Severe hip displacement reduces health-related quality of life in children with cerebral palsy

Figures & data

Table 1. Children with cerebral palsy (GMFCS III–V, age 7–12 years): participants in the study compared to non-responders

	Participants, n	Non-responders, n	p-value
Sex			0. 9
Boys	40	42
Girls	27	27
Age in years (mean, SD)	9.1 (1.4)	9.4 (1.6)	0.4
CP type			0.1
Spastic diplegia	18	21
Spastic quadriplegia	36	26
Bilateral dyskinetic	13	19
Ataxic	0	3
Ambulation			0.3
GMFCS III	12	20
GMFCS IV	17	17
GMFCS V	38	32

GMFCS: gross motor function classification system.

Table 2. CPCHILD domain scores: associations with GMFCS level and hip displacement (MP)

		Score
Domain	mean	mean diff., 95% CI	p-value
Activities of Daily Living/Personal Care (1)
GMFCS III	51	10 (−4 to 24)	0.2 (III vs. IV)
GMFCS IV	41	4 (−6 to 15)	0.7 (IV vs. V)
GMFCS V	37	14 (2 to 26)	0.2 (III vs. V)
MP <40	42	7 (−1 to 15)	0.1
MP ≥40	35
Positioning, Transfer and Mobility (2)
GMFCS III	63	23 (10 to 36)	< 0.001 (III vs. IV)
GMFCS IV	40	8 (−2 to 18)	0.1 (IV vs. V)
GMFCS V	32	31 (20 to 43)	< 0.001 (III vs. V)
MP <40	42	9 (−1 to 18)	0.1
MP ≥40	33
Comfort and Emotions (3)
GMFCS III	87	11 (−4 to 27)	0.2 (III vs. IV)
GMFCS IV	75	8 (−4 to 20)	0.3 (IV vs. V)
GMFCS V	67	19 (5 to 33)	0.004 (III vs. V)
MP <40	78	18 (9 to 27)	< 0.001
MP ≥40	60
Health (5)
GMFCS III	95	14 (−3 to 32)	0.1 (III vs. IV)
GMFCS IV	81	23 (10 to 37)	< 0.001 (IV vs. V)
GMFCS V	57	38 (23 to 53)	< 0.001 (III vs. V)
MP <40	75	18 (6 to 30)	0.004
MP ≥40	57
Overall Quality of Life (6)
GMFCS III	80	6 (−16 to 28)	0.8 (III vs. IV)
GMFCS IV	74	15 (−2 to 32)	0.09 (IV vs. V)
GMFCS V	59	22 (2 to 41)	0.03 (III vs. V)
MP <40	69	9 (−5 to 23)	0.2
MP ≥40	60

GMFCS: gross motor function classification system.

MP: hip displacement expressed as migration percentage.

Table 3. Associations of CPCHILD Comfort and Emotion item scores with GMFCS level and hip displacement (MP)

		Score
Item	mean	mean diff., 95% CI	p-value
Eating
GMFCS III	96	8 (−13 to 29)	0.6 (III vs. IV)
GMFCS IV	88	11 (−5 to 28)	0.2 (IV vs. V)
GMFCS V	77	19 (1 to 38)	0.04 (III vs. V)
MP <40	86	10 (−3 to 22)	0.1
MP ≥40	76
Toileting
GMFCS III	96	18 (−3 to 40)	0.1 (III vs. IV)
GMFCS IV	78	8 (−9 to 24)	0.5 (IV vs. V)
GMFCS V	71	26 (7 to 45)	0.01 (III vs. V)
MP <40	84	25 (14 to 38)	< 0.001
MP ≥40	59
Clothing
GMFCS III	98	14 (−8 to 35)	0.3 (III vs. IV)
GMFCS IV	84	13 (−4 to 30)	0.2 (IV vs. V)
GMFCS V	71	27 (8 to 45)	0.003 (III vs. V)
MP <40	86	27 (15 to 39)	< 0.001
MP ≥40	60
Transfers
GMFCS III	88	8 (−12 to 29)	0.6 (III vs. IV)
GMFCS IV	80	13 (−2 to 30)	0.1 (IV vs. V)
GMFCS V	67	22 (4 to 40)	0.01 (III vs. V)
MP <40	80	22 (10 to 33)	< 0.001
MP ≥40	58
Sitting
GMFCS III	100	20 (−2 to 43)	0.09 (III vs. IV)
GMFCS IV	80	10 (−7 to 28)	0.3 (IV vs. V)
GMFCS V	70	31 (11 to 50)	0.001 (III vs. V)
MP <40	82	17 (3 to 31)	0.02
MP ≥40	65
Lying
GMFCS III	75	18 (−5 to 41)	0.2 (III vs. IV)
GMFCS IV	57	3 (−14 to 21)	0.9 (IV vs. V)
GMFCS V	53	21 (1 to 41)	0.04 (III vs. V)
MP <40	64	21 (8 to 34)	0.002
MP ≥40	43
Sleeping
GMFCS III	95	19 (−9 to 47)	0.3 (III vs. IV)
GMFCS IV	77	15 (−7 to 36)	0.2 (IV vs. V)
GMFCS V	62	34 (9 to 58)	0.004 (III vs. V)
MP <40	79	28 (12 to 44)	0.001
MP ≥40	51
Agitated
GMFCS III	60	4 (−21 to 28)	0.9 (III vs. IV)
GMFCS IV	61	−4 (−23 to 15)	0.9 (IV vs. V)
GMFCS V	65	−1 (−22 to 20)	1.0 (III vs. V)
MP <40	65	5 (−10 to 19)	0.5
MP ≥40	60
Unhappy
GMFCS III	66	−7 (−31 to 18)	0.8 (III vs. IV)
GMFCS IV	72	2 (−17 to 22)	1.0 (IV vs. V)
GMFCS V	70	−4 (−26 to 17)	0.9 (III vs. V)
MP <40	71	5 (−9 to 20)	0.5
MP ≥40	66

GMFCS: gross motor function classification system.

MP: hip displacement expressed as migration percentage.

Table 4. Associations between hip displacement and GMFCS levels and scores on the 5 CPCHILD domains, assessed by multivariable linear regression

CPCHILD domain	Beta (95% CI)	p-value
If MP ≥ 40%
Activities of Daily Living/Personal Care	−3.7 (−12.0 to 4.7)	0.4
Positioning, Transfer and Mobility	−1.0 (−9.1 to 7.0)	0.8
Comfort and Emotions	−14.1 (−23.1 to −5.1)	0.003
Health	−8.4 (−18.7 to 1.9)	0.1
Overall Quality of Life	−3.3 (−16.8 to 10.3)	0.6
Increasing GMFCS level
Activities of Daily Living/Personal Care	−6.0 (−10.8 to −1.2)	0.02
Positioning, Transfer and Mobility	−14.2 (−18.8 to −9.6)	< 0.001
Comfort and Emotions	−6.9 (−12.0 to −1.7)	0.01
Health	−18.2 (−24.1 to −12.2)	< 0.001
Overall Quality of Life	−10.7 (−18.5 to −2.9)	0.008

GMFCS: gross motor function classification system;

MP: migration percentage

Table 5. CPCHILD domain scores for children at GMFCS V and corresponding scores given in the CPCHILD manual (Narayanan et al. 2007). Values are mean (SD)

CPCHILD domain	Study sample (n = 38)	CPCHILD manual sample (n = 35)
Activities of Daily Living/Personal Care	37 (14)	31 (15)
Positioning, Transfer and Mobility	32 (14)	28 (14)
Comfort and Emotions	67 (20)	68 (23)
Communication and Social Interaction	Not examined	43 (24)
Health	57(22)	57 (17)
Overall Quality of Life	59 (27)	55 (25)

Narayanan U, Weir S, Fehlings D. The CPCHILD© Manual & Interpretation Guide 2007 [Online]. http://www.sickkids.ca/Research/CPCHILD-Questionaire/Manual-interpretation-guide/index.html: The Hospital for Sick Children; 555 University Avenue, Toronto, Ontario, Canada [Accessed April 29th 2016].

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