Susan A Rethlefsen1, Melissa A Bent1,2, Nicole M Mueske1, Tishya A L Wren1,2. 1. Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA. 2. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Abstract
PURPOSE: To examine associations between neurosegmental and functional level classifications in children with Spina Bifida, and determine which classification best reflects daily walking activity. MATERIALS AND METHODS: A prospective correlational study was conducted. Children with Spina Bifida were given ratings for lesion level [X-ray and International Myelodysplasia Study Group (IMSG) level determined by muscle strength] and functional level [Hoffer ambulatory level and Dias functional classification of myelomeningocele (FCM), Functional Mobility Scale (FMS)]. Daily walking activity was measured with a StepWatch monitor. Data were analyzed using Spearman rank correlation. RESULTS: Sixty-one children were included, [56% male, average age 9.8 (SD 2.7) years]. The neurosegmental level classifications, X-ray lesion level and IMSG level showed little to no correlation with each other (r = 0.17). Among functional classifications, the Dias FCM correlated strongly with the FMS (r = 0.80-0.87). Correlations with steps per day were moderate to good for the Dias FCM and the FMS (r = 0.53-0.62), fair for IMSG level (r = 0.45), and little to none for X-ray lesion level (r = 0.03). CONCLUSIONS: The Dias FCM is comprehensive, including elements of neurosegmental level and function, and correlates well with walking activity. We recommend its use for classifying function in patients with Spina Bifida.Implications for rehabilitationFunctional classifications correlate better with daily walking activity than neurosegmental level classifications for patients with Spina Bifida.The Dias FCM includes neurosegmental and functional level elements, correlates well with daily activity, and is recommended for use in classifying Spina Bifida patients.Combined use of the FMS and activity monitoring is recommended for research and clinical assessment.
PURPOSE: To examine associations between neurosegmental and functional level classifications in children with Spina Bifida, and determine which classification best reflects daily walking activity. MATERIALS AND METHODS: A prospective correlational study was conducted. Children with Spina Bifida were given ratings for lesion level [X-ray and International Myelodysplasia Study Group (IMSG) level determined by muscle strength] and functional level [Hoffer ambulatory level and Dias functional classification of myelomeningocele (FCM), Functional Mobility Scale (FMS)]. Daily walking activity was measured with a StepWatch monitor. Data were analyzed using Spearman rank correlation. RESULTS: Sixty-one children were included, [56% male, average age 9.8 (SD 2.7) years]. The neurosegmental level classifications, X-ray lesion level and IMSG level showed little to no correlation with each other (r = 0.17). Among functional classifications, the Dias FCM correlated strongly with the FMS (r = 0.80-0.87). Correlations with steps per day were moderate to good for the Dias FCM and the FMS (r = 0.53-0.62), fair for IMSG level (r = 0.45), and little to none for X-ray lesion level (r = 0.03). CONCLUSIONS: The Dias FCM is comprehensive, including elements of neurosegmental level and function, and correlates well with walking activity. We recommend its use for classifying function in patients with Spina Bifida.Implications for rehabilitationFunctional classifications correlate better with daily walking activity than neurosegmental level classifications for patients with Spina Bifida.The Dias FCM includes neurosegmental and functional level elements, correlates well with daily activity, and is recommended for use in classifying Spina Bifida patients.Combined use of the FMS and activity monitoring is recommended for research and clinical assessment.
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