Classification of patient-defined hand-arm treatment goals in young people with cerebral palsy and upper extremity spasticity undergoing upper extremity surgery.

Abstract

To classify and evaluate patient-defined hand-arm treatment goals in young people with cerebral palsy (CP) undergoing upper extremity surgery. Patient-defined hand-arm treatment goals were collected from young people with CP and upper extremity spasticity using a semi-structured Canadian Occupational Performance Measure interview. Goals were classified within the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). Inter-rater agreement of the classification was assessed. Frequencies of goals were analyzed, with subgroup analyses across Manual Ability Classification System (MACS) levels. Twenty-one participants (62% male; mean age 16.3 years, SD 3.9) reported 107 goals. All but two goals were classified within the Activities and Participation domain with perfect inter-rater agreement (100%). Inter-rater agreement for ICF-CY third- and fourth-level categories was 79.9%. The most frequent categories were grasping (20.5%) and manipulating (11.0%). Patients with MACS-levels IV-V mainly reported goals related to self-care and pain. Patients with MACS-levels I-III focused on bimanual activities. Patient-defined hand-arm treatment goals were successfully classified to the Activities and Participation domain, with variation across manual ability levels. Classification into ICF-CY third- and fourth-level categories is anticipated to enhance the development of individualized treatment plans.