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Measuring Physical Function of Children with Spinal Impairments

The electronic medical record is showing up in more and more doctors' offices. Instead of filling out pages of paperwork, patients are taking surveys and answering questions on a computer.

Using an interactive program that adapts the questions based on previous answers helps save time. It cuts out unnecessary questions. For example, if a child can walk independently, then asking about wheelchair skills or stair climbing abilities isn't needed.

In this study, parents of children with spine impairments complete the Pediatric Evaluation of Disability Inventory Multidimensional Computerized Adaptive Testing (PEDI-MCAT). The goal was to see if this tool could be used effectively to assess the physical function of children with a wide range of abilities and impairments.

The PEDI-MCAT was given to parents of children with complex spinal impairments. All were patients in a busy pediatric spine clinic. Questions about self-care and mobility were the main focus. A tablet computer was used to complete the parent-report in the clinic waiting room before seeing the doctor. The parents said that it was easy to complete. They preferred it to answering questions on paper.

Data collected showed that children with adolescent idiopathic scoliosis (AIS) tested at a higher level of function compared with children who had early-onset scoliosis. Scoliosis refers to a condition of curvature in the spine. Idiopathic means the cause remains unknown.

This particular tool did not have high enough functional scores for some children. The test needs to be modified for older children to provide a broader range of items to match the children's abilities. More items need to be added to reflect their skills and abilities.

This study showed that the PEDI-MCAT is a good tool for use in a busy pediatric spine clinic. Speed and accuracy were key ingredients. Test results were reproducible, which helps prove that the test is reliable. Further modifications will be made to the test to include higher-level skills for older children.

References: M. J. Mulcahey, PhD, OTR, et al. Measuring Physical Functioning in Children with Spinal Impairments with Computerized Adaptive Testing. In Journal of Pediatric Orthopaedics. April/May 2008. Vol. 28. No. 3. Pp. 330-335.

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