The Stability of the Gross Motor Function Classification System in Children with Cerebral Palsy Living in Stockholm and Factors Associated with Change

Figures & data

Figure 1. Flowchart for inclusion, in numbers

Table 1. Children’s year of birth.

Year of Birth	n	%
2000	43	5.6
2001	45	5.9
2002	43	5.6
2003	57	7.7
2004	47	6.1
2005	43	5.6
2006	51	6.6
2007	62	8.1
2008	57	7.7
2009	65	8.5
2010	44	5.7
2011	55	7.2
2012	46	6
2013	41	5.3
2014	39	5.1
2015	19	2.5
2016	9	1.2
2017	2	0.02

Table 2. Number of GMFCS ratings per child.

Number of GMFCS ratings	n	%
2	69	9
3	77	10
4	76	9.9
5	78	10.2
6	66	8.6
7	96	12.5
8	67	8.7
9	88	11.5
10	60	7.8
11	41	5.3
12	22	2.9
13	17	2.2
14	9	1.2
15	2	0.3

Table 3. Absolute number and percentage of children without change of GMFCS level and those with change, divided by level at first assessment, number (n) and percentage (% and median, mean and SD of the standard deviation of change of GMFCS level expressed against initial GMFCS level.

		Change of GMFCS level			Standard deviation for change of GMFCS level
		Total	No n (%)	Yes n (%)	Median (25–75 percentile)	Mean GMFCS-SD	SD GMFCS-SD
GMFCS level first follow- up	I	380	336 (88%)	44 (12%)	0 (0.00–0.00)	0.06	0.17
	II	94	30 (32%)	64 (68%)	0.41 (0.00–0.52)	0.32	0.24
	III	65	32 (49%)	33 (51%)	0.29 (0.00–0.48)	0.25	0.26
	IV	101	47 (47%)	54 (54%)	0.32 (0.00–0.49)	0.27	0.30
	V	128	106 (83%)	22 (17%)	0 (0.00–0.00)	0.10	0.24
Total		768	551 (72%)	217 (28%)	0 (0.00–0.33)	0.14	0.24

Table 4. Cross-tabulation of GMFCS level at first and last assessment, in absolute numbers. Numbers in bold indicate the total amount of children with similar GMFCS level at first and last assessment.

		GMFCS level at last assessment					Total
		I	II	III	IV	V
GMFCS level at first assessment	I	360	19	1	0	0	380
	II	39	39	14	2	0	94
	III	2	6	43	14	0	65
	IV	2	1	9	60	29	101
	V	0	2	2	10	114	128
Total		403	67	69	86	143	768

Table 5. Linear regression. Univariate analysis for the association with GMFCS-SD (dependent variable) and personal and treatment-related factors. Number of children in the analysis (n), median, minimum and maximum (min - max), for those who had changed and those who did not change GMFCS level during the follow-up period). The standardized regression coefficient (beta), 95% confidence interval (95%CI) for beta and p-value.

	GMFCS level		n	Median (Min- max)	Standardized Beta coefficienta)	95%CI Lower bound	95%CI Upper bound	p-value
Personal factors
Follow-up time	Change Stabile	217 551		7 (1–12) 6 (1–13)	0.038	−0.002	0.008	0.288
Number of GMFCS ratings	Change Stabile	217 551		8 (2–15) 6 (2–13)	0.157	0.007	0.018	0.000
GMFCS level at first assessment	Change Stabile	217 551		3 (1–5) 1 (1–5)	0.162	0.014	0.036	0.000
Age at first change	Change	217		5 (1–18)	−0.053	−0.009	0.004	0.441
Number of assessors (number of registered names)	Change Stabile	217 551		3 (1–10) 3 (1–11)	0.083	0.001	0.017	0.021
Medical interventions since the previous assessment
Surgery since last assessment	Change Stabile	217 549		0 (0–5) 0 (0–6)	0.023	−0.012	0.024	0.531
Botulinumtoxin- injections	Change Stabile	217 551		0 (0–13) 0 (0–13)	0.088	0.002	0.016	0.014
Spasticity reducing medicine	Change Stabile	217 548		0 (0–10) 0 (0–14)	−0.012	−0.011	0.007	0.733
SDR surgery	Change Stabile	201 473		0 (0–3) 0 (0–2)	0.013	−0.064	0.089	0.744
Serial casting	Change Stabile	214 521		0 (0–3) 0 (0–4)	0.059	−0.010	0.090	0.113
Fracture since last assessment	Change Stabile	217 550		0 (0–5) 0 (0–4)	0.027	−0.026	0.058	0.449
Use of orthosis	Change Stabile	217 551		7(0–17) 4 (0–17)	0.157	0.005	0.014	0.000
Physical therapy interventions
Physiotherapy interventions other than CPUP	Change Stabile	217 551		8 (0–18) 4 (0–17)	0.183	0.007	0.015	0.000
Intensive training period	Change Stabile	217 549		2 (0–10) 1 (0–13)	0.155	0.009	0.025	0.000

a Dependent variable: GMFCS-SD.

Table 6. Multiple regression analysis for the relationship between significant personal and treatment-related variables from the initial model and GMFCS-SD (dependent variable). The regression coefficient (beta), 95% confidence interval for beta and p-value in initial and final model.

	Initial model				Final model
	Standardized Beta coefficient^a^)	95%CI Lower bound	95%CI Upper bound	p-value	Standardized Beta coefficient ^a)	95%CI Lower bound	95%CI Upper bound	p-value
Number of GMFCS ratings	0.094	0.000	0.015	0.047	0.074	−0.001	0.012	0.076
GMFCS level at first assessment	0.133	0.009	0.032	0.000	0.127	0.009	0.031	0.001
Number of assessors	−0.034	−0.013	0.006	0.432
Botulinumtoxin-injections	−0.014	−0.009	0.007	0.739
Intensive training period	0.104	0.002	0.021	0.016	0.097	0.002	0.020	0.018

a Dependent variable: GMFCS-SD.