An Assessment of Clinically
Relevant Pediatric Physical
Therapy Outcome Tools
Regis University
Sept 29, 2010
Cody Butler, SPT
Courtney Haia, SPT
Sydney Stan, SPT
Objectives
At the end of this presentation, each clinician should be able to:
 Accurately identify Sn, Sp, MCID, & MDD when selecting an
outcome tool
 Compare and contrast the psychometric properties of Pediatric
PT outcome tools
 Describe the effectiveness of the PEDI as an outcome tool in the
pediatric setting
 Examine the psychometric properties of the PEDI based on
evidence-based literature
 Accurately search and critically appraise literature for high
quality and clinically relevant research regarding outcome
measures
Benefits of Outcome
Measurement
 Information about developmental progress
 Ensure continuation of funding
 Improve program planning
 Inform decision making
 Improve guidance in goal development
Challenge
 The use of measures that are sensitive to small
changes in children with differing developmental
and functional disabilities.
Stakeholders
 The Children’s Hospital
 Department of Rehabilitation
 Individual Physical Therapists
 Patients and Families
Recommendations for
Outcome Measure Systems
 Ask Questions
 Purpose
 If purpose is for comparing performance to same age peer then you need a
scale that can give a normative standard score. (PEDI, Peabody, TIMP,
AIMS)
 If purpose is to measure progress along a continuum of difficulty then you
need a measure that can give you a scaled score.(GMFM, PEDI)
 Consider validity, reliability, sensitivity to change and responsiveness of the
measure
 Consider the group or individual of interest: homogenous, heterogeneous, dx,
age, severity of functional challenges, rate of change
Specificity and Sensitivity
 A test’s ability to obtain a
negative result when the
condition actually is absent.
A true negative.
 “SpIN”
 When a test is positive,
you can rule in the
disease/ condition
 The ability to obtain a
positive test when the
target condition is actually
present.
 “SnOUT”
 If the test is negative,
you can rule the
condition out.
 Overestimates the
amount of people
who have it.
Clinically Significant Difference
1. Responsiveness
“The power of a test to detect a clinically important
difference.”
1. Sensitivity to Change
“Accurate detection of change when it has occurred.”
Minimal detectable
difference (MDD)
 Defines the amount of change in a variable that
must be achieved in order to reflect a true difference
 The smallest amount of change that passes the threshold of
error.
Minimal clinically-important
difference (MCID)
 Smallest difference in a measured variable that
signifies and important rather than trivial
differences in patients’ conditions.
 Smallest difference a patient or clinician would
perceive as beneficial & would result in a change in
the management of the pt.
Psychometric Properties
TIMP
GMFM
PEDI
Responsive
-ness
Discriminates
between children
with various
conditions
Discriminates
between GMFCS
levels I-II and
II-III3
Greater responsiveness to
change with children > 4yo
Sensitivity
to change
Age-related
changes in motor
performance
(r = .83)1
ES and SRM > 0.54
ES and SRM > 0.84
Reliability
ICC: 0.89-0.95
Inter-rater: 0.077
and 0.885
ICC: 0.95-0.996
Inter-respondent reliability:
0.64-0.746
Validity
Concurrent
validity with
AIMS2
Children with CP
and Down’s
Syndrome (66)
Construct: strong correlation
between mean scale scores and
child’s age for functional skills
and care giver assistance scales7
Patient
population
34 weeks – 4
months
5mo – 16 yrs
< 7yo
International Classification of Functioning,
Disability and Health (ICF)
 Body Function: physiological function
 Activity: execution of an action
 Participation: places activities in to life situations
ICF
Level8-10
TIMP
Wee
FIM
Health
Condition
NO
NO
NO
NO
Body
Function
NO
NO
NO
NO
Activity
YES
YES
YES
YES
Participation
NO
NO
NO
YES
Environment
NO
NO
NO
YES
GMFM PEDI
Env mod,
caregiver
asst
We started with the
Question
 What outcome tool effectively measures change in
activity level and participation for children with a
wide variety of neurological disorders?
PEDI (CP or children) AND physical therapy
AND responsiveness to change AND
assessment
 Pub-med
 1 result (Ketelaar 200811)
 Conclusion
 “Only two evaluative assessment measures, the Gross Motor
Function Measure (GMFM) and the Pediatric Evaluation of
Disability Inventory (PEDI), fulfill the criteria of reliability and
validity with respect to responsiveness to change.”
What is the PEDI?
 Pediatric Evaluation of Disability Inventory (1990)
 Discriminative device
 Detects functional limitations and participation
 Self-care, mobility, social function, caregiver assistance,
modifications
 Evaluative
 Tracks progress in individual children with disabilities;
Sensitive to small increments of change
 Examples: Cerebral Palsy, hemiplegia, spina bifida, TBI,
Down’s syndrome
PEDI
 Number of items/questions
 197
 Time to complete
 30-60 minutes
 Age range
 <1-7 years
 Score range
 0-100
 Administered by clinician/guardian
Usefulness to everyday
practice
 Engelen 200712
 CONCLUSION
 Individual goals set in a physical therapy practice for
children with cerebral palsy can be linked, to a large
extent, to items and activities of 2 standardized
measures.
 GMFM-88 and PEDI
Identifying quality
evidence in the literature
 When asking a question based on gaps in the literature, use
the PICO format:




Person/patient population
Intervention
Comparison
Outcome
 Databases: PubMed, CINAHL, Cochrane Library
Future Endeavors
 Standardized format for
documenting pediatric
interventions (PPTIA)13
 PEDI Multidimensional Computer
adaptive testing (PEDI-MCAT)14
Conclusion
 No one assessment tool is able to capture the impact
of pediatric physical therapy and the use of
environmental modifications/adaptive equipment
on the multiple dimensions of the ICF (body
function, activity, participation).
Questions?
References
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14.
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