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Reproducibility of an instrumented measure for passive ankle dorsiflexion in conscious and anaesthetized children with cerebral palsy

Hastings-Ison, T, Blackburn, CG, Opie, N, Graham, KE, Rawicki, B, Wolfendale, R, Simpson, P and Baker, RJ 2014, 'Reproducibility of an instrumented measure for passive ankle dorsiflexion in conscious and anaesthetized children with cerebral palsy' , Developmental Medicine and Child Neurology, 56 (4) , pp. 376-385.

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AIM: The aims of this study were to (1) determine whether an instrumented measure will reduce measurement error to less than 5 degrees in children with cerebral palsy (CP), (2) determine agreement and reliability of this instrumented measure in both conscious and anaesthetized participants, and (3) compare the method with previously reported measures. METHOD: Thirty-four ambulant children (15 males, 19 females), aged 3 to 9 years, with spastic CP were studied in a tertiary-care paediatric hospital (21 with hemiplegia, 11 with diplegia, and two with quadriplegia). The majority of children functioned at Gross Motor Function Classification System level I (n=11) or II (n=18), with five children at level III. Ankle dorsiflexion at 50% bodyweight was photographed and measured. Each child was measured when conscious and when under mask anaesthesia by two experienced assessors. RESULTS: The standard error of measurement (SEM) ranged from 3.9 degrees (anaesthetized; 95% confidence interval [CI] 3.3-4.0 degrees ) to 6.7 degrees (conscious; 95% CI 5.3-8.0 degrees ). This compared favourably with previously reported dorsiflexion measures (SEM range 6.5-7.8 degrees ) in conscious children with CP. Intrarater reliability was good in both conditions (intraclass correlation coefficient [ICC]: range 0.95 [anaesthetized; 95% CI 0.92-0.98] to 0.86 [conscious; 95% CI 0.76-0.95]). The ICC for interrater reliability ranged from 0.87 (anaesthetized; 95% CI 0.81-0.93) to 0.65 (conscious; 95% CI 0.50-0.81). INTERPRETATION: Passive ankle dorsiflexion using an instrumented measure has face validity and may assist in the improvement of reproducibility under anaesthesia for clinical research. When an individual is conscious, this technique is not better than trained assessors using conventional goniometry reported in the literature and is not recommended for routine clinical use.

Item Type: Article
Themes: Health and Wellbeing
Schools: Schools > School of Health Sciences > Centre for Health Sciences Research
Schools > School of Health Sciences
Journal or Publication Title: Developmental Medicine and Child Neurology
Publisher: Mac Keith Press
Refereed: Yes
ISSN: 1469-8749
Related URLs:
Funders: Non funded research
Depositing User: Prof Richard Baker
Date Deposited: 01 Apr 2014 17:33
Last Modified: 30 Nov 2015 23:43

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