In thiscross-sectional studywith non-probability sampling, 200 children with CP were enrolled fromeight rehabilitation centers and three schools for children with physical disabilities. We included children aged 4-12 years diagnosed with CP according to their medical records or their therapists’ report, whose parents were literate andagreed with their participation. Children were classified topographically and physiologically according to the Surveillance of Cerebral Palsy in Europe (SCPE)(16).
Tools and Measures
The data for this study were collected using asocio-demographic characteristics questionnaire,the Persian version of the CPQOL-parent, GMFCS,Manual Ability Classification System (MACS), and the SPARCLE cognitive level estimation form.
The socio-demographic questionnaire includes 46 questions divided intofour sections: questions related to the child, the parents, the child’s caregiver, and the child's health status.
The CPQOL-parent versionmeasures condition-specific QOL and is completed by the parents.This questionnairehas 66 items and is appropriate to assess the QOL of children with CP aged 4-12 years.The answer to each question is divided into a 9-pointLikertscale, which the parent either selectsor draws a line around (17, 18).CPQOL has sevensubscales, including(1) social well-being and acceptance; (2) functioning; (3) participation and physical health; (4) emotional well-being; (5) pain and impact of disability; (6) access to services; and (7) family health.The Persian version of the CPQOL-parent version questionnaire was validated according to the protocol provided by the developers (19), and had acceptable reliability (ICC=0.47-0.84) and the subscales had appropriate internal consistency (α=0.61-0.87)(19).
Gross motor function was assessed according to the GFMCS and based on spontaneous gross movement such as the child’s head control, sitting, standing, and transferring(20). In this system, the gross motor function of children with CP is classified into five levels. In level one, children have the most, and in level five, children have the least independent motor function. This scale has acceptable validity and reliability (20, 21).
The MACS assesseschildren’s manual ability based on how their hands are used to control objects in everyday life(22). This system is defined in five levels similar to the GFMCS. Children in level one have the highest manual ability function, and children in Level five have the least control over the objects. MACS has been validated in Persian and has an acceptable level of validity and reliability (23).
Cognitive function in children with CP was estimated and classified into three levels including: >70, 70-50, <50. This classification was prepared and used by SPARCLEin Europe(24). Parents with children with CP are asked to answer four questions. Then, based on their responses, the children’s cognitive level is identified.
Following the recruitment of the participants, the aims and steps of completing the questionnaireswere explained to them. Then, upon their willingness,written consent was obtainedfrom the parents. In the next steps, the questionnaires of the study were completed according to the following order. First, CPQOL and socio-demographicquestionnaireswere completed consecutively by the parents. Then, the children’s GFMCS, MACS, and level of cognition were identified by an assessor (three occupational therapists) by interviewing the parents. On average, the whole process took about 60 minutes. This study was approved by the Ethical Committee of the University of Social Welfare and Rehabilitation Sciences(ID: 801/4/88/58).
Data were analyzed using SPSS software, version 19. Descriptive statistics were used to determine the characteristics of the participants. Linear regression was used to investigate the relationship between the subscalesof CPQOL and children’s functions, including gross motor function, manual ability, and cognitive function.