Reliability and validity of the Japanese version of the Visual Function Classification System for children with cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) often experience visual dysfunction that affects motor function and activities of daily living, but no 'gold standard' classification of visual function has been established. In recent years, however, a valid and reliable Visual Function Classification System (VFCS) for children with CP has been developed. AIMS: To examine the reliability and validity of the Japanese version of the VFCS in individuals with CP. METHODS: The translation of the VFCS was performed according to international standards for the translation of measurements. We conducted questionnaires of professionals (three physicians, eight physical therapists, five occupational therapists, six speech-language-hearing therapists and a certified orthoptist) regarding the content validity of the Japanese version of the VFCS. For reliability and concurrent validity, 148 individuals with CP were classified twice by professionals using the Japanese version of the VFCS, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Ability Classification System (EDACS), with several weeks between each evaluation. RESULTS: The content validity of the Japanese version of the VFCS almost met the criteria set. The percentage of positive and neutral opinions given by the professionals with regard to the four items ranged from 74% to 92%. The intra-rater reliability was 0.86 (95% CI 0.75-0.96) by Cohen's kappa and 0.93 (95% CI 0.88-0.96) by intraclass correlation coefficient. The inter-rater reliability was 0.67 (95% CI 0.56-0.78) by Cohen's kappa and 0.79 (95% CI 0.69-0.86) by intraclass correlation coefficient. The Spearman correlation coefficients between the VFCS and the GMFCS, MACS, CFCS and EDACS were 0.783, 0.764, 0.738, 0.738 and 0.830, respectively. The concurrent validity was confirmed by the correlations observed with other classification systems. CONCLUSIONS: The results indicated good reliability and validity for the Japanese version of the VFCS.

Psychometric evaluation and distribution of classification systems in children with cerebral palsy in Japan.

PURPOSE: The study sought to examine the content validity, the intra- and inter-rater reliability, and concurrent validity of the Japanese versions of the Manual Ability Classification System, the Communication Function Classification System, and the Eating and Drinking Ability Classification System, and representation of the distribution of the levels of each classification systems in comparison to the Gross Motor Function Classification System levels for children with cerebral palsy. METHODS: The Japanese versions were developed using the back-translation method. For content validity, professionals were asked to complete a questionnaire including items on the appropriateness of the translation, its validity, and distinctions among levels. For reliability, professionals used the three classification systems twice in children with cerebral palsy. For concurrent validity, relationships among the four classification systems were examined by correlation analyses. RESULTS: Participants included twenty-one professionals and 290 children with cerebral palsy (mean age: 12 years two months, female: 132, male: 158). The content validity was generally good. For reliability, the lower limit of the 95% confidence interval for the intraclass correlation coefficients was greater than 0.89, and the correlation coefficients were high. CONCLUSION: The results of this study showed good reliability and validity of the functional classification systems in Japan.

Reliability, validity, and minimal clinically important differences of the Japanese version of the early clinical assessment of balance in children with cerebral palsy.

PURPOSE: We aimed to translate the Early Clinical Assessment of Balance (ECAB) from English to Japanese and examine the content validity, inter-rater reliability, intra-rater reliability, construct validity, and minimal clinically important difference (MCID) for children with cerebral palsy (CP). METHODS: The ECAB was translated into Japanese per international standards. The study included 106 children with CP and, aged 1.5-12 years. The ECAB, the Gross Motor Function Classification System (GMFCS), and the Gross Motor Function Measure 66 Basal & Ceiling (GMFM-66-B&C) were measured. The content and construct validity were examined based on therapist feedback and correlations between the ECAB and GMFM-66-B&C. The inter-rater reliability and the intra-rater reliability were examined by the intra-class correlation coefficient (ICC). The MCID was calculated by the anchor-based method with the GMFM-66-B&C. RESULTS: High content validity (more than 80% agreement), inter-rater and intra-rater reliability (ICC = 0.99 & 0.99, respectively), and construct validity (r = 0.96) were demonstrated, with MCID values of 7.39, 5.32, and 6.88 observed for the GMFCS I/II, III, and IV/V, respectively. CONCLUSION: The Japanese version of the ECAB is a reliable and valid measure of balance ability in children with CP. Furthermore, the MCID of the ECAB was established, appears to be useful in helping to provide rehabilitation.Implications for RehabilitationThe Japanese version of the Early Clinical Assessment of Balance is easy, safe, and low-cost, and has high reliability and validity for assessing balance ability in children with cerebral palsy.The use of the Japanese version of the Early Clinical Assessment of Balance is beneficial for determining the therapeutic effect, appropriate treatment, and prediction of prognosis regarding balance ability in children with cerebral palsy.The minimal detectable change of the Japanese version of the ECAB suggest that a score exceeding 6 is a true change and the minimal clinically important difference of the Japanese version of the ECAB suggest that the scores exceeding 8, 6, and 7 for the GMFCS I/II, III, and IV/V, respectively, is a clinically useful change.

Motion analysis and surgical results of anterior transfer of flexor hallucis longus for equinovarus gait in children with hemiplegia.

BACKGROUND: Rigid equinovarus foot deformities are seen in patients with cerebral palsy (CP). This retrospective study was undertaken to evaluate flexor hallucis longus tendon (FHL) transfer with gastrocsoleus recession (GSR) using motion analyses and quantitative measurement, and to investigate postoperative complications. METHODS: This study included 10 hemiplegic CP patients who underwent FHL transfer with GSR, and were evaluated by motion analyses consisting of weight distribution in static standing position and three-dimensional gait analysis, both pre and post-operatively. They were assessed in terms of kinematic data, Gait Variable Scores (GVS), and Gait Profile Score (GPS). RESULTS: The mean age at operation was 7.3 years (range, 4-13 years), and mean follow-up duration was 35 months (range, 25-64 months) post-operatively. Weight distribution at surgical site significantly rose from 34.3% pre-operatively to 47.3% post-operatively, and abnormal asymmetry of weight distribution between surgical site and contralateral site disappeared post-operatively. Maximum ankle dorsiflexion (ADF) at initial contact rose from -20.9° to -6.28°. Similarly, Maximum ADF at both stance and swing phase rose from -13.8° to 17.7° (P = 0.0003), and from -19.5° to 1.35° (P = 0.001), respectively. Although mean GPS decreased from 15.6° pre-operatively to 11.8°, which corresponded to 2.38 times the minimal clinically important difference (MCID = 1.6°), three cases manifested talipes calcaneus at final follow-up. CONCLUSION: Although quantitative assessment showed that the potential value of FHL transfer with GSR was to obtain initial heel contact and maintain sufficient clearance from the ground in swing, it also revealed a risk of leading to talipes calcaneus. In the near future, we should establish accurate criteria for determination of transfer site, and consider the possibility of modification of this procedure in order to balance between recurrent equinus and significant talipes calcaneus. STUDY DESIGN: Clinical comparison between preoperative and postoperative.

Cross-Cultural Validation Study of the Japanese Version of the ABILOCO-Kids in Ambulatory Children With Cerebral Palsy Using Rasch Analysis.

Aims: To determine the structural validity, construct validity, cross-cultural validity, internal consistency and test-retest reliability of the Japanese version of the ABILOCO-Kids in children with cerebral palsy. Methods: One-hundred sixteen parents of children with cerebral palsy (Gross Motor Function Classification System level I [n = 66], II [n = 32], and III [n = 18]) reported on walking ability using the Japanese version of the ABILOCO-Kids. For test-retest reliability, 23 participants were evaluated. Results: The mean ABILOCO-Kids logit score was 2.48 (range -7.44 to 5.83). Rasch analysis and principal component analysis were used to determine the structural validity. The construct validity was confirmed on the basis of differences in the ABILOCO-Kids scores among the Gross Motor Function Classification System levels. Cronbach's α and the item-to-total correlation coefficient supported the internal consistency. The intra-class correlation coefficient was 0.96, standard error of measurement 0.56 and minimal detectable change 1.55. The cross-cultural validity analyses showed differential item functioning according to the analyses of the invariance of item difficulty and person's ability estimates. Conclusions: The ABILOCO-Kids is a reliable and valid measure of walking ability in children with cerebral palsy in Japan. The lack of evidence on cross-cultural validity indicates we should interpret results cautiously in cases of international comparison.

The criterion validity and intra-rater reliability of the Japanese version of the Functional Mobility Scale in children with cerebral palsy.

OBJECTIVE: The purpose of this study was to develop a Japanese version of the Functional Mobility Scale (FMS), and examine the criterion validity and intra-rater reliability of the FMS in Japan. METHODS: The translation of the FMS was performed according to international standards for the translation of measurements. For criterion validity, 111 children with cerebral palsy (mean age; 12year 1mo±3year 7mo; range 5-18) were rated the Japanese version of the FMS and Gross Motor Function Classification System (GMFCS). For intra-rater reliability, the Japanese version of the FMS was rated twice by 24 parents of children with cerebral palsy by interview and/or telephone with a one- to two-week interval between assessments. RESULTS: The criterion validity was confirmed with a strong correlation between GMFCS level and FMS scores (r2=-0.71 to -0.75). For intra-rater reliability, there was a substantial to excellent level of agreement (kappa=0.72-0.87). CONCLUSION: The study provides evidence of the criterion validity and intra-rater reliability of the Japanese version of the FMS as a measurement of mobility in children with cerebral palsy.

Easy-to-use clinical measures of walking ability in children and adolescents with cerebral palsy: a systematic review.

OBJECTIVE: The aims of this systematic review were to identify quick, simple and easy-to-use measures of walking ability currently used to assess children and adolescents with cerebral palsy (CP), and to evaluate the clinical utility and psychometric properties of these measures. DATA SOURCES: The PubMed, CINAHL, SPORTDiscus and MEDLINE databases were searched up to March 2015. REVIEW METHODS: Two independent reviewers rated the methodological quality of the identified measures using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. RESULTS: The 1-Minute Walk Test, Timed Up and Go Test, ABILOCO-Kids, Gillette Functional Assessment Questionnaire and Functional Mobility Scale were identified. Each measure can be carried out within 5 min with limited equipment, and does not require examiner training. There was "limited" to "strong" evidence on the reliability and validity of these measurements, whereas evidence on measurement error and responsiveness was limited. CONCLUSION: The identified measures in this systematic review may be considered for the clinical measurement of walking ability in children and adolescents with CP in a quick, simple and easy-to-use manner. However, there is overall a lack of evidence on the psychometric properties of these tools. The lack of evidence regarding measurement error and responsiveness might limit their value in measuring change over time. Implications for Rehabilitation The ABILOCO-Kids, 1-Minute Walk Test, Timed Up and Go Test, Gillette Functional Assessment Questionnaire, Functional Mobility Scale can be performed within 5 min with limited equipment, and do not require examiner training for measuring of walking ability in children and adolescents with cerebral palsy. The clinicians should use these measurement tools carefully when assessing change over time as the available evidence on measurement error and responsiveness is limited. When clinicians use these measurement tools, the psychometric properties reported in this systematic review should be considered in the selection of tools and subsequent interpretation of results.