SEREBRAL PALSİLİ ÇOCUKLARDA GİLLETTE FONKSİYONEL YÜRÜME DEĞERLENDİRME ANKETİNİN GÖZLEMCİ İÇİ GÜVENİRLİK VE GEÇERLİĞİNİN ARAŞTIRILMASI

Yıl 2018, Cilt: 29 Sayı: 3, 73 - 78, 17.12.2018

Kübra Seyhan , Özge Çankaya , Tülay Tarsuslu Şimşek , Mintaze Kerem Günel

https://doi.org/10.21653/tfrd.339724

Cited By: 2

Öz

Amaç: Serebral palsili (SP) çocuklarda motor ve duyusal bozukluklar nedeni ile
yürüyüş etkilenmektedir. Tedavi boyunca yürüme fonksiyonunun geliştirilmesi ve
normalleştirilmesi için yürüyüş değerlendirilmelidir. Bu çalışmada amacımız
klinikte yaygın olarak kullanılan Gillette Fonksiyonel Yürüme Değerlendirme
Anketi (Gillette-FYDA)’nin gözlemci
içi güvenirliğini ve geçerliğini incelemekti.

Yöntem: Bu çalışmaya 5-18 yaş arasında 70 SP’li çocuk dahil edildi. Gözlemci
içi güvenirlik değerlendirilmesi için Gillette-FYDA 15 gün ara ile iki defa
aileye sorularak yapıldı. Yapısal geçerlik için Kaba Motor Fonksiyon Ölçütü’nün
(GMFM-88) D ve E alt başlıkları ile Pediatrik Fonksiyonel Bağımsızlık Ölçeği
(WeeFIM) kullanıldı. Eş-zamanlı geçerlilik için Kaba Motor Fonksiyon Sınıflama
Sistemi (GMFCS) kullanıldı. Cronbach alfa (a) katsayısı hesaplandı.

Sonuçlar: Çocukların ortalama yaşları 8,15±3,81 yıldı. Çocukların %72,9’u
spastik, %20’si diskinetik, %5,7’si ataksik ve %1,4’ü hipotonik tip SP’li idi.
Gillette-FYDA’nın gözlemci içi güvenirliğinde sınıf içi korelasyon (ICC) değeri
0,993 (0,988-0,996) bulundu ve Croanbach a değeri 0,993’tü.
Gillette-FYDA ile GMFM alt bölümleri (r_D=0,940 ve r_E=0,945,
p<0,01) ve WeeFIM (r_Motor=0,910, r_Toplam=0,883,
p<0,01) puanları arasında pozitif güçlü ilişkiler bulundu. Tek yönlü ANOVA
sonuçları, farklı GMFCS seviyelerinde yer alan çocukların Gillette-FYDA
skorlarının da farklı olduğunu gösterdi (p<0,05). Post-hoc analize göre
GMFCS seviyelerinin düşmesi ile Gillette-FYDA puanları yükseldi (p<0,05).

Tartışma: Gillette-FYDA,SP’li
çocukların fonksiyonel yürüyüşünün değerlendirilmesinde ve rehabilitasyon
programı sonuçlarının belirlenmesinde güvenilir ve geçerli bir yöntemdir. 

Anahtar Kelimeler

Serebral Palsi, Yürüyüş, Fonksiyon, Değerlendirme

AN INVESTIGATION OF INTRA-OBSERVER RELIABILITY AND VALIDITY OF THE GILLETTE FUNCTIONAL GAIT ASSESSMENT QUESTIONNAIRE IN CHILDREN WITH CEREBRAL PALSY

Öz

Purpose: Gait is affected by
sensorial and motor impairments in Cerebral Palsy (CP). Apropriate gait must be
evaluated for improving and normalizing gait function during treatment. In this
study, our purpose is to investigate the intrarater validity and reliability of
the Gillette Functional Gait Assessment Questionaire (Gilette-FAQ) commonly
used in clinically.

Methods: 70 children between 5
and 18 years were included in this study. Gilette-FAQ was asked to family twice
fifteen days interval for intrarater-reliability. Gross
Motor Function Measure (GMFM-88) D and E sub-dimensions and pediatric
functional independence measurement (WeeFIM) were used for construct validity
and Gross Motor Function Classification System (GMFCS) was
used concurrent validity. Cronbach alpha (a)
coefficient  was calculated. Alpha was
accepted as enough between 0.70 and 0.95.

Results: The mean age was 8.15±3.81 years. 72.9% of children was
spastic,  20% was dyskinetic, 5.7 %  was ataxic and 1.4% was hypotonic type of
CP.  Intra-class correlation (ICC) value
was found 0.99 in test-retest
reliability and internal consistency of Gilette-FAQ. There were positive strong correlations between Gilette-FAQ and GMFM-D, E (r=0.94, r=0.94, p<0.01); Gilette-FAQ and WeeFIM motor and total score
(r=0.91, r=0.88, p<0.01). The results of one way ANOVA showed that Gilette-FAQ
scores of GMFCS levels were different (p<0.05). Statistical difference was
found between GMFCS levels in Post-hoc test (p<0.05).

Conclusion: Gilette-FAQ
was valid and reliable among the parents of children with CP for evaluating
functional gait and determining rehabilitation results according to results.

Anahtar Kelimeler

Cerebral Palsy, Gait, Function, Assessment

Kaynakça

• 1- Himuro N, Abe H, Nishibu H, Seino, T, Mori M. Easy-to-use clinical measures of walking ability in children and adolescents with cerebral palsy: a systematic review. Disabil Rehabil.2017;39(10):957-968.
• 2- Dodd K, Fooley S. Partial body-weight-supported treadmill training can improve walking in children with cerebral palsy: a clinical controlled trial. Dev Med Child Neurol.2007;49(2):101-105.
• 3- Oeffinger D, Bagley A, Rogers S, Gorton G, Kryscio R, Abel M et al. Outcome tools used for ambulatory children with cerebral palsy: responsiveness and minimum clinically important differences. Dev Med Child Neurol.2008;50(12):918–25.
• 4- Baker R, McGinley JL, Schwartz MH, Thomason P, Rodda J, Graham HK. The minimal clinically important difference for the Gait Profile Score. Gait Posture. 2012;35(4):612-615.
• 5- Adair B, Said CM, Rodda J, Morris ME. Psychometric properties of functional mobility tools in hereditary spastic paraplegia and other childhood neurological conditions. Dev Med Child Neurol 2012;54:596-605.
• 6- Novacheck TF, Stout JL, Tervo R. Reliability and validity of the Gillette Functional Assessment Questionnaire as an outcome measure in children with walking disabilities. J Pediatr Orthop.2000;20(1): 75–81.
• 7- Sullivan E, Barnes D, Linton JL, Calmes J, Damiano D, Oeffinger D et al. Relationshios among functional outcome measures used for assessing children with ambulatory CP. Dev Med Child Neurol.2007;49(5):338-44.
• 8- Kerem Günel M, Tarsuslu T, Mutlu A, Livanelioğlu A. Spastik diparetik beyin felçli çocuklarda Gilette Fonksiyonel Yürüme Değerlendirme Anketinin gözlemciler arası güvenirliğinin araştırılması. Acta Orthop Traumatol Turc.2010;44(1):63-69.
• 9- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics.1977;33(1):159-74.
• 10- Feise RJ, Menke JM. Functional Rating Index: A new valid and reliable instrument to measure the magnitude of clinical change in spinal conditions. Spine. 2001;26(1):78-87.
• 11- Ottenbacher KJ, Msall ME, Lyon NR, Duffy LC, Granger CV, Braun S. Interrater agreement and stability of the functional independence measure for children (weefim™):Use in children with developmental disabilities. Arch Phys Med Rehabil.1997;78(12):1309-1315.
• 12- Ko J, Kim M. Reliability and responsiveness of the gross motor function measure-88 in children with cerebral palsy. Phys Ther.2013;93(3):393-400.
• 13- Aslan E, Karaduman A, Yakut Y, Aras B, Simsek IE, Yaglı N. The cultural adaptation, reliability and validity of neck disability index in patients with neck pain: a Turkish version study. Spine (Phila Pa 1976).2008;33(11):362-365.
• 14- Hayran M, Hayran M. Sağlık araştırmaları için temel istatistik.1ed. Ankara: Omega Araştırma Organizasyon Eğitim Danışmanlık Ltd. 2011.
• 15- Bjornson KF, Zhou C, Stevenson R, Christakis DA. Capacity to participation in cerebral palsy: evidence of an indirect path via performance. Arch Phys Med Rehabil. 2013; 94(12): 2365–2372.
• 16- Vargus-Adams JN, Martin LK. Domains of importance for parents, medical professionals and youth with cerebral palsy considering treatment outcomes. Child Care Health Dev.2011;37(2):276–81.
• 17- Daltroy LH, Liang MH, Fossel AH, Goldberg MJ. The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. Pediatric Outcomes Instrument Development Group. Pediatric Orthopaedic Society of North America. J Pediatr Orthop.1998;18(5):561-71.
• 18- Chong J, Mackey AH, Broadbent E, Stott NS. Relationship between walk tests and parental reports of walking abilities in children with cerebral palsy. Arch Phys Med Rehabil. 2011;92(2):265-70.
• 19- McDowell BC, Kerr C, Parkes J. Interobserver agreement of the Gross Motor Function Classification System in an ambulant population of children with cerebral palsy. Dev Med Child Neurol.2007;49(7):528-33.
• 20- White-Koning M, Arnaud C, Bourdet-Lubère S, Bazex H, Colver AF, Grandjean H. Subjective quality of life in children with intellectual impairment − how can it be assessed? Dev Med Child Neurol.2005;47(4):281–85.
• 21- Tucker CA, Gorton GE, Watson K, Fragala-Pinkham MA, Dumas HM, Montpetit K, et al. Development of a parent-report computer adaptive test to assess physical functioning in children with cerebral palsy 1:lower-extrmity and mobility skills. Dev Med Child Neurol. 2009;51(9):717-24.
• 22- Ammann‐Reiffer C, Bastiaenen CH, Bie RA, Hedel HJ. Interrater reliability of two gait performance measures in children with neuromotor disorders across two different settings. Dev Med Child Neurol.2017;Ahead of print.
• 23- Gorton GE, Stout JL, Bagley AM, Bevans K, Novacheck T, Tucker CA. Gilette Functional Assessment Questionnaire 22-item skill set: factor and Rasch analyses. Dev Med Child Neurol.2011;53(3):250-55.
• 24- Stout JL, Gorton GE, Novacheck T, Bagley AM, Tervo RC, Bevans K, Tucker CA. Rasch analysis of items from two self-report measures of motor function:determination of item difficulty and relationships with children’s ability levels. Dev Med Child Neurol.2012;54(5):443-50.
• 25- Stout J, Novacheck T, Gorton G, Tervo R, Bagley A, Tucker C. Gilette Functional Assessment Questionnaire:application of rasch analysis to link classification levels to performance of functional skills in children with disabilities. Gait Posture.2009;30(2):92-93.