Activity Limitations Questionnaire-Cerebral Palsy

Instrument Name: Activity Limitations Questionnaire-Cerebral Palsy

Abbreviation: ACTIVLIM-CP

Points for Consideration:

Has been used successfully in CMD.

Description of Tool:

The Activity Limitations Questionnaire - Cerebral Palsy is an ObsRO measuring both upper and lower extremity activity performance. Caregivers are asked to rate the difficulty their child has achieving 48 functional activities over the last 3 months from "impossible (0)," "difficult (1)," or "easy(2)". Activities include "playing with both hands while standing", "lifting a grocery bag," "riding a tricycle,", "closing velcro fasteners". Activities Not completed in the last 3 months are marked as missing. Higher scores represent higher functioning.

Other Related Tools (if applicable):

ACTIVLIM; ACTIVLIM-Stroke

Minimum Qualification Required by COA Administrator: No degree requirement

Year: 2017

Objective of Development:

To measure global activity performance in children with Cerebral Palsy (CP)

Population of Development: Age range (therapeutic indication):

2-20 years (Cerebral Palsy)

Pediatric Population(s) in which COA has been used:

Nervous system diseases

COA type:

Number of Items 43

Mode of Administration:

Data Collection Mode:

Time for Completion: Not reported

Response Scales: 3-point verbal rating scale ranging from 0 "impossible" to 2 "easy" with a "?" option

Summary of Scoring:

Available Scores:
Global score is Rasch transformed ranging from 0 to 80

Weighting:
No

Score Interpretation:
Higher score: Higher activity performance

Evidence of Literature Review: None identified

Evidence of Instrument Review: Yes

Evidence of Clinical or Expert Input: Yes

Evidence of concept elicitation in target patient population: None identified

Evidence of a Saturation Grid: None identified

Evidence for Selection of Data Collection Method: None identified

Recall/Observation Period:

Evidence for Selection of Reponse Options: None identified

Evidence of cognitive interviewing of draft instrument in target patient population: None identified

Evidence of Preliminary Scoring of Items and Domains: Yes

Evidence related to respondent and administrator burden: None identified

Evidence of a Conceptual Framework: None identified

Evidence of an item-tracking matrix: None identified

Evidence related to item selection: Yes

Evidence of re-testing the final version: None identified

Internal consistency (Cronbach's alpha): Yes

Evidence of internal consistency:

Test-retest Reliability (ICC):

Bleyenheuft (2017)
- Intraclass Correlation Coefficient (ICC):
ICC: 0.99, p<0.001 for the item difficulty hierarchy ICC: 0.96, p<0.001 for the children's global activity performance (person location) - Was a definition of stability applied to identify stable patients: No - Time frame or interval between the two administrations: 4 to 6 weeks - Population/Disease: Children with cerebral palsy ; n=129, from a sample with a mean age: 10.3 years (2-6)

Inter-rater/ inter-interviewer reliability (kappa):

Not applicable

Evidence of test-retest or inter-rater reliability: Yes

Concurrent validity (convergent, divergent):

Bleyenheuft (2017)
- Correlation coefficient used: Pearson's correlation coefficient
- Measure: Pediatric Evaluation of Disability Inventory (PEDI)
- Results:
Significant correlation was found between the ACTIVLIM-CP and PEDI: 0.87, p<0.001 ACTIVLIM-CP demonstrated less ceiling effect than PEDI but a worse capability to discriminate between children with a very low level of motor performance - Population/Disease: Children with cerebral palsy ; n=214

Known-group validity:

Bleyenheuft (2017)
KNown-groups validity:
- Measure/Groups of patients: Children with quadriplegia, diplegia, and hemiplegia
- A priori hypotheses: Children scores would be significantly different between groups
- Were hypotheses confirmed: Yes
- Results: Significant differences were found between scores of the three groups (Kruskall-Wallis, data Not shown, p<0.001). Children with quadriplegia showed significantly lower activity performance scores than both other groups: post-hoc analysis (data Not shown and p Not stated) Median score logits: Quadriplegia: -0.82 Diplegia: 1.04 Hemiplegia: 1.96 - Population/Disease: Children with cerebral palsy ; n=214, mean age 10.3 yeats (2-6)

Evidence of Translatability Assessment: None identified

Evidence related to missing data: None identified

Evidence for Selection of Recall Period: None identified

Evidence of Administration Instructions and Training Provided: None identified

Evidence of concurrent validity: Yes

Evidence of known-groups validity: Yes

Evidence of ability to detect change over time: Yes

Ability to detect change (Responsiveness):

Paradis (2018)
Methods: Anchor-based method
1- Population/Disease: Patients with cerebral palsy; n=47, mean age (SD) y:mo= 10:4 (3:6)
- Time horizon: Baseline (T0), 2 weeks (T1) and 3-4 months (T2)
- Group definition: Gross Motor Function Classification System (GMFCS)
- Statistics used: Post hoc analysis (Tukey), Effect size, RM-ANOVA and Friedman Main effect
Results:
Post hoc analysis: Significant Tukey results were found for the T0-T1 time horizon only in both GMFCS groups
Effect size: Moderate to large effect sizes were found between T0 and T1 only. Time horizons T0-T1, and T1-T2 respectively:

-GMFCS levels I and II: 0.73, 0
-GMFCS levels III and IV: 1.36, 0.15
RM-ANOVA (χ²) and Friedman Main effect (F):

-GMFCS levels I and II: χ²=5.18, p=0.07
-GMFCS levels III and IV: F=30.03, p<0.001 - Group size: - GMFCS levels I and II: n=27 - GMFCS levels III and IV: n=20 - Magnitude of change for each group: Mean ACTIVLIM-CP logits from T0 to T2 respectively: -GMFCS levels I and II: 2.34, 2.94, 2.94 -GMFCS levels III and IV: 0.55, 1.48, 1.77 2- Population/Disease: Patients with cerebral palsy; n=29, mean age (SD) y:mo= 8:5 (4:5) - Time horizon: Baseline (T0), 6 weeks (T1) and 3-4 months (T2) - Group definition: Gross Motor Function Classification System (GMFCS) - Statistics used: Effect size Results: Effect size: Small to large effect sizes were found. Time horizons T0-T1, and T1-T2 respectively: -GMFCS levels I and II: 0.22, -0.21 -GMFCS levels III and IV: -0.32, 0.88 - Group size: - GMFCS levels I and II: n=24 - GMFCS levels III and IV: n=5 - Magnitude of change for each group: Mean ACTIVLIM-CP logits from T0 to T2 respectively: GMFCS levels I and II: 2.09, 2.22, 2.42 GMFCS levels III and IV: 2.07, 1.84, 2.69

Evidence of responder thresholds: None identified

Bleyenheuft Y, Paradis J, Renders A, Thonnard JL, ArNould C. ACTIVLIM-CP a new Rasch-built measure of global activity performance for children with cerebral palsy. Res Dev Disabil. 2017 Jan;60:285-294
(Full text article: https://www.sciencedirect.com/science/article/pii/S0891422216302256?via%3Dihub)

Paradis J, ArNould C, Thonnard JL, Houx L, Pons-Becmeur C, Renders A, Brochard S, Bleyenheuft Y. Responsiveness of the ACTIVLIM-CP questionnaire: measuring global activity performance in children with cerebral palsy. Dev Med Child Neurol. 2018 Nov;60(11):1178-1185 (Full text article: https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.13927)

Paradis, Julie, Carlyne ArNould, and Yannick Bleyenheuft. "Normative values and discriminative ability across functional levels of ACTIVLIM-CP, a measure of global activity performance for children with cerebral palsy." Disability and rehabilitation 42.19 (2020): 2790-2796. (Full text article: https://pubmed.ncbi.nlm.nih.gov/30973788/)

None identified

Original language: French for Belgium and France

Translations:
English

None identified

Prof. Yannick Bleyenheuft
Institute of NeuroScience
Université catholique de Louvain
Brussels
Belgium
E-mail: yannick.bleyenheuft@uclouvain.be

Not reported

http://rssandbox.iescagilly.be/activlim.html

ACTIVLIM-CP available in English and French on the ACTIVLIM website (http://rssandbox.iescagilly.be/activlim-downloads.html)