Pediatric Evaluation of Disability Inventory

Last Updated

August 30, 2024

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Purpose

The PEDI assesses functional skills, level of independence, and the extent of modifications required to perform functional activities in young children.

Link to Instrument

Instrument Details

Acronym PEDI

Area of Assessment

Activities & Participation
Cognition
Communication
Bodily Functions
General Health & Development
Language
Mental Functions

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$195.90

Cost Description

$149.80, manual; $46.10, pack of 25 scoring sheets

Pediatric and Congenital Conditions

Brain Injury

Non-Patient

The PEDI measures functional status in the domains of self-care, mobility, and social function across the following 3 measurement scales:
Part I: Functional Skills includes 197 items of functional skills (73 self-care, 59 mobility, & 65 social function). Each item is rated 0-1 for performance capability.
Part II: Caregiver Assistance includes 20 items of complex functional activities (8 self-care, 7 mobility, & 5 social function). Each item is rated 0-5 for assistance level.
Part III: Modifications includes the same 20 items as for Caregiver Assistance, which are rated on the modifications element (i.e., the environmental or technical adaptations required to facilitate performance: N (No Modifications), C (Child-oriented), R (Rehabilitation Equipment), or E (Extensive Modifications).
Scores are distributed from 0-100, with higher scores representing greater functionality. Scaled scores can be used for children of all ages because scaled scores are not adjusted for age.
The PEDI is a paper-based assessment administered via parent/caregiver report, structured interview, observation or professional judgement of therapists or teachers, or by a combination of methods.

Number of Items

197

Score form
Writing utensil
Software program
Manual

31-60 minutes

Experienced therapists and teachers can complete the PEDI in 20 to 30 minutes. The parent interview takes 45-60 minutes.

Required Training

Reading an Article/Manual

0 - 8

years

Instrument Reviewers

Initial review completed by University of Illinois at Chicago Master of Science in Occupational Therapy students Sarah Brew, Erin Langan, and Amanda Link-Dudek. Updated in August 2024 by Master of Occupational Therapy students Hannah Buesseler, Ellie Chesko, Hannah McFarlane, & Sarah Smythe under the supervision of faculty mentor Danbi Lee, PhD, OTD, OTR/L, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle.

ICF Domain

Activity
Participation
Environment

Measurement Domain

Activities of Daily Living
Cognition
Motor

Professional Association Recommendation

None found--last searched 8/30/2024

Considerations

Use of a normative scoring model assumes that comparing children with disabilities to those without disabilities is an appropriate method for determining functional performance; a significant validation study on children with disabilities is necessary to verify this assumption (Haley et al., 1992).
The PEDI has been translated into multiple languages including Dutch, Norwegian, Swedish, Spanish, Portuguese, Slovene, Turkish, Icelandic, French, Hebrew, Japanese, German, and Chinese.
Reid et al. (1994) note several weaknesses:
- There are no guidelines for scoring missing items.
- Items cannot be scored based on quality of performance. Child is deemed either capable or not capable.
- The PEDI is not adequate for addressing school-related items in an educational setting.
- The PEDI does not adequately assess cognitive skills, focusing on functional skills instead.
The PEDI German version showed misfit with 24 items and DIF in 34 items when compared among different German speaking countries. Schulze et al. (2016) suggests that it can be used "on a preliminary basis as a generic tool to evaluate ADL ability and performance in children with and without disabilities."
The Pediatric Evaluation of Disability Inventory- Computer Adapted Test (PEDI-CAT) is a revised version of the PEDI that uses item response theory. In addition to the original three domains, a responsibility domain has been added. The PEDI-CAT has been validated for clients birth through twenty years old. There is also a specific module for youth with Autism Spectrum Disorder. (Find more information here)

Standard Error of Measurement (SEM)

Down Syndrome: (Galeoto, 2022; n = 54; mean age = 5.62 (4.03) years; male = 27 (50%); Italian translation of PEDI into PEDI-I; calculated SEM)

Functional Skill Scale

SEM for Self-Care: 1.101
SEM for Mobility: 0.502
SEM for Social: 0.000

Caregiver Assistance Scale

SEM for Self-Care: 0.735
SEM for Mobility: 1.166
SEM for Social: 0.766

Autism Spectrum Disorder (ASD): (Tofani, 2019; n = 60; mean age = 7.18 (2.7) years; inclusion criteria: ASD diagnosis according to DSM- 5 from age 6 months to 7.5 years or age between 7.5 and 12 years with functional abilities below those expected in 7.5-year-old children without disabilities; Italian translation of PEDI; calculated SEM)

Functional Skill Scale

SEM for Self-Care: 2.659
SEM for Mobility: 1.858
SEM for Social: 1.914

Caregiver Assistance Scale

SEM for Self-Care: 2.237
SEM for Mobility: 2.025
SEM for Social: 1.333

Congenital or acquired neurological and orthopedic disorders: (Ryll, 2019; n = 36; median age = 10.8 (25th, 75th percentiles: 8.7, 13.0); neurological n = 24, orthopedic n = 3, both n = 9; Swiss sample, German translation of PEDI)

SEM for FSS: 5.21
SEM for CAS: 3.94
SEM for FSS self-care: 2.62
SEM for FSS mobility: 3.28
SEM for FSS social function: 2.85
SEM for CAS self-care: 1.77
SEM for CAS mobility: 2.12
SEM for CAS social function: 1.85

FSS = Functional Skills Scale; CAS = Caregiver Assistance Scale

Minimal Detectable Change (MDC)

Children with Cerebral Palsy (CP): (Amer et al, 2022; CP n = 118; CP mean age = 11 years, 3 months (5 years, 1 month); MACS levels: Level 1 n = 25, level 2 n = 41, level 3 n = 26, level 5 n = 8, level 5 n = 18; GMFCS level: level 1 n = 37, level 2 n = 24, level 3 n = 21, level 4 n = 20, level 5 n = 16; CFCS levels: level 1 n = 34, level 2 n = 10, level 3 n = 27, level 4 n = 26, level 5 n = 21; typically developing children n = 249; mean age = 3 years, 5 months (SD = 1 year, 9 months); Ugandan translation of PEDI into PEDI-UG)

MDC for self-care: 4.43
MDC for mobility: 5.10
MDC for social function: 5.27

Down Syndrome: (Galeoto, 2022)

MDC = 0.18 – 1.63 across all PEDI-I subscales

Congenital or acquired neurological and orthopedic disorders: (Ryll, 2019; MDC calculated)

Minimum Detectable Change (MDC) for PEDI-G Scales/Domains

Scale/Domain	MDC at 90% CI	MDC at 95% CI	MDC at 99% CI
FSS	12.12	14.44	18.98
CAS	9.17	10.92	14.35
FSS self-care	6.10	7.26	9.54
FSS mobility	7.63	9.09	11.95
FSS social function	6.63	7.90	10.38
CAS self-care	4.12	4.91	6.45
CAS mobility	4.93	5.88	7.72
CAS social function	4.30	5.13	6.74

FSS = Functional Skills Scale; CAS = Caregiver Assistance Scale

Minimally Clinically Important Difference (MCID)

Traumatic Brain Injury, Spinal Cord Injury, Lower Extremity Trauma, Non-traumatic Brain Injury, Developmental Disorders: (Iyer, 2003; n = 53; mean (standard deviation) age = 9.7 (4.5); Mean Length of Stay = 65.36 days)

Mean for each of the 6 scales = 11 points
Mean (Standard Deviation) for Likert Scale categories = 11.3 (2.5)
Likert scale ranged from 8.7 to 14.9 (X = 10.9 for Functional Skills and X = 11.6 for Caregiver Assistance)
Mean for visual analog scale categories = 11.5 (3.5)
Visual analog scale scores ranged from 6.0 to 15.6 (X = 11.6 for Functional Skills and X = 11.2 for Caregiver Assistance)

Normative Data

Normative Sample: (Haley, Coster, Ludlow, Haltiwanger, & Andrellos, 1992; n = 412)

The normative sample was selected to be representative of the U.S. population. It should be noted that the sample is non-disabled. See first point under Considerations for more information on the use of a non-disabled population as a comparison group.

Demographics

	PEDI Sample (%) (n = 412)	U.S. Population (%)
Age Range (Years)	[0.5, 7.0]	n/a
Gender
Female	n = 209, 50.7%	48.6
Male	n = 203, 49.3%	51.4
Race
Asian	0.7	1.6
Black	18.7	11.7
Caucasian	76.6	83.5
Hispanic	7.8	2.5
Native American	1.0	0.7
Other	3.0	6.5

Note: In accordance with the US census protocol at publication, Hispanics were counted twice, as also Black, Caucasian, or other. Therefore, percent for race totals 100 before adding Hispanic data.

Normative Standard Scores, Scaled Scores, and Standard Deviations by Self-Care Domain

Age Range, Years	n	Functional Skills			Caregiver Assistance
		Standard Score Range	Scaled Score Mean	SD	Standard Score Range	Scaled Score Mean	SD
0.5-0.9	36	22.0-65.9	26.6	5.3	39.4-69.8	8.9	8.3
1.0-1.4	39	21.3-68.9	37.6	7.1	29.7-68.4	24.8	12.2
1.5-1.9	30	31.1-67.7	48.0	5.3	20.8-64.4	37.2	8.8
2.0-2.4	32	31.2-78.7	55.4	7.1	34.6-73.4	47.1	9.5
2.5-2.9	39	27.8-70.6	59.4	6.2	22.0-72.7	53.6	10.1
3.0-3.4	25	38.1-84.5	67.9	9.3	31.0-78.1	64.2	9.0
3.5-3.9	34	23.6-75.7	69.9	5.9	31.9-74.2	66.7	6.7
4.0-4.4	25	34.6-75.7	74.7	5.6	32.7-68.2	72.5	5.9
4.5-4.9	26	32.3-73.9	78.3	6.1	31.1-78.4	75.3	8.7
5.0-5.4	35	30.7-72.1	80.7	8.7	29.4-68.9	77.7	11.7
5.5-5.9	28	37.5-66.2	84.6	9.5	28.2-64.5	85.4	10.1
6.0-6.4	25	28.7-62.4	92.5	7.1	37.5-64.6	84.4	10.7
6.5-6.9	22	33.9-62.4	88.5	9.3	32.9-63.2	88.0	9.0
7.0+	16	30.7-55.3	96.8	6.1	37.4-61.9	85.9	11.7

Normative Standard Scores, Scaled Scores, and Standard Deviations by Mobility Domain

Age Range, Years	n	Functional Skills			Caregiver Assistance
		Standard Score Range	Scaled Score Mean	SD	Standard Score Range	Scaled Score Mean	SD
0.5-0.9	36	24.1-65.0	32.8	8.3	33.4-67.9	20.7	12.3
1.0-1.4	39	22.8-71.4	50.4	9.2	16.2-65.3	44.7	13.2
1.5-1.9	30	29.4-73.6	62.7	7.2	26.3-69.9	57.7	8.8
2.0-2.4	32	35.7-73.5	72.8	6.9	31.3-66.0	68.5	8.7
2.5-2.9	39	27.8-67.9	74.6	6.1	27.2-73.7	74.3	10.8
3.0-3.4	25	30.8-68.2	84.7	8.4	29.4-68.4	80.5	10.6
3.5-3.9	34	33.4-68.9	85.5	7.3	31.2-70.6	82.4	8.5
4.0-4.4	25	34.5-63.8	90.4	6.9	31.3-60.8	88.4	10.7
4.5-4.9	26	27.9-60.7	93.4	6.2	28.4-58.8	90.7	10.3
5.0-5.4	35	27.8-60.1	92.9	7.0	32.4-59.2	91.4	9.2
5.5-5.9	28	18.1-54.3	98.3	4.0	10.4-53.0	97.9	6.4
6.0-6.4	25	14.3-54.9	98.3	3.6	13.6-53.8	97.4	6.8
6.5-6.9	22	25.4-53.9	99.2	2.1	11.2-52.7	98.7	4.3
7.0+	16	29.9-54.7	98.9	2.4	31.5-57.9	93.4	8.3

Normative Standard Scores, Scaled Scores, and Standard Deviations by Social Function Domain

Age Range, Years	n	Functional Skills			Caregiver Assistance
		Standard Score Range	Scaled Score Mean	SD	Standard Score Range	Scaled Score Mean	SD
0.5-0.9	36	24.3-63.4	27.8	8.2	41.9-75.6	7.6	9.4
1.0-1.4	39	15.6-64.5	39.3	7.1	32.7-67.7	26.2	15.1
1.5-1.9	30	33.3-70.5	47.0	3.6	19.1-68.9	40.5	13.1
2.0-2.4	32	30.1-75.5	52.5	3.5	30.4-71.0	53.8	13.8
2.5-2.9	39	33.0-73.3	57.1	5.0	35.0-75.9	61.7	14.8
3.0-3.4	25	32.5-76.8	60.4	8.1	26.1-77.0	66.0	12.6
3.5-3.9	34	37.3-78.1	64.6	6.2	32.1-73.9	70.5	12.3
4.0-4.4	25	31.0-82.3	67.7	4.5	29.9-73.7	75.7	10.2
4.5-4.9	26	32.4-76.4	72.6	6.3	30.9-68.8	79.8	10.7
5.0-5.4	35	31.7-82.8	73.7	7.9	34.9-66.3	80.9	11.6
5.5-5.9	28	34.3-71.5	79.8	9.4	28.0-63.8	84.3	11.3
6.0-6.4	25	34.6-67.8	85.7	8.0	26.7-65.7	85.2	9.4
6.5-6.9	22	26.2-60.4	88.7	10.8	28.8-62.3	86.6	10.9
7.0+	16	31.8-59.4	86.4	10.5	37.1-74.1	76.1	10.0

Clinical Samples: (Haley et al., 1992)

Description of Sample Groups

Sample Group	n (N = 102)	Mean Age, Years (SD)	Age Range, Years	Disability Type	Setting
A	46	2.8 (0.9)	[2.8, 4.5]	Minor injuries with serious residual functional deficits	Hospitalized at least overnight in a pediatric trauma center
B	32	4.1 (2.7)	[1, 9.8]	Severe disabilities	Enrolled in a hospital-based day school program
C	24	7.4 (2.1)	[3.5, 10.4]	Cerebral palsy, developmental delay, traumatic brain injury	Enrolled in a hospital-based day school program

Functional Skills: Means and Standard Deviations by Domains

Sample	Mobility Mean (SD)	Self-care Mean (SD)	Social Function Mean (SD)
A	45.0 (20.3)	43.0 (14.0)	42.2 (13.2)
B	67.9 (26.2)	61.8 (23.6)	61.1 (22.7)
C	61.8 (25.2)	54.0 (16.0)	52.9 (11.8)

Caregiver Assistance: Means, and Standard Deviations by Domains

Sample	Mobility Mean (SD)	Self-care Mean (SD)	Social Function Mean (SD)
A	45.0 (21.8)	40.3 (16.2)	43.3 (23.0)
B	69.0 (29.8)	56.9 (29.6)	58.9 (31.1)
C	65.7 (23.2)	52.4 (17.8)	40.2 (16.5)

Spina Bifida: (Tsai, Yang, Chan, Huang, & Wong, 2002; n = 63)

Domain	Myelomeningocele Mean (SD)	Lypomyelomeningocele Mean (SD)
Self-care	36.8 (18.6)	43.5 (11.3)
Mobility	25.8 (19.5)	49.1 (14.1)
Social Function	36.7 (18.8)	49.2 (14.4)

Notes: The mean standard score is 50 for a child’s chronological age; scores between 30 and 70 indicate that a child is within 95% of the normative sample's scores.

Children with Cerebral Palsy: (Amer et al, 2022)

Functional Skills Part
- Children with Cerebral Palsy
  - Mean self-care score= 58.76 (23.99)
  - Mean mobility score= 55.66 (24.42)
  - Mean social function score= 56.12 (26.46)
- Typically Developing Children
  - Mean self-care score= 62.04 (20.36)
  - Mean mobility score= 66.84 (19.27)
  - Mean social function score= 60.08 (21.52)
Caregiver Assistance Part
- Children with Cerebral Palsy
  - Mean self-care score= 54.96 (32.10)
  - Mean mobility score= 54.86 (36.01)
  - Mean social function score= 52.82 (32.67)
- Typically Developing Children
  - Mean self-care score= 73.17 (27.94)
  - Mean mobility score= 73.38 (27.88)
  - Mean social function score= 71.59 (29.65)

Down Syndrome: (Galeoto, 2022)

Summary results for the PEDI-I (n = 54)

Scale	Mean ± SD	Range
Functional Skill Scale
Self-Care (73 items)	38.4 ± 20.1	4-70
Mobility (59 items)	45.5 ± 15.9	5-59
Social Function (65 items)	32.3 ± 16.1	2-57
Caregiver Assistance Scale
Self-Care (8 items)	19.3 ± 13.4	0-40
Mobility (7 items)	26.1 ± 10.6	0-35
Social Function (5 items)	11.8 ± 7.7	0-23
Modifications Scale (MS)
Self-Care (8 items)
No Modifications (N)	6.2 ± 1.8	2-8
Child-oriented (C)	1.8 ± 1.8	0-6
Rehabilitation Equipment (R)	0	0
Extensive Modification (E)	0	0
Mobility (7 Items)
No Modifications (N)	5.6 ± 1.4	3-7
Child-oriented (C)	1.3 ± 1.4	0-4
Rehabilitation Equipment (R)	0.1 ± 0.4	0-3
Extensive Modification (E)	0	0
Social Function (5 items)
No Modifications (N)	4.6 ± 1.1	1-5
Child-oriented (C)	0.1 ± 0.4	0-3
Rehabilitation Equipment (R)	0.1 ± 0.8	0-4
Extensive Modification (E)	0.2 ± 0.7	0-4

Autism Spectrum Disorder (ASD): (Tofani, 2019)

Mean and Standard Deviation for PEDI domains in ASD Population

Scale/Domain	Mean (SD)
Functional Skill Scale
Self-Care	34.35 (14.64)
Mobility	49.26 (9.41)
Social	18.82 (11.05)
Caregiver Assistance Scale
Self-Care	16.88 (11.79)
Mobility	24.79 (6.57)
Social	7.38 (5.19)

Developmental Disability: (Yarar et al, 2019; n = 98; mean age = 10.3 (3.9) years; Cerebral palsy n = 68, Duchenne muscular dystrophy n = 10, Brachial plexus injury n = 2, Physical disability n = 8, Hydrocephalus n = 2, Spina bifida n = 2, Autism n = 1, Visually disabled n = 1, Mental retardation n = 4; Turkish translation of Caregiver Assistance Scale of PEDI)

Mean (SD) Scores for PEDI Caregiver Assistance Scale (CAS) Domains (n = 98)

PEDI domains	PEDI Scores: Mean (SD)
PEDI CAS self-care	19.39 (14.52)
PEDI CAS mobility	19.81 (13.70)
PEDI CAS social function	15.03 (9.38)

Test/Retest Reliability

Children with Cerebral Palsy: (Amer et al, 2022; retest = 2 weeks after the first interview)

Excellent test-retest reliability (ICC = 0.99)

Down Syndrome: (Galeoto, 2022; n = 30; 3 days between assessments)

Excellent test-retest reliability (ICC = 0.988 – 1)

Interrater/Intrarater Reliability

Normative Sample: (Haley et al., 1992)

Excellent interrater reliability when tested by a nurse practitioner and a PEDI research member (n = 29):
- caregiver assistance across all domains: self-care (ICC = 0.99), mobility (ICC = 0.96), and social function (ICC = 0.99)
- modifications across all domains: self-care (ICC = 0.91), mobility (ICC = 1.00), and social function (ICC = 0.79)

Clinical Samples: (Haley et al., 1992)

Excellent interrater reliability when tested by a rehabilitation team for:
- caregiver assistance across all domains: self-care, mobility and social function (ICC = 1.00 for all)
- modifications across all domains: self-care (ICC = 1.00), mobility (ICC = 0.93), and social function (ICC = 1.00)
Excellent interrater reliability when tested by family member report for:
- caregiver assistance across all domains: self-care (ICC = 0.88), mobility (ICC = 0.98), and social function (ICC = 0.97)
- modifications across all domains: self-care (ICC = 1.00), mobility (ICC = 1.00), and social function (ICC = 0.84)

Cerebral Palsy, Developmental Delay, Other: (Nichols & Case-Smith, 1996; n = 23; mean age = 60.6 months; parent interviews were one week apart)

Excellent intrarater reliability among all domains, Functional Performance and Caregiver Assistance
ICC for normative scores ranged from .70 to .98
Excellent intrarater reliability for scaled scores among Self-care domain, Mobility domain, and Social domain on Functional Performance
Excellent intrarater reliability for scaled scores among Self-care and Mobility domain on Caregiver Assistance; adequate reliability on Self-care domain on Caregiver Assistance

Taiwanese children with physical disabilities: (Kang et al., 2017; n = 94; mean age = 2.4 (1.4) years (range 2-6 years) and their parents; Chinese translation of PEDI)

Excellent interrater reliability in Functional Skills Scales (ICC= 0.77-0.93)
Adequate to excellent interrater reliability in Caregiver Assistance Scales (ICC= 0.67-0.96)

Autism Spectrum Disorder (ASD): (Tofani, 2019)

Excellent inter-rater reliability for FSS (ICC = 0.96-0.97) and CAS (ICC = 0.90-0.96)
Excellent intra-rater reliability for both subscales (ICC = 1.00)

Congenital or acquired neurological and orthopedic disorders: (Ryll, 2019), two PEDI-G raters were two healthcare professionals (one a trained research nurse with 9 years of nursing experience in different fields of pediatrics, and the other a physiotherapist with 3 years of experience and a researcher in the field of neuropediatrics.)

Excellent inter-rater reliability (ICC = 0.97-1.00)

Internal Consistency

Chronological Age: (Haley et al., 1992)

Excellent correlation between Functional Skills in Self-care, Mobility, and Social Function in infants < 2.0 years (r = 0.87, 0.90*, 0.89 respectively)
Excellent correlation between Caregiver Assistance in Self-care, Mobility, and Social Function in infants < 2.0 years (r = 0.76, 0.85, 0.74)
Excellent correlation between Functional Skills in Self-care, Mobility, and Social Function in preschoolers 2.0 - 5.0 years (r = 0.77, 0.70, 0.78)
Excellent correlation between Caregiver Assistance in Self-care, and Social Function in preschoolers 2.0 - 5.0 years (r = 0.77, 0.63)
Adequate correlation between Caregiver Assistance in Mobility in preschoolers 2.0 - 5.0 years (r = 0.57)
Adequate correlation between Functional Skills in Self-care, Mobility, and Social Function in school age children >5.0 years (r = 0.44, 0.41, 0.43)
Adequate correlation between Caregiver Assistance in Self-care in school age children >5.0 years (r = 0.36)
Poor correlation between Caregiver Assistance in Mobility and Social Function school age children >5.0 years (r = 0.21. 0.09)
Overall Excellent correlation for Functional Skills and Caregiver Assistance in Self-care, Mobility, and Social Function for the total sample of children (r = 0.89, 0.77, 0.89, 0.91*, 0.78, 0.84)

Normative Sample: (Haley et al., 1992)

Excellent: Cronbach's alpha range from 0.95-0.99*

Down Syndrome: (Galeoto, 2022)

Excellent internal consistency (Cronbach’s alpha = 0.899 - 0.986*)

Autism Spectrum Disorder (ASD): (Levy-Dayan, 2023; n = 53, mean age = 7.75 (1.06) years, age range = 6-10; Hebrew translation of PEDI)

Excellent internal consistency (Cronbach’s alpha = 0.93*)

Autism Spectrum Disorder (ASD): (Tofani, 2019)

Excellent internal consistency for FSS domains: Self-Care (Cronbach’s alpha = 0.965*), Mobility (Cronbach’s alpha = 0.940*), Social (Cronbach’s alpha = 0.950*)
Excellent internal consistency for CAS domains: Self-Care (Cronbach’s alpha = 0.961*), Mobility (Cronbach’s alpha = 0.885), Social (Cronbach’s alpha = 0.923*)

*Scores higher than .9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

Cerebral Palsy, Developmental Delay, Other: (Nichols et al., 1996)

Excellent correlation between the Fine Motor Scale of the PDMS and each domain of the Functional Skill and Caregiver Assistance Scales of the PEDI
Excellent correlation between the Gross Motor Scale, except for the reflexes subscale, of the Peabody Developmental Motor Scales (PDMS) and each domain of the Functional Skill and Caregiver Assistance Scales of the PEDI.
Poor correlation (r = .24) of the reflexes subscale of the PDMS and each domain of Functional Performance of the PEDI
Poor correlation (r=.25-.26) of the reflexes subscale of the PMDS and the Self-care and Social domain of the PEDI
Adequate correlation of the Mobility domain of the PEDI and the reflexes subscale of the PDMS
Excellent correlation between age equivalent scores for the PEDI and PDMS (r=.82-.95)

Myelodysplasia, Juvenile Rheumatoid Arthritis: (Haley et al., 1992; n = 20 (disabled), mean age = 5.1 years (1.43); n = 20 (non-disabled); mean age = 5.1 years (1.37); PEDI and Battelle Developmental Inventory Screening Test (BDIST))

Excellent correlation between children with disabilities in PEDI Functional Skills and Caregiver Assistance with BDIST (r = 0.70, 0.73)
Excellent correlation between children who are not disabled in PEDI Functional Skills and Caregiver Assistance with BDIST (r = 0.81, 0.62)
Overall Excellent correlation between Functional Skills with BDIST (r = 0.73)
Overall Excellent correlation between Caregiver Assistance with BDIST (r = 0.71)

Autism Spectrum Disorder: (Levy-Dayan, 2023; n = 53; mean age = 7.5 (1.06))

Excellent concurrent validity of the PEDI with the Do-Eat Washy (r = 0.80, p < 0.001 for all groups)

Cerebral Palsy: (Choi et al., 2018; n = 50; mean age = 7.2 (3.5) years; n = 47 with speech as a method of communication, n = 3 used gestures, eye gaze, facial expression, pointing)

Excellent concurrent validity between the scaled score of the social functioning domain of the PEDI and the Communication Function Classification System (CFCS) (p < 0.001) when administered by:
- Pediatric Physiatrist: ƙ=-0.75
- Speech Language Pathologist (SLP): ƙ=-0.69
- Parents: ƙ=-0.60
Excellent Concurrent Validity between the scaled score of the social functioning domain of the PEDI and the Viking Speech Scale (VSS) (p < 0.001) when administered by:
- Pediatric Physiatrist: ƙ=-0.63
- SLP: ƙ=-0.66
- Parents: ƙ=-0.60

Cerebral Palsy: (Pinto et al., 2016; n = 76, mean age = 5.3 (4.1) years; Hemiplegia (n = 17), Diplegia (n = 26), Triplegia (n = 13), Quadriplegia (n = 20))

Excellent concurrent validity between the self-care and mobility domains of the PEDI and the Sarah scale (r = 0.80-0.98)

Congenital or acquired neurological and orthopedic disorders: (Ryll, 2019)

Excellent concurrent validity correlations between FSS and CAS scales/domains and those of WeeFIM
Excellent concurrent validity correlations between FSS and CAS scale and domain scores

Concurrent validity between PEDI-G and WeeFIM and association between FSS and CAS on scale and domain level

Concurrent validity	Spearman correlation coefficients
PEDI-G- WeeFIM
Scale level
FSS-WeeFIM total	0.98
CAS-WeeFIM total	0.96
Domain level
FSS self-care- WeeFIM self-care	0.98
FSS mobility- WeeFIM mobility	0.97
FSS social function- WeeFIM cognition	0.92
CAS self-care- WeeFIM self-care	0.97
CAS mobility- WeeFIM mobility	0.95
CAS social function-WeeFIM cognition	0.95
Association between PEDI-G FSS and CAS
Scale scores	0.97
Self-care domain	0.96
Mobility domain	0.95
Social function domain	0.94

Construct Validity

Convergent Validity:

Identification of Disability and Degree of Delay: (Haley et al., 1992)

Overall Excellent correlation between the PEDI Scales BDIST in total Caregiver Assistance and Personal Social domain (r = 0.79)
Overall Excellent correlation between the PEDI Scales and BDIST in total Functional Skills and total Caregiver Assistance (r = 0.92, 0.89)
PEDI modifications and Functional Skills Scales were better predictors of group status than the BDIST (p. 70).
Overall Excellent correlation between the PEDI Scales and Wee-Functional Independence Measure (Wee-FIM) in total Functional Skills and total Caregiver Assistance (r = 0.92, 0.93)
Between the normative sample (n = 412) and the clinical samples (n = 102), PEDI summary scores can accurately predict a child’s correct group membership for ages > 2.0 years (p.70). (p= <.001 - 0.27)

Taiwanese children with physical disabilities: (Kang et al., 2017; n = 94; children of mean age = 4.2 (1.4) years (range 2-6 years) and their parents; diagnoses included: cerebral palsy (36.2%), developmental delay (34.0%), chromosomal disorder (14.9%), acquired brain injury (12.8%), congenital anomalies (musculoskeletal) (2.1%); Chinese translation of PEDI)

Adequate to Excellent correlations between PEDI-C scores for Mobility and Social Functioning and APCP-C total diversity and intensity scores (r = 0.38-0.68)
Adequate correlations between PEDI-C scores for Mobility and APCP-C diversity and intensity scores for Skill Development Activities and Active Physical Recreation (r = 0.33-0.42)
Adequate to Excellent correlations between PEDI-C scores for social functioning and APCP-C diversity and intensity scores for Play Activities, Skill Development Activities, and Social Activities (r = 0.46-0.65)

Down Syndrome:(Galeoto, 2022)

Excellent correlations between the domains of the Functional Skill Scale and the Italian Barthel Index (IcaBI) (r = 0.804 - 0.951)
Adequate to Excellent correlations between the domains of the Caregiver Assistance Scale and the IcaBI (r = 0.758 - 0.948)

Autism Spectrum Disorder (ASD): (Tofani, 2019)

Adequate to Excellent correlations between PEDI subscales and Italian Barthal Index (IcaBI) in Functional Skills Scale (FSS) and Caregiver Assistance Scale (CAS) in Self-Care

Pearson correlation coefficients of PEDI subscales and Italian Barthel Index (IcaBI)

	FSS Self-Care	FSS Mobility	FSS Social	CAS Self-Care	CAS Mobility	CAS Social	IcaBI
FSS Self-Care	1	.651*	.712*	.921*	.658*	.725*	.881*
FSS Mobility		1	.423*	.567*	.773*	.340*	.787*
FSS Social			1	.669*	.406*	.859*	.556*
CAS Self-Care				1	.576*	.714*	.845*
CAS Mobility					1	.432*	.695*
CAS Mobility						1	.558*
IcaBI							1

*p < 0.01

Developmental Disability: (Yarar et al., 2019)

Excellent convergent validity between PEDI domains and Assistance to Participation Scale (Turkish translation -- APS-TR)

Correlations between PEDI domains and Assistance to Participation Scale (Turkish translation – APS-TR)

PEDI domains	Correlation Coefficients
PEDI (self-care)	0.762*
PEDI (mobility)	0.694*
PEDI (social function)	0.803*

*p < 0.001

Discriminant validity:

Children with Cerebral Palsy: (Amer et al, 2022)

Statistically significant differences between levels of function (MACS, GMFCS, CFCS) (p < 0.05)
Statistically significant differences in scores for both functional skills and caregiver assistance parts at different levels of function classifications (GMFCS, MACS, CFCS) (p < 0.001)
PEDI-UG functional skills scores significantly discriminated between children with CP and normally developing children for the mobility domain (p < 0.001)
PEDI-UG caregiver assistance scores significantly discriminated between children with CP and normally developing children for the self-care, mobility, and social function domains (p < 0.001)

Taiwanese children with physical disabilities: (Kang et al., 2017)

Excellent correlations between the PEDI-C scores for Mobility and the APCP-C intensity scores for Play Activities and diversity and intensity scores for Social Activities (r = 0.18-0.28)
Adequate correlation between the PEDI-C scores for Mobility and APCP-C diversity scores for Play Activities (r = 0.36)
Adequate correlations between the PEDI-C scores for Social Functioning and APCP-C diversity and intensity scores for Active Physical Recreation (r = 0.39-0.45)

Content Validity

Content validity of the PEDI was determined by a panel of 31 experts in physical therapy, occupational therapy, medicine, education, and speech therapy. Each expert ranked items quantitatively and qualitatively. From the results of this panel, Haley and colleagues (1992) concluded that the instrument has strong content validity.

Floor/Ceiling Effects

Cerebral Palsy: (Vos-Vromans, Ketelaar, & Gorter, 2005; n = 55; mean age = 4.6 years; 18 months after baseline)

Poor ceiling effect; 24.1% of subjects scored equal to or higher than 90 points
Adequate ceiling effect of caregiver assistance on Self-care domain with 10.9% scoring equal to or higher than 90 points
Excellent ceiling effect for children less than 48 months of Functional Skills on the Self-care or Mobility domains
Excellent ceiling effect for the Self-care domain of caregiver assistance for children less than 48 months; Adequate ceiling effect (9.1%) for Mobility domain of Caregiver Assistance for children less than 48 months
Only Self-Care and Mobility domains were tested; Social Function domain was not included in the study

Spastic Cerebral Palsy: (McCarthy et al., 2002; n = 115; mean age= 5.67 years (SD = 1.5 years))

Excellent/No ceiling or floor effects found in Self-care or Social Function domains.
Adequate ceiling effect of 6% found for the Mobility domain and excellent floor effects found.

Children with Cerebral Palsy: (Amer et al, 2022)

Adequate to Excellent floor effects for the functional skills (0% for self-care, 2.5% for mobility, and 0.8% for social function) and caregiver assistance (10.3%, 17.8%, and 11.9%) parts.
Adequate ceiling effect for the functional skills part (8.5%, 6.8%, and 7.6%).
Adequate ceiling effect for self-care (14.5%) and social function (16.1%) within the caregiver assistance part.
Poor ceiling effect for mobility (21.2%) within the caregiver assistance part.

Responsiveness

Cerebral Palsy: (Vos-Vromans et al., 2005)

For children less than 48 months, Functional Skills of Self-Care (r = 1.29) and Mobility (r = 1.27) had a change/effect size
For children less than 48 months, Caregiver Assistance of Self-care (r = 1.45) and Mobility (r = 2.14) had a large change
For children equal to or older than 48 months, Functional Skills of Self-care had a large change (r = 0.98). Functional Skills of Mobility had a moderate change (r = 0.78).
For children equal to or older than 48 months, Caregiver Assistance of Self-care (r = 1.41) and Mobility (r = 0.98) had a large change.

Minor to Moderate Traumatic Injury: (Haley et al., 1992; n = 21-23; assessed at 1 and 6 months after discharge from the hospital; PEDI scaled scores of clinical sample)

Statistically significant, positive changes for all Functional Skills in Self-care, Mobility, and Social Function were found (p = <0.001, 0.011, 0.004)
Statistically significant, positive changes for all Caregiver Assistance in Self-care, Mobility, and Social Function were found (p = <0.001, 0.021, 0.005)

Multiple Significant/Severe Disabilities: (Haley et al., 1992; n = 22-23; assessed 8 months apart on 2 occasions; PEDI scaled scores of clinical sample)

Statistically significant, positive change only found for Functional Skill and Caregiver Assistance in Mobility was found (p = <0.001, <0.001)

Normative Data

Traumatic Brain Injury: (Kissane et al., 2015; n = 52; mean age = 12.0 (3.3) years; median (IQR) time since injury = 16.5 (1.9, 44.9) months; 26.9% moderate TBI, 59.6% severe TBI, 13.5% TBI level undocumented; subgroup n = 12; time since injury = < 12 months.)

Median (IQR) score at initial assessment (n = 12): 100 (84.5, 100)
Median score (IQR) at 90 day follow-up (n = 12): 100 (97.1, 100)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Traumatic Brain Injury: (Kissane, 2015)

Excellent correlation between the PEDI Functional Skills Mobility Domain and the High-level Mobility Assessment Tool (HiMAT) (r = 0.68)

Floor/Ceiling Effects

Traumatic Brain Injury: (Kissane, 2015)

Poor ceiling effect of 69%

Responsiveness

Traumatic Brain Injury: (Kissane, 2015, subgroup n = 12; mean age = 10.3 (3.7) years, median time interval between tests = 90 days; median (IQR) time post injury = 1.9 (0.7, 2.6) months)

The PEDI was unable to discriminate change in mobility skills early in the rehabilitation process due to the ceiling effect present (7 of the 12 children achieved the maximum score).

Test/Retest Reliability

Typically developing children in Uganda (Amer et al., 2018; n = 249; mean age = 3.4 (1.9) years, age range = 6 months – 7.5 years; Ugandan sample)

Functional Skills Scales (ICC (95% CI))

Acceptable test-retest reliability for self-care scale: (0.87 (0.77, 0.93))
Acceptable test-retest reliability for mobility scale: (0.88 (0.80, 0.93))
Excellent test-retest reliability for social function scale: (0.92 (0.86, 0.96))

Caregiver Assistance Scales (ICC (95% CI))

Acceptable test-retest reliability for self-care scale (0.87 (0.67, 0.92))
Acceptable test-retest reliability for mobility scale (0.86 (0.71, 0.92))
Acceptable test-retest reliability for social function scale (0.88 (0.73, 0.94))

Floor/Ceiling Effects

Typically developing children in Uganda: (Amer et al., 2018)

Functional Skills Scales

Self-care

Adequate ceiling effect (2.0%)
Adequate floor effect (1.6%)

Mobility

Adequate ceiling effect (9.6%)
Adequate floor effect (1.6%)

Social Function

Adequate ceiling effect (1.2%)
Adequate floor effect (2.8%)

Caregiver Assistance Scales

Self-care

Poor ceiling effect (32.4%)
Adequate floor effect (2.0%)

Mobility

Poor ceiling effect (38.5%)
Adequate floor effect (2.5%)

Social Function

Adequate ceiling effect (16.8%)
Adequate floor effect (2.5%)

Bibliography

Amer, A., Hermansson, L., Jarl, G., Kamusiime, S., Forssberg, H., Andrews, C., Kakooza‐Mwesige, A., & Eliasson, A. C. (2022). Validity and test–retest reliability of the Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI-UG) in children and youth with cerebral palsy. Child: Care, Health and Development, 49(3), 464–484. https://doi.org/10.1111/cch.13062

Amer, A., Kakooza, M. A., Jarl, G., Tumwine, J. K., Forssberg, H., Eliasson, A. C., & Hermansson, L. (2018). The Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI‐UG). Part II: Psychometric properties. Child: Care, Health & Development, 44(4), 562–571.

Choi, J. Y., Hwang, E. H., Rha, D., & Park, E. S. (2018). Reliability and validity of the Korean‐language version of the Communication Function Classification System in children with cerebral palsy. Child: Care, Health & Development, 44(1), 140–146. https://doi.org/10.1111/cch.12507

Galeoto, G., Mignolli, E., Tofani, M., Sogos, C., Servadio, A., Valente, D., & Berardi, A. (2022). Evaluation of test-retest reliability and concurrent validity of the Italian version of the Pediatric Evaluation of Disability Inventory in children with down syndrome: A cross-sectional study. Journal of Pediatric Rehabilitation Medicine, 15(3), 487–497. https://doi.org/10.3233/prm-190674

Haley, S. M., Coster, W. J., Ludlow, L. H., Haltiwanger, J., & Andrellos, P. (1992). Pediatric Evaluation of Disability Inventory (PEDI): Development, Standardization and Administration Manual. Boston, MA: Boston University.

Haley, S. M., Coster, W. J., Dumas, H. M., Fragala-Pinkham, M. A., & Moed, R. (2012). PEDI-CAT: Development, Standardization and Administration Manual. Boston, MA: CRECare, LLC.

Iyer, L., Haley, S. M., Watkins, M., & Dumas, H. M. (2003). Establishing minimal clinically important differences for scores on the Pediatric Evaluation of Disability Inventory for inpatient rehabilitation. Physical Therapy, 83(10), 888-898.

Kang, L.-J., Hwang, A.-W., Palisano, R. J., King, G. A., Chiarello, L. A., & Chen, C.-L. (2017). Validation of the Chinese version of the Assessment of Preschool Children’s Participation for Children with physical disabilities, Developmental Neurorehabilitation, 20(5), 266-273. https://dx.doi.org/10.3109/17518423.2016.1158746

Kissane, A. L., Eldridge, B. J., Kelly, S., Vidmar, S., Galea, M. P., & Williams, G. P. (2015). High-level mobility skills in children and adolescents with traumatic brain injury. Brain Injury, 29(13–14), 1711–1716. https://doi.org/10.3109/02699052.2015.1075174

Levy-Dayan, H., Josman, N., & Rosenblum, S. (2023). Basic activity of daily living evaluation of children with autism spectrum disorder: DO-eat washy adaption preliminary psychometric characteristics. Children, 10(3), 514. https://doi.org/10.3390/children10030514

McCarthy, M. L., Silberstein, C. E., Atkins, E. A., Harryman S. E., Spoonseller P. D., & Hadley-Miller N. A. (2002). Comparing reliability and validity of pediatric instruments for measuring health and wellbeing of children with spastic cerebral palsy. Developmental Medicine & Child Neurology, 44(7), 265-269.

Nichols D. S., & Case-Smith, J. (1996). Reliability and validity of the Pediatric Evaluation of Disability Inventory. Pediatric Physical Therapy, 8(1),15-24.

Østensjø, S., Bjorbækmo, W., Carlberg, E. B., & Vøllestad, N. K. (2006). Assessment of everyday functioning in young children with disabilities: An ICF-based analysis of concepts and content of the Pediatric Evaluation of Disability Inventory (PEDI). Disability & Rehabilitation, 28(8), 489-504. https://doi.org/10.1080/09638280500212013

Pinto, K. S., Carvalho, C. G. C., Nakamoto, L., & Nunes, L. G. N. (2016). The Sarah evaluation scale for children and adolescents with cerebral palsy: description and results. Revista Brasileira de Fisioterapia, 20(3), 267–274. https://doi.org/10.1590/bjpt-rbf.2014.0156

Reid, D. T., Boschen K., & Wright V. (1994). Critique of the Pediatric Evaluation of Disability Inventory (PEDI). Physical & Occupational Therapy in Pediatrics, 13(4), 57-93.

Ryll, U. C., Bastiaenen, C. H. G., Iten, N., & van Hedel, H. J. A. (2019). Administration of the German Pediatric Evaluation of Disability Inventory (PEDI-G) using the mode of observation in children undergoing inpatient rehabilitation: A reliability and validity study. Physical & Occupational Therapy In Pediatrics, 40(3), 345-359. https://doi.org/10.1080/01942638.2019.1695698

Tofani, M., Galeoto, G., Cazzetta, D., Berardi, A., Sansoni, J., & Valente, D. (2019). Validation of the Pediatric Evaluation of Disability Inventory in an Italian population with autism spectrum disorder: A cross-sectional study. La Clinica Terapeutica, 170(6), e460-e464. https://iris.uniroma1.it/bitstream/11573/1331878/3/Tofani_PEDI_Autismo_2019.pdf

Tsai P. Y., Yang T. F., Chan R. C., Huang P. H., & Wong T. T., (2002). Functional investigation in children with spina bifida measured by the Pediatric Evaluation of Disability Inventory (PEDI). Child’s Nervous System, 18(1), 48-53. https://doi.org/10.1007/s00381-001-0531-6

Vos-Vromans, D., Ketelaar, M., & Gorter, J. (2005). Responsiveness of evaluative measures for children with cerebral palsy: The Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory. Disability Rehabilitation, 27(20), 1245-1252. https://doi.org/10.1080/09638280500076178

Yarar, F., Aslan Telci, E., Kılavuz Oren, G., Kara, G., Cetisli Korkmaz, N., Engin Simsek, I., & Karahan, S. (2019). Cross cultural adaptation, validity, and reliability of the Turkish version of assistance to participate scale. Child: Care, Health and Development, 46(1), 83–89. https://doi.org/10.1111/cch.12728

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