and between GMFCS and mobility skills was 64.4% (Kappa=0.54; p< 0.001).

Conclusion: The findings support the adequacy of functional classifications and functioning repertoires. The magnitude of agreement reinforces the importance of the concomitant use of functional classification and assessments.