Clinical Bottom Line
“How can I apply this information in spinal cord injury rehabilitation clinical practice?”
Comprehensive standardized functional outcome measures should be used to capture changes in children undergoing rehabilitation to examine the effectiveness of clinical practice. The Pediatric Evaluation of Disability Inventory (PEDI) is one such standardized functional assessment tool that identifies the areas and extent of functional deficits and may be used to detect changes in functional recovery over time. Inpatient rehabilitation is the current standard of care after spinal cord injury (SCI), both in adults and children. The psychometric properties of the PEDI are well documented, and the test is easy to administer by clinicians or self-report in a rehabilitation setting, and it covers many aspects of both self-care and functional mobility that are the focus of initial SCI inpatient rehabilitation programs. Based on this retrospective study, the PEDI seems to have potential to be used to document functional recovery in pediatric rehabilitation for children with SCIs. Standardized assessments should be used in pediatric rehabilitation as health care reimbursement for services will become dependent on such objective measures of change. Furthermore, the use of standardized measures that we believe best reflect meaningful clinical changes may make it less likely that individuals outside our profession choose standardized measures for us.
“What should I be mindful about in applying this information?”
In applying this information, the reader is encouraged to review the stated limitations of the study. These include small sample size (n = 32), sample that may not be indicative of larger population due to single-facility design, and the retrospective design with records pulled from a 12-year period of time. As noted by the authors, further study and prospective designs are needed. Reliability and validity need to be established for use of the PEDI for children with SCI. The reader is referred to a newly published review article by Haley et al1 that details plans for continued study with the PEDI.
The choice of outcome measures should be based not only on the measurement characteristics of the instrument but also whether it measures the change relevant to your program and outcomes needs. In short, can it capture the level of change in the clinical areas of greatest interest to your program? The items contained in the PEDI for both caregiver and functional scales are critical in SCI inpatient rehabilitation—the measure certainly seems to capture change in these areas. Change scores in the caregiver assistance (CA) pose an interesting issue, whereas parents by the end of rehabilitation are taught to provide the necessary level of assistance, this may not be true at admission to rehabilitation. Change in CA over the rehabilitation phase may reflect both the caregiver's improved confidence and understanding of what assistance is necessary, and the actual change in level of assistance. Whether these two can be or need to be teased apart is a separate issue, but one should consider what change scores represent. The authors also consider subgroups of items based on task similarity (eg, transfers, dressing) as assessed by experts. These subgroupings are intuitive; however, they should not necessarily be used for formal “subscoring” until the measurement characteristics of these subgroups are more formally tested.
Given that many rehabilitation programs rely on standardized instruments, if the PEDI is not currently being used, introduction and testing of the PEDI along with the existing measure is suggested.
Ryan Brown, DPT, PT
Physical Therapy Department, Shriners Hospital for Children, Philadelphia, PA
Carole A. Tucker, PhD, PT, PCS
Department of Physical Therapy, College of Health Professions and Social Work, Temple University, Philadelphia, PA
1. Haley S, Coster W, Kao YC, et al. Lessons from use of the Pediatric Evaluation of Disability Inventory: where do we go from here? Pediatr Phys Ther