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Pediatric Evaluation of Disability Inventory-  Computer Adaptive Test

Pediatric Evaluation of Disability Inventory- Computer Adaptive Test

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Purpose

  • Identification of functional delay
  • Examination of improvement for an individual child after intervention
  • Evaluation and monitoring of group progress in program evaluation and research

Link to Instrument

Instrument Details

Acronym PEDI-CAT

Area of Assessment

Activities of Daily Living
Cognition
Communication
Developmental
Functional Mobility
Language
Life Participation
Social Relationships
Upper Extremity Function

Administration Mode

Computer

Cost

Not Free

Cost Description

PEDICAT for Window costs $89.00 for a one-year license.(2018)

PEDICAT for iPad costs $399.00 for a perpetual license (2018)

Diagnosis/Conditions

  • Pediatric + Adolescent Rehabilitation

Key Descriptions

  • The PEDI-CAT software utilizes Item Response Theory (IRT) statistical models to estimate a child’s abilities from a minimal number of the most relevant items or from a set number of items within each domain. All respondents begin with the same item in each domain in the middle of the range of difficulty or responsibility and the response to that item then dictates which item will appear next (a harder or easier item), tailoring the items to the child. The CAT program generates scores and they can be viewed immediately after the measure is completed.

  • Three functional domains: Daily Activities, Mobility and Social/Cognitive. Responsibility domain measures the extent to which the caregiver or child takes responsibility for managing complex, multi-step life tasks.
    Each domain is self-contained and can be administered separately or with the other domains.
  • Focuses on typical performance at the present time
  • Two Versions: Speedy (≤15 items per selected domain(s)) and Content-Balanced (≤ 30 items with a balance of items from each of the content areas for each selected domain; most useful for individual program planning for children who have functional abilities ranging in the middle to higher end of the scale).
    Scores on the Speedy and Content-Balanced PEDI-CAT, though not identical, have been shown to be with the margin of error suggested by the standard error. Thus, the same version of the PEDI-CAT does not need to be used each time.
  • Age, gender and mobility device filters prevent irrelevant items from being presented
  • Items are worded using everyday language and clear examples and illustrations of Daily Activities and Mobility items are included to facilitate understanding of item intent.
  • Can be completed directly by the child’s caregiver(s) or by the child's therapist/clinician who is familiar with the child’s typical performance.
  • Normative Standard Scores: provided as age percentiles and T-scores
    Scaled Scores (criterion scores): 20-80 scale
  • PEDI-CAT (ASD): PEDI-CAT (ASD) is a module of the PEDI-CAT that has been validated for children and adolescents with Autism Spectrum Disorders (ASD) and includes additional directions to help parents select an appropriate rating given the unique characteristics of children with autism. Additional items have been added to the Daily Activities (n=8), Social/Cognitive (n=9), and Responsibility (n=11) domains and coring adjustments were made to the Social/Cognitive domain based on the unique patterns of children and youth with autism.
  • Can be used on multiple occasions for the same child (e.g. initial, interim, discharge and follow-up); no minimum time between assessments

Number of Items

Speedy PEDI-CAT: ≤ 15 items per domain

Content-Balanced PEDI-CAT: ≤ 30 items per domain which include a balance of items from each of the content areas within each of the selected domains

Equipment Required

  • Personal Computer or iPad with PEDI-CAT software
  • Does not require any special environment, materials or activities for administration.

Time to Administer

12 minutes

For all 4 domains using the Speedy Version (Dumas, Fragala-Pinkham, Haley, et. al. 2012)

Varies based on version (Speedy or Content-Balanced) and number of domains chosen for administration

Required Training

No Training

Age Ranges

Infant

0 - 1

years

Preschool Children

2 - 5

years

Child

6 - 12

years

Adolescent

13 - 17

years

Adult

18 - 21

years

Instrument Reviewers

Helene M. Dumas PT, DPT, MS
Maria A. Fragala-Pinkham PT, DPT, MS
Franciscan Children’s Hospital
Boston, MA

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Cognition
Motor
Participation & Activities

Considerations

  • Each download includes English and Spanish versions
  • PEDI-CAT ASD available for Windows version only (as of April, 2018)

Tags

Pediatric + Adolescent Rehabilitation Pediatric and Adolescent Rehabilitation Pediatrics Neurological Conditions Pediatric Lab

Pediatric Disorders

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Standard Error of Measurement (SEM)

(Dumas HM, Fragala-Pinkham MA, Haley SM, Ni P, Coster W, Kramer JM, Kao YC, Moed R, Ludlow LH., 2012)

SEM estimates for the PEDI-CAT T-scores calculated using the retest reliability estimates are as follows:

PEDI-CAT Domain

Reliability

SEM

Mobility

.986

1.18

Daily Activities

.997

0.55

Social/Cognitive

.979

1.45

Responsibility

.958

2.05

Professionals using PEDI-CAT T-scores for decisions such as determining eligibility for services are strongly encouraged to use the SEM to interpret T-scores and confidence levels.  The intervals set using + 2 SEM (for 95% confidence interval) or + 3 (for 98% confidence interval). 

Standard errors are also generated with the PEDI-CAT Scaled Scores and users are encouraged to consider the SEM when determining change.

Minimal Detectable Change (MDC)

Children in Hospital-Based Rehabilitation (ages 2 to 21 years) (n=80) (Fragala-Pinkham, et. al., 2017)

Domains

MDC95th

Value

≥MDC95th ***

n (%)

Mobility (n=48)

2.5

55(83%)

Daily Activities (n=23)

2.2

27(90%)

Social/ Cognitive (n=20)

3.3

8 (42%)

Normative Data

Children in the Normative Sample (n=2,205) (Haley Coster, Dumas, Fragala-Pinkham, Moed, 2011)

Normative data for the PEDI-CAT were collected using a sample of 2,205 parents from civilian households in the contiguous United States with children under 21 years of age.  Quota sampling based on age was used to ensure that sufficient cases were collected within each of the PEDI age-based strata (100 cases in each of the 21 PEDI age strata).  Within each age group, equal proportions of gender were represented and efforts were made to assure that subjects were representative of the racial and ethnic distribution of the US according to the Year 2000 Census Bureau data.  T-scores were derived from the normative sample data by first converting the scores for each age group into z-scores and then transforming z-scores onto a T-scale with a mean of 50 and a standard deviation of 10. On this T-scale, approximately 95% of the population is expected to score between ± 2 SD, or between 30 and 70.

Test/Retest Reliability

All Pediatric Disorders: (Dumas HM, Fragala-Pinkham MA, Haley SM, Ni P, Coster W, Kramer JM, Kao YC, Moed R, Ludlow LH., 2012)

  • Excellent: Test-Retest Reliability for all 4 domains was as follows: Daily Activities 0.997, Mobility 0.986, Social/Cognitive 0.979 and Responsibility 0.958.

Criterion Validity (Predictive/Concurrent)

Children in the Normative Sample (n=2,198) (Haley, Coster, Dumas, Fragala-Pinkham, Moed, 2012)

  • Excellent (range = .81 - .93) across all four domains

Children with Disabilities (n=617) (Haley, Coster, Dumas, Fragala-Pinkham, Moed, 2012)

  • Excellent for Daily Activities and Mobility (.81)
  • Adequate for Daily Activities, Social/cognitive and Responsibility (range =.72 -.78)
  • Poor for Mobility and Social/Cognitive (.69) and Mobility and Responsibility (.60)

Children Receiving Early Intervention (n=37) (Khetani, McManus, Arestad,, et al., 2018)

  • Adequate: r = 0.35 across PEDI-CAT domain scores

Children and Youth with Neurodevelopmental Disabilities (4 to 20 years of age) (Dumas and Fragala-Pinkham, 2012)

  • Poor to Excellent: Item-specific reliability between the PEDI-CAT Mobility domain and PEDI FS Mobility Scale - Intraclass correlation coefficients ranged from .3390 to 1.000 and agreement results ranged from 60% to 100% for the 8 items that had at least 20 responses on the PEDI-CAT Mobility.

Young Children (<18 months of age) (Dumas, Fragala-Pinkham, Rosen, Lombard, Farrell, 2015)

  • Adequate Validity: A statistically significant, fair association (r =0.313; p =.02) was found between the PEDI-CAT and Alberta Infant Motor Scales. 
  • There was no significant difference in motor delay identification between tests; however, the AIMS had a higher percentage of infants with scores ≤ 5th percentile.

Children and Youth with Neurodevelopmental Disabilities (4 to 20 years of age)  (Dumas and Fragala-Pinkham, 2012)

  • Excellent: Strength of association between the PEDI-CAT Mobility domain scaled scores and the PEDI FS Mobility scaled scores (r = .82; p < .001).

Children Born to Mothers with Preeclampsia (n=111) (Nicolas, Benitez, Riano, et. al., 2016)

  • Lower Social/Cognitive age percentiles were associated with both lower maternal IgG levels and presence of necrotizing enterocolitis during the neonatal period.

Children Admitted and Discharged from PICU (1 to 17 years of age) (n=182) (Choong, Fraser, Al Harbi , et. al., 2018)

  • Higher baseline function prior to PICU admission  associated with a slower functional recovery across all domains at 6 months

Children Receiving Early Intervention (n=37) (Khetani, McManus, Arestad, Richardson, Charlifue-Smith, et al., 2018)

Adequate: r = 0.33 between PEDI-CAT and YC-PEM median summary scores

Construct Validity

Children who use walking aids vs wheelchairs (Dumas, Fragala-Pinkham, Feng, Haley, 2012)

  • Mean scaled scores were significantly different (p < 0.001) for the two groups.  Mean score for the Wheelchair Group (38.37, SD=7.09) was lower than the Walking Aid Group (46.97, SD=5.10). The Walking Aid Group score range started and ended higher on the 20 to 80 scale than the Wheelchair Group.

Children with and without Disabilities (Dumas, Fragala-Pinkham, Haley, et. al., 2012)

  • Mean scaled scores were significantly different (p < 0.001) for the two groups across all 4 domains with the children in the disability group having a lower mean score.

Children with Cerebral Palsy (mean age=11 years, 11 months) (Shore, Allar, Miller, Matheney, 2017)

  • Excellent: Mobility domain distinguished between ambulatory and nonambulatory participants [area under the curve (AUC) = 0.98 and 0.97)
  • Excellent: Daily Activities domain distinguished between independent and dependent hand function (AUC = 0.93).
  • Excellent: All PEDI-CAT domains were able to discriminate between ambulatory (GMFCS levels I-III) or nonambulatory (GMFCS levels IV-V) as well as manually independent (MACS levels I-II) or manually dependent functional levels (MACS levels III-V) (p < .001).

Children with Autism Spectrum Disorders (ASD) and Intellectual Developmental Disabilities (IDD)  (Kao, Kramer, Liljenquist, Feng, Coster, 2012)

  • Scores on the PEDI-CAT differentiated children with ASD (n=108) from a group without disabilities (n=2,205).
  • Children with ASD (n=108) and IDD (n=150) did not demonstrate different performance profiles.

Children and Young Adults with Spinal Muscular Atrophy (n=58) (Pasternak, Sideridis, Fragala-Pinkham, Glanzman, Montes, 2016)

  • Unidimensional content for each domain was confirmed and most informative for type III SMA; Item and person abilities were not distributed evenly across all types

Children with Medical Complexity (Dumas, Fragala-Pinkham, Rosen, O’Brien, 2017)

  • Divergent Validity: Significant differences were found between mean PEDI-CAT Daily Activities (12.62, p<0.001), Mobility (9.99, p<0.003), and Social/Cognitive (10.21, p<0.002) normative scores across the two complexity groups with children in the “Less Complex” group having higher PEDI-CAT normative scores for all three domains, indicating higher levels of function.
  • Convergent Validity: PEDI-CAT domains measure similar but distinct constructs of functional behavior for children with medical complexity of various ages.

Domains

Infant Group

Preschool Group

School-Age Group

Daily Activities and Mobility

r=0.809, p<0.001

r=0.636 p<0.001

r=0.512 p<0.001

Daily Activities and

Social/Cognitive

r=0.725, p<0.001

r=0.646, p<0.001

r=0.718, p<0.001

Mobility and

Social/Cognitive

r=0.864, p<0.001

r=0.376, p<0.037)

r=0.311, p<0.037

Children with HIV Encepholapthy (Mann, Donald, Laughton , Lamberts , Langerak, 2017)

PEDI-CAT demonstrated that children with HIV encephalopathy and bilateral lower limb spasticity (n=30) demonstrate higher levels of difficulty with Daily Activities and Mobility than typically developing children (n=20).

Content Validity

Items and response scales were developed based on literature and measure review, expert review, parent and clinician focus groups, and cognitive testing of items and response scales. (Haley Coster, Dumas, Fragala-Pinkham, Moed, 2012)

Floor/Ceiling Effects

Children and Youth with Neurodevelopmental Disabilities (4 to 20 years of age) (Dumas and Fragala-Pinkham, 2012)

  • No child with minimum score, 1 child had maximum scaled score (3%)

Children who use walking aids and wheelchairs (Dumas, Fragala-Pinkham, Feng, Haley, 2012)

  • No floor or ceiling effects were seen for the scoring of the 27 items specifying use of a mobility device.

Children in Hospital-Based Rehabilitation (ages 2 to 21 years) (n=80) (Fragala-Pinkham, Dumas, Rosen, O’Brien, 2017)

  • No ceiling effects for any of the PEDI-CAT domains on admission. 

Responsiveness

Young Children (<18 months of age) (Dumas, Fragala-Pinkham, Rosen, Lombard, Farrell, 2015)

  • 24 of 32 children (75%) showed significant changes from initial examination at hospital admission to final testing at discharge with the PEDI-CAT Mobility domain scaled scores (p<.001).

Children in Hospital-Based Rehabilitation (ages 2 to 21 years) (n=80) (Fragala-Pinkham, Dumas, Rosen, O’Brien, 2017)

  • Significant differences were found for all domains when mean admission and discharge scaled scores were compared.
  • Moderate to large effect sizes and SRMs for the Mobility and Daily Activities domains and Wheelchair subdomain. 
  • Small effect size but large SRM for the Social/Cognitive domain.

Domains

Mean Difference

*(Discharge – Admission )

p

Value

Effect

Size

SRM

 

Mobility

(n=48)

7.9 (6.7)

<0.001

0.87

1.18

Wheelchair Subdomain

(n=9)

7.7(5.8)

0.004

1.54

1.33

Daily Activities

(n=23)

5.7(7.3)

0.004

0.71

0.78

Social/ Cognitive

(n=20)

3.1 (3.4)

 

<0.001

 

0.37

0.91

  • Large effect sizes and SRM reported for all diagnostic groups and for the two older age groups for the Mobility domain.  For the youngest age group, a moderate effect size was demonstrated for the mobility change score.
 

n

Mean Change (SD)

p

Value

Effect Size           

SRM    

Diagnostic Groups

Traumatic Brain Injury

17

8.1 (5.4)

<0.001

1.38

1.51

Neurological

36

7.9 (1.3)

<0.001

0.80

1.08

Orthopedic

7

5.3 (5.0)

0.032

0.94

1.05

Medical

6

6.4 (2.7)

0.002

1.36

2.34

Age Groups

<5 years

15

5.9 (5.9)

0.001

 0.70

 1.05

≥5 and < 13 years

26

7.1 (5.4)

<0.001

 0.90

 1.33

> 13 years

25

9.73 (8.1)

<0.001

0.96

1.20

Children with CP (n=3), Gross Motor Function Classification System (GMFCS) Levels III or IV, 5 - 14 years of age (Kenyon, Westman, Hefferan, et. al, 2017)

  • Post-intervention body-weight-supported treadmill training PEDI-CAT Mobility scores were within the 95% confidence interval of pre-intervention scores for all participants indicating no change.

Children with CP (n=3), Gross Motor Function Classification System (GMFCS) Levels IV or V, <3.5 years of age (Kenyon, Farris, Gallagher, et. al., 2017)

  • Post-intervention power mobility training scaled scores exceeded baseline scores (2 standard errors) as follows: Daily Activities and Responsibility domains (1 of 3 participants), Mobility and Social/Cognitive domains (2 of 3 participants).

Children Discharged from PICU (1 to 17 years of age) (n=182) (Khetani, Albrecht, Jarvis. et.al. 2018)

  • Children scoring above the 10th percentile on the PEDI-CAT demonstrated significantly increased participation frequency and involvement at home at baseline, 3 months, and 6 months after discharge from the PICU (b=1.47, p<0.05 for frequency; b=0.34, p<0.05 for involvement).

Bibliography

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