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Measuring Functional Change in Children With Acquired Brain Injury (ABI): Comparison of Generic and ABI-Specific Scales Using the Pediatric Evaluation of Disability Inventory (PEDI)

DH Kothari, PT, MS, is Research Associate, VA Rehabilitation Research and Development Center (Building 51), 3801 Miranda Ave, Palo Alto, CA 94304 (USA) (dhara{at}rrdmail.stanford.edu).
SM Haley, PT, PhD, is Director, Center of Rehabilitation Effectiveness, and Associate Professor of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Mass
KM Gill-Body, PT, MS, DPT, NCS, is Clinical Associate Professor, MGH Institute of Health Professions, and Clinical Associate, Massachusetts General Hospital, Physical Therapy Services, Boston, Mass
HM Dumas, PT, MS, PCS, is Manager, The Research Center for Children With Special Health Care Needs, Franciscan Children's Hospital and Rehabilitation Center, Boston, Mass

Address all correspondence to Ms Kothari

Background and Purpose. The Pediatric Evaluation of Disability Inventory (PEDI) subscales are hierarchic in nature, with item placements within each subscale reflecting the general order of skill attainment in children without disabilities. The purpose of this study was to determine whether a hierarchical subscale developed in this study for children with acquired brain injuries (ABIs) corresponds to the generic PEDI subscales, and, if not, whether condition-specific (ABI-specific) PEDI subscales are more sensitive for measuring change. Subjects. Eighty-seven children and adolescents (mean age=9.2 years, SD=5.2, range=1–20) with ABI during inpatient rehabilitation admissions were included. Methods. Data were collected by retrospective chart review. Rasch one-parameter analyses were conducted to construct the ABI-specific PEDI scale focusing on the Mobility and Self-care domains (content areas) only. Each domain consists of a Functional Skills subscale and a Caregiver Assistance subscale. Thus, in all, 4 scales were constructed within the ABI-specific PEDI scale. Differences in item hierarchies and sensitivity between generic and ABI-specific PEDI subscales for each domain were then examined. Results. Both generic and ABI-specific PEDI scales were sensitive for measuring functional changes during inpatient rehabilitation hospitalization. Even though the generic and ABI-specific item hierarchies differed substantially, only one of the 4 ABI-specific PEDI subscales (Caregiver Assistance Self-care subscale) was more sensitive for measuring change than the generic PEDI scale. Discussion and Conclusion. The ABI-specific scales added relatively little improvement in sensitivity compared with the generic PEDI scales of the Mobility and Self-care domains. Thus, for group analyses, the authors recommend use of the generic PEDI subscales for children with ABI. Future work with ABI-specific subscales may improve the physical therapist's ability to describe an individual's pattern of functional recovery.

Key Words: Item response theory • Outcome measurement • Pediatric brain injury • Pediatric Evaluation of Disability Inventory • Rasch measurement

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