Purpose
The FMS classifies the functional mobility of children 4-18 years of age with cerebral palsy, taking into account the assistive devices a child might use.
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The FMS classifies the functional mobility of children 4-18 years of age with cerebral palsy, taking into account the assistive devices a child might use.
3 distances
5-10 minutes
Lynette Reina, PT, DPT; reviewed by Ada Terman March, 2019.
Inter-rater Reliability:
Cerebral Palsy: (Graham et al., 2004; n=310, n (spastic hemiplegia) = 114, n (spastic diplegia) = 124, n (spastic quadriplegia) = 72; mean age = 11 (3.7), mean age (spastic hemiplegia) = 12 (3.6), mean age (spastic diplegia) = 12 (4.0), mean age (spastic quadriplegia) = 10 (3.7))
Intraclass Correlation Coefficient (ICC), Cronbach’s α, and Concordance Correlation Coefficient (CCC) (95% confidence intervals) Between Attending Surgeon and Research Fellow | |||
| ICC | Chronbach’s α | CCC |
FMS-5 | 0.95* (0.88-0.98) | 0.95* (0.86-0.98) | 0.97* (0.94-0.99) |
FMS-50 | 0.94* (0.88-0.97) | 0.94* (0.87-0.99) | 0.96* (0.93-0.99) |
FMS-500 | 0.95* (0.89-0.99) | 0.96* (0.89-0.99) | 0.98* (0.93-0.99) |
*indicates “Excellent” |
Cerebral Palsy: (Harvey et al., 2010; n (total) = 118, n (2-6 year) = 16, n (6-12 years) = 66, n (12-18 years) = 36, n (GMFCS I) = 13, n(GMFCS II) = 49, n(GMFCS III) = 44, n(GMFCS IV) = 12; mean age (SD) = 10.3 (3.6); raters = hospital physiotherapist, community physiotherapist, and surgeon)
Kappa Coefficients and 95% Confidence Intervals for Independent Ratings of Mobility for the Three Distances by Age Group | |||
Age | Distance | Kappa (CI) | Agreement (%) |
2-6 years (n=16) | 5m | 0.87* (0.47, 1.00) | 93* |
50m | 0.95* (0.47, 1.00) | 99* | |
500m | 0.64** (0.20, 1.00) | 92* | |
6-12 years (n=66) | 5m | 0.86* (0.68, 1.00) | 96* |
50m | 0.90* (0.66, 1.00) | 98* | |
500m | 0.89* (0.65, 1.00) | 96* | |
12-18 years (n=36) | 5m | 0.83* (0.58, 1.00) | 96* |
50m | 0.94* (0.61, 1.00) | 99* | |
500m | 0.86* (0.54, 1.00) | 96* | |
*Indicates “Excellent” **Indicates “Adequate” |
Intra-rater Reliability:
Cerebral Palsy: (Himuro et al., 2017; n (all participants) = 24, mean age 13 (2 y 4 mo); n=18 (spastic unilateral), n=3 (spastic bilateral), n=2 (dyskinetic), n=1 (ataxic); n (GMFCS level I) = 11, n (GMFCS level II) = 8, n (GMFCS level III) = 5; Japanese version rated twice with a 1-2 week interval between assessments)
Cerebral Palsy: (Graham et al., 2004)
Concurrent validity:
Cerebral Palsy: (Graham et al., 2004)
Spearman Correlation Coefficient Matrix Between FMS-5, FMS-50, and FMS 500 and PODCI, CHQ, and Uptime (UT) | ||||||||
---|---|---|---|---|---|---|---|---|
| FMS – 5 | FMS – 50 | FMS – 500 | PODCI | CHQ | E | RS | UT |
FMS – 5 | 1.00 |
|
| 0.89*? | 0.78*? | 0.51***?? | 0.78*? | 0.87*? |
FMS – 50 |
| 1.00 |
| 0.84*? | 0.82*? | 0.52***?? | 0.72*? | 0.83*? |
FMS – 500 |
|
| 1.00 | 0.82*? | 0.81*? | 0.55***?? | 0.71*? | 0.84*? |
PODCI |
|
|
| 1.00 | 0.75**? | 0.53?? | 0.80***? | 0.79*? |
CHQ |
|
|
|
| 1.00 | 0.54?? | 0.74***? | 0.81*? |
E |
|
|
|
|
| 1.00 | 0.54***?? | 0.61? |
RS |
|
|
|
|
|
| 1.00 | 0.78**? |
UT |
|
|
|
|
|
|
| 1.00 |
*p<0.001 **p<0.01 *** p<0.05 ? Indicates “Excellent” ?? Indicates “Adequate” |
Cerebral Palsy: (Himuro et al., 2017; n (all participants) = 111, n (GMFCS level I) = 64, n (GMFCS level II) = 29, n (GMFCS level III) = 18; mean age (all participants) = 12 y 1 mo (± 3 y 7 mo), mean age (GMFCS level I) = 12 y 3 mo (3 y 8 mo), mean age (GMFCS level II) = 11 y 4 mo (3 y 7 mo), mean age (GMFCS level III) = 12 y 8 mo (3 y 2 mo); Japanese sample)
Predictive validity:
Cerebral Palsy: (Wilson et al, 2014; n (all participants) = 143, n (GMFCS level I) = 44, n (GMFCS level II) = 75, n (GMFCS level III) = 24; mean age = 10.6 (3.2)
Multiple Ordinal Logistic Regression Analysis | |||||||||
---|---|---|---|---|---|---|---|---|---|
| FMS 5 | FMS 50 | FMS 500 | ||||||
| Step 1 | Step 2 | Step 3 | Step 1 | Step 2 | Step 3 | Step 1 | Step 2 | Step 3 |
R2 | 0.27 | 0.32 | Not add-itional | 0.20 | 0.22 | 0.24 | 0.22 | 0.26 | 0.28 |
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|
|
|
|
|
| |
6MWT | P<.001 | P<.001 | P<.0001 | P<.0001 | P<.001 | P<.0001 | P<.0001 | P<.0001 | |
WS |
| P<.001 |
| P=.01 | P=.006 |
| P<.0001 | P=.008 | |
Unilateral vs bilateral |
|
|
|
| P=.04 |
|
| P<.001 | |
Step 1 = 6MWT Step 2 = 6MWT and WS Step 3 = 6MWT, WS, and Unilateral vs bilateral spasticity |
Convergent validity:
Cerebral Palsy (spastic diplegia): (Graham et al., 2004; n= 35 (subsample of original study population who underwent surgical intervention); mean age = 10.3 (2.3))
| Spearman Correlation Coefficient for Change in Ratings Between FMS-5, FMS-50, and FMS 500 and Other Outcome Tools at 6 and 12 Months Postoperatively (n=35, spastic diplegia) | |||
| PODCI | CHQ | E | UT |
6 months | ||||
FMS – 5 | 0.78*? | 0.77**? | 0.53*?? | 0.86**? |
FMS – 50 | 0.82*? | 0.80*? | 0.59*?? | 0.84**? |
FMS – 500 | 0.81**? | 0.80**? | 0.52*?? | 0.85**? |
PODCI | 1.00 | 0.78***? | 0.51*?? | 0.81**? |
CHQ |
| 1.00 | 0.53*?? | 0.82**? |
UT |
|
| 1.00 | 1.00 |
12 months | ||||
FMS – 5 | 0.79*? | 0.75**? | 0.54*?? | 0.78**? |
FMS – 50 | 0.81**? | 0.82*? | 0.55*?? | 0.85**? |
FMS – 500 | 0.80**? | 0.83**? | 0.53*?? | 0.89**? |
PODCI | 1.00 | 0.81***? | 0.55*?? | 0.84**? |
CHQ |
| 1.00 | 0.56*?? | 0.81**? |
UT |
|
| 1.00 | 1.00 |
| *p<0.05 **p<0.01 ***p<0.01 ? Indicates “Excellent” ?? Indicates “Adequate” |
Cerebral Palsy (spastic): (Harvey et al, 2009; n (all participants) = 18, n (GMFCS level II) = 5, n (GMFCS level III) = 4, n (GMFCS level IV) = 9; mean age = 12 y 8 mo (±2y 8 mo); n (spastic quadriplegia) = 9, n (spastic diplegia) = 7, n (spastic hemiplegia) = 2)
Cerebral Palsy: (Graham et al., 2004)
Cerebral Palsy: (Harvey et al., 2007; n (all participants) = 66, n (GMFCS level I) = 18, n (GMFCS level II) = 24, n (GMFCS level III) = 24; mean age = 10 (2y 6mo); average procedures per child = 8 (range of 4-12 procedures)
Odds ratios (OR) for FMS distances for post-operative time period compared with baseline (preoperatively) | |||||||||
Time post-op | 5m | 50m | 500m | ||||||
OR | CI | p value | OR | CI | p value | OR | CI | p value | |
3 mo | 0.13* | 0.07-0.24 | <0.001 | 0.09* | 0.04-0.17 | <0.001 | 0.24** | 0.14-0.43 | <0.001 |
6 mo | 0.36** | 0.23-0.58 | <0.001 | 0.32** | 0.19-0.55 | <0.001 | 0.50** | 0.32-0.80 | 0.004 |
9 mo | 0.69** | 0.45-1.04 | 0.08 | 0.77** | 0.49-1.19 | 0.24 | 0.90*** | 0.57-1.41 | 0.628 |
12 mo | 1.12*** | 0.77-1.64 | 0.55 | 1.22*** | 0.82-1.81 | 0.33 | 1.47*** | 0.97-2.22 | 0.071 |
24 mo | 2.08*** | 1.33-3.24 | 0.002 | 2.16*** | 1.37-3.41 | 0.001 | 2.23*** | 1.44-3.45 | <0.001 |
CI – Confidence Interval *Indicates “Small change” **Indicates “Moderate change” ***Indicates “Large change” |
Graham, H.K., Harvey, A., et al. (2004). “The Functional Mobility Scale (FMS).” Journal of Orthopaedics 24(5): 514-520.
Harvey, A., Baker, R., et al. (2009). “Does parent report measure performance? A study of the construct validity of the Functional Mobility Scale.” Developmental Medicine & Child Neurology 52: 181-185.
Harvey, A., Graham, H.K., et al. (2007). “The Functional Mobility Scale: ability to detect change following single event multilevel surgery.” Developmental Medicine & Child Neurology 49: 603-603.
Harvey, A.R., Morris, M.E., et al. (2010). “Reliability of the Functional Mobility Scale for children with cerebral palsy.” Physical & Occupational Therapy in Pediatrics 30(2): 139-149.
Himuro, N., Nishibu, H., et al. (2017). “The criterion validity and inter-rater reliability of the Japanese version of the Functional Mobility Scale in children with cerebral palsy.” Research in Developmental Disabilities 68: 20-26.
Stahlhut, M., Downs, J., et al. (2016). “Building the repertoire of measures of walking in Rett syndrome.” Disability and Rehabilitation 39(19): 1926-1931.
The Royal Children’s Hospital. (2014). FMS: The Functional Mobility Scale (version 2) – For children with cerebral palsy ages 4-18 years. Retrieved from
Wilson, N.C., Mackey, A.H., et al. (2014). “How does the Functional Mobility Scale relate to capacity-based measures of walking ability in children and youth with cerebral palsy?” Physical & Occupational Therapy in Pediatrics 34(2): 185-196.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.