Clinical Review of the Pediatric Evaluation of Disability Inventory,
by V. Knox and Y. Usen, British Journal of Occupational Therapy, 2000;63:29–32.
Helene Dumas, MS, PT, PCS
The Pediatric Evaluation of Disability Inventory (PEDI) is a standardized functional assessment used by therapists to examine functional limitations, monitor progress for individual children, and evaluate program outcomes. The Functional Skills Scale from the PEDI assesses a child’s capability with basic self-care, mobility, and social function activities. The PEDI Caregiver Assistance Scale assesses the amount of help required of others during complex multistep, self-care, mobility, and social function activities. The modifications scale identifies environmental and equipment needs. The PEDI has been standardized for children between six months and seven and one-half years of age, but the content can be used to assess performance of older children who demonstrate deficits in basic functioning. The purpose of this report was to describe the experience of using the PEDI for repeat assessments over time for 10 children with cerebral palsy.
Using parent interviews, the PEDI was administered and then readministered six to nine months later by an occupational therapist to 30 children with a diagnosis of cerebral palsy who were receiving therapy at the Bobath Centre. Retrospectively, PEDI-scaled scores were documented for all subjects. The first 10 children with complete examination and reexamination data were included in this study. Four classifications of cerebral palsy were noted, including spastic quadriplegia (n = 2), spastic diplegia (n = 6), ataxia (n = 1), and athetoid quadriplegia (n = 1). The average age was 10 years two months. Children received physical, occupational, and/or speech and language therapy daily for one to two weeks or one to two times a week on an ongoing basis.
Most subjects showed a positive change (increased scaled score) for some domains and a negative change (decreased scaled score) for other domains on the Functional Skills and Caregiver Assistance Scales. The four oldest children (more than nine years of age) with spasticity had a negative change on the Functional Skills Mobility Scale and three of the four had a decrease on the Caregiver Assistance Mobility Scale.
This study illustrates the use of a functional assessment for documenting individual children’s functional capabilities and level of independence and the use of the same tool for reassessment to monitor progress or loss of function over time. The authors discuss the need for familiarity with the PEDI manual before administration and acknowledge the lengthy administration time for the interviews. The authors reported, however, that parents responded favorably to the interview and that the interviews highlighted areas requiring intervention.
For this study sample, the PEDI was shown to be sensitive to change over time. Changes in PEDI scores were linked with clinical observations, including a specific therapeutic focus, equipment usage, increased muscle tightness, and behavioral observations. Conversely, the authors reported that some score changes seemed unrelated to observations and recommended that consideration be given to the potential bias of interviews done with only one caregiver. The authors reported expecting negative change scores due to the ages of the majority of children in the sample.
Readers are cautioned that no conclusions can be drawn regarding the effects of therapeutic input, inasmuch as therapy may not have focused on areas measured by the PEDI. The authors concluded that the PEDI is a useful tool to describe areas of functional delay in children with cerebral palsy, and that it seems sensitive to changes observed clinically. Recommendations were made to relate the PEDI to postural tone and patterns of movement as well as other standardized assessments. Additional investigation into the sensitivity of the PEDI over time and with children with differing disabilities was also recommended.
Limitations and Implications
Additional demographic information would have enhanced the overall picture of the children in this study for the reader. It is unclear if the same therapist performed all of the assessments and tester training, because reliability and bias were not addressed. No rationale for using parent interviews vs observation and interview was given. The results reported in the text and/or graphically were limited to one subset of children: older children with spasticity and two individual cases. Results were described in terms of most or some of the children. With the limited number of subjects, additional descriptions of individual cases or groups of cases would have been valuable.
Few functional assessments are available for use by pediatric physical therapists despite the continued emphasis on measuring functional activity at both the individual and program level. Additionally, limited research exists examining the value of the available tools for measuring the functional capabilities of children, monitoring a child’s progress over time, or for program evaluation. Reports such as this describing the use of a functional assessment and the implications for pediatric therapists can provide beneficial information.