The importance of motor functional levels from the activity limitation perspective of ICF in children with cerebral palsy

Our purpose in this study was to evaluate performance and capacity as defined by Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) from the 'activity limitation' perspective of International Classification of Functioning, Disability, and Health (ICF) and to investigate the relationship between the two classification systems in different subtypes of cerebral palsy (CP). This prospective cross-sectional study was performed on 448 children with CP ranging from 4 to 15 years of age. Activity limitations were studied with the GMFCS for gross motor function and MACS for manual ability. The Spearman's correlation coefficient, contingency coefficient, and Cramer's V coefficient were used to assess the strength and significance of the association between GMFCS and MACS. The overall agreement between GMFCS and MACS was found to be 41%. The agreement was 42% in spastic children, 40% in dyskinetic children, 50% in ataxic children, and 28% in mixed type children. The overall kappa value was kappa=0.235 (P<0.001). The kappa coefficient was 0.252 in spastic children, 0.245 in dyskinetic children, 0.318 in ataxic children, and 0.023 in mixed type children. All the kappa coefficients except the value for the mixed type were found to be significant. The usage of two different classification systems, GMFCS and MACS, to describe the capacity and performance in children with CP as defined by the ICF provides an easy and quick classification tool for indicating 'activity limitations' of ICF in children with CP. The next step in research should be to highlight the other domains such as participation restrictions in these children.