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Who best to make the assessment? Professionals’ and families’ classifications of gross motor function in cerebral palsy are highly consistent
  1. C Morris1,
  2. J J Kurinczuk1,
  3. R Fitzpatrick2,
  4. P L Rosenbaum3
  1. 1National Perinatal Epidemiology Unit, University of Oxford, UK
  2. 2Department of Public Health, University of Oxford, UK
  3. 3CanChild Centre for Childhood Disability Research, McMaster University, Canada
  1. Correspondence to:
    Dr C Morris
    Department of Public Health, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK; christopher.morris{at}


Aim: To determine the reliability of family assessment for the Gross Motor Function Classification System (GMFCS) for children with cerebral palsy in the UK.

Methods: Families of a complete geographically defined population of children with cerebral palsy between 6 and 12 years old were identified from the 4Child epidemiological database. Postal surveys were conducted with the families and any of the child’s health professionals that were nominated by the families.

Results: Families of 129/314 eligible children took part in the study (41%). The indices of agreement and reliability between families and professionals were also equivalent to those observed between the professionals (κ = 0.5, ICC ⩾0.9). Reliability coefficients were higher when more of the professionals classified children using direct observation rather than only reviewing their clinical records.

Conclusions: Despite excellent reliability, families and professionals did not always agree exactly on a child’s GMFCS level. Classifications may differ due to children’s varying performance in different environments, in which case families will almost certainly know their children’s ability in a broader range of settings. The indices of reliability of family assessment for the GMFCS meet the recommended criteria for use with individuals and groups, indicating that the method is suitable for use in research studies and clinical practice.

  • cerebral palsy
  • disability
  • families
  • survey

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  • Published Online First 25 April 2006

  • Funding: Chris Morris was funded by the Medical Sciences Division at the University of Oxford and is now a MRC Special Training Fellow in Health Services Research; Jenny Kurinczuk is funded through a Public Health Career Scientist Award from the Department of Health and NHS R&D (PHCS 022); Peter Rosenbaum holds a Canada Research Chair in Childhood Disability; 4Child and the NPEU are both funded by the Department of Health.

  • Competing interests: none