The Impact of Functional Classification Systems on Quality of Life in Children with Cerebral Palsy
Abstract
Cerebral palsy (CP) is associated with heterogeneous functional limitations that influence children’s participation and quality of life (QOL). This study aimed to examine the predictive contributions of functional capacity classification systems, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Eating and Drinking Ability Classification System (EDACS), to multidimensional QOL outcomes in children with CP. This cross-sectional study included 125 children with CP aged 4-12 years. Caregivers completed the Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child). Functional classifications were determined through structured online observation and caregiver interviews. Correlation analyses and multiple linear regression models were used to evaluate the effects of functional capacity classifications on seven QOL domains. MACS emerged as the most consistent predictor, significantly contributing to six QOL domains: social well-being and acceptance (p = 0.006), participation and physical health (p <0.001), emotional well-being (p <0.001), access to services (p = 0.007), pain and impact of disability (p <0.001), and family health (p <0.001). GMFCS showed a domain-specific effect, predicting emotional well-being only (p<0.001). EDACS demonstrated limited predictive value, contributing significantly to functioning (p = 0.001) and participation and physical health (p = 0.003). Explained variance ranged from 12% to 44%, with emotional well-being showing the strongest model. Manual ability classification plays a central role in shaping QOL in children with CP. Rehabilitation should prioritize upper-extremity function alongside participation and family-centered approaches.
Keywords
Supporting Institution
Ethical Statement
References
- Akpinar, P., Tezel, C. G., Eliasson, A. C., & Icagasioglu, A. (2010). Reliability and cross-cultural validation of the Turkish version of Manual Ability Classification System (MACS) for children with cerebral palsy. Disability and Rehabilitation, 32(23), 1910-1916. [CrossRef] [PubMed]
- Atasavun Uysal, S., Düger, T., Elbasan, B., Karabulut, E., & Toylan, İ. (2016). Reliability and validity of the cerebral palsy quality of life questionnaire in the Turkish population. Perceptual and Motor Skills, 122(1), 150-164. [CrossRef] [PubMed]
- Badia, M., Riquelme, I., Orgaz, B., Acevedo, R., Longo, E., & Montoya, P. (2014). Pain, motor function and health-related quality of life in children with cerebral palsy as reported by their physiotherapists. BMC Pediatrics, 14(1), 192. [CrossRef] [PubMed]
- Bingöl, H., & Günel, M. K. (2022). Investigating the effects of functional ımpairment on health-related quality of life parameters in ındividuals with adolescent cerebral palsy: a cross-sectional study. Child and Civilization, 7(13), 9–28.
- Bingöl, H., & Karaoba, D. D. (2025). Psychological Problems in Children with Cerebral Palsy and Its Relationship with Health-Related Quality of Life. Istanbul Gelisim University Journal of Health Sciences, (25), 329-342. [CrossRef]
- Bjornson, K. F., & McLaughlin, J. F. (2001). The measurement of health‐related quality of life (HRQL) in children with cerebral palsy. European Journal of Neurology, 8, 183-193. [CrossRef] [PubMed]
- Chin, E. M., Johnson, T. L., & Hoon, A. H., Jr. (2021). Cerebral palsy: Epidemiology, neurobiology, and lifespan management. In L. M. Glidden, L. Abbeduto, L. L. McIntyre, & M. J. Tassé (Eds.), APA handbook of intellectual and developmental disabilities: Foundations. (pp. 261–294). American Psychological Association. [CrossRef]
- Christovão, I. S., Chagas, P. S. D. C., Aniceto, A. A. V., Bettoni, D. A. D. O., Ferreira, L. C., Leite, H. R., & Camargos, A. C. R. (2025). Outcomes and standardized tools in telehealth physical therapy for children with cerebral palsy: A scoping review using the ICF framework. Developmental Medicine & Child Neurology. 68(4), 477-488. [CrossRef] [PubMed]
- Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Routledge. [CrossRef]
- Dang, V. M., Colver, A., Dickinson, H. O., Marcelli, M., Michelsen, S. I., Parkes, J., Parkinson, K., & Fauconnier, J. (2015). Predictors of participation of adolescents with cerebral palsy: A European multi-centre longitudinal study. Research in Developmental Disabilities, 36, 551-564. [CrossRef] [PubMed]