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 |
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|
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 |
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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) |
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---|---|---|---|---|---|---|---|---|
|
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 |
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---|---|---|---|---|---|---|---|---|---|
|
FMS 5 |
FMS 50 |
FMS 500 |
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|
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 |
|
|
|
|
|
|
|
|
|
|
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) |
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|
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) |
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Time post-op |
5m |
50m |
500m |
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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 https://www.schn.health.nsw.gov.au/files/attachments/the_functional_mobility_scale_version_2.pdf
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.