Reliability and validity of a revised version of the self-care domain of the Child Engagement in Daily Life Measure.

Research Report
Population: Pediatric

Alyssa C LaForme Fiss, PT, PhD, PCS, Associate Professor, Mercer University Department of Physical Therapy

Lisa Chiarello, PT, PhD, PCS, FAPTA, Professor, Drexel University, Department of Physical Therapy and Rehabilitation Sciences

Sarah Westcott McCoy, PT, PhD, FAPTA, Professor, Department of Rehabilitation Medicine

Keywords: Participation, Self-Care, Cerebral palsy

PURPOSE/HYPOTHESIS: Participation in self-care is an important outcome for young children with cerebral palsy (CP). This study aimed to examine reliability and validity of a revised version of the self-care domain of the Child Engagement in Daily Life Measure (CEDL).
SUBJECTS: 692 children with CP ages 18-months to 11-years and their families participated in the validity portion and a subset of 43 children participated in test retest reliability. 54% were boys and 81% of participating parents were mothers. Participants were a sample of convenience across Canada and the United States.
MATERIALS/METHODS: The self-care domain contains 18-items asking parents to rate the degree their child is able to participate in daily self-care activities. These items are scored on a 5-point Likert scale from 1- does not do the activity to 5- does the activity independently most of the time. Parents completed this measure during the initial assessment of a longitudinal study on developmental trajectories. During the same assessment session, children’s abilities were classified using the Gross Motor Function Classification System (GMFCS), the Manual Abilities Classification System (MACS), and the Communication Function Classification System (CFCS). For the test-retest reliability, parents completed the CEDL a second time. Children were placed into four age groupings: 18-months to 3 years, 3 to 6 years, 6 to 9 years, and 9 to 11 years. Test-retest reliability was calculated using intraclass correlation coefficient. Construct validity was established using known group methods with data analyzed using one-way ANOVAs with post hoc pairwise Tukey tests to compare group means for the GMFCS, MACS, CFCS and age groupings, and an independent t-test to compare means between boys and girls. An alpha level of p RESULTS: Test-retest reliability was excellent (ICC (2,1) = .984). Significant differences existed in participation in self-care across all GMFCS and CFCS levels. Significant differences also existed across MACS levels, except levels IV and V. For all classifications, children with higher functioning abilities participated in self-care with more independence than children with lower functioning abilities. Children ages 1.5 to 3 years had significantly lower self-care abilities than all other ages (All p<.001). No differences in self-care participation were found for children 3-6 years through 9-11 years. Differences between boys and girls were not observed (p=.019).
CONCLUSIONS: The self-care domain of the Child Engagement in Daily Life demonstrates excellent test-retest reliability and strong known groups validity across functional classification systems. Communication, manual abilities and gross motor function support children to be able to participate more independently in self-care abilities.
CLINICAL RELEVANCE: CEDL can be used as a descriptive and discriminative measure of participation in self-care for children with CP.

LaForme Fiss, Alyssa C, PT, PhD, PCS; Chiarello, Lisa A, PT, PhD, PCS, FAPTA; Westcott McCoy, Sarah , PT, PhD, FAPTA. Reliability and validity of a revised version of the self-care domain of the Child Engagement in Daily Life Measure.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online.