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Pediatric Evaluation of Disability Inventory

Pediatric Evaluation of Disability Inventory

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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 of Daily Living
Behavior
Cognition
Communication
Eating
Functional Mobility
Infant & Child Development
Language
Life Participation
Occupational Performance
Reasoning/Problem Solving
Social Relationships

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$171.55

Cost Description

$125.95, manual; $45.60, pack of 25 scoring sheets

Key Descriptions

  • 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. Each item is rated 0-1 for performance capability.
  • Part II: Caregiver Assistance includes 20 items of complex functional activities. Each item is rated 0-5 for assistance level.
  • Part III: Modifications includes 20 items of complex functional activities rated 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

Equipment Required

  • Score form
  • Writing utensil
  • Software program
  • Manual

Time to Administer

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

Age Ranges

Months

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

ICF Domain

Activity
Participation
Environment

Measurement Domain

Activities of Daily Living
Cognition
Motor

Professional Association Recommendation

There are currently no professional association recommendations.

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 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

Pediatric Disorders

back to Populations

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.

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

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*

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

Criterion Validity (Predictive/Concurrent)

Concurrent Validity Evidence:

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)

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)

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.

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)

Bibliography

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.

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

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.

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

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