Research Report

Concurrent and Construct Validity of the Pediatric

Evaluation of Disability Inventory

The purpose of this study was to determine the validity of the Development Edition
@lot vm7on) of the Pediattic Evaluation of Disability Inventoy (PDQ in p u p s
of disabled and nondisabled children. The PEDI is a new functional assessment
insmment for the evaluation of disabled children q e d G months to 7 years. The
PEDl has been developed to identtB functional status and change along three
dimemmenno'm:
1)functional skill level, 2) caregiver &tance, and 3) modijications
or adaptive equipment used. The PEDls were administered as a parental-report
questionrlaire, and the results were compared with data obtained by the Battelle
Developmental Inventoy Screening Test (BDISV. The BDIST is a standardized
assessmertt with developmental and adaptive content. Subjects were 20 children
between the ages of 2 and 8 years with arthritic conditions and spina btwa and
20 nondisabled chikiren matched for age and sex. All subjects' scores o n the
BDIST cqgnitive domain were no greater than 1.50 standard deuiations below the
mean for their age group. Concurrent validity was supported by moderately high
Peamn product-moment correlations between BDIST and PEDl summay scores
(r = .70-..80). Consn-uct validity was supported by signijicant d ~ ~between
e s
the disabled and nodisabled p u p s ' PEDI scores and by discriminant analysk
identrtng the PEDI scores as better p u p dixn'minators than the BDIST scores.
Results validate the Developmental Edition of the PEDI and support the further
development and stamhrdization of theBnal version. Use of the PEDI in clinical
pediatric ,pQsical therapy practice is discussed. IFeldman AB, Haley M,CoyellJ.
Concurrent and consn-uct validity of the Pediattic Evaluation of Disability Inventory. PQs Ther. 1990;70:602410.]

Amy B Feldman
Stephen M Haley
Jane Coryell

Key Words: Functional assessment; Pedianics; Tests and measurements,functionuk Validity.

A Feldman, MS, PT, is a level-I1 therapist, Children's Hospital of Los Angeles, 4650 Sunset Blvd, PO
Box 54700, Los Angeles, CA 90054-0700. She was a student in the master's degree program, Depart-

ment of Physical Therapy, Sargent College of Mied Health Professions, Boston University, when
this study atas completed in partial fulfillment of her degree requirements. Address all correspondence to Ms Feldman at 11640 Kiowa Ave, #206, Los Angeles, CA 90049 (USA).
S Haley, PhD, PT, is Assistant Professor, Tufts University School of Medicine, and Acting Director,
Research arid Training Center in Rehabilitation and Childhood Trauma, New England Medical Center Hospitals, Boston, MA 02111.
J Coryell, PhD, PT, was Associate Professor, Department of Physical Therapy, Sargent College of
Allied Heal1.h Professions, Boston University, 1 University Rd, Boston, MA 02215, when this study
was conduc~ted.

This study was supported in pan by a grant from the US Department of Education, Office of Special Education and Rehabilitation Senices, awarded to Boston University; a Clinical Research Grant
from the American Physical Therapy Association, Section on Pediatrics, awarded to Ms Feldman;
and Grant No. H133G80043 from the US Department of Education, National Institute on Disability
and Rehabilitation Research, awarded to Dr Haley.
This study was approved by the New England Medical Center's Human Investigation Review
Committee.
This article was submitted March 19, 1990, and was accepted May 31, 1930.

Physical Therapyllrolume 70, Number 10/0ctober 1990

A major component of a comprehensive pediatric evaluation is the assessment of functional abilities. Development of standardized functional
assessments for young children is
needed to enhance the quality of
physical therapy evaluation of young
children.l.2The purpose of this study
was to determine the concurrent and
construct validity of a new instrument
for the assessment of pediatric functional ability, the Pediatric Evaluation
of Disability Inventoxy (PEDI).

Functional assessment instruments

measure the actual ability of the child
to perform necessaxy daily activities.35 The focus of functional assessments is to determine the extent of

independence and the maximization

of function achieved within the limitation imposed by physical or cognitive
deficits.6 Comprehensive functional
assessment instruments contain
mobility, transfer, self-care, and social
function items5; include measurement
dimensions of assistance and adaptive
equipment4.7; and incorporate developmental stages of functional skill
attainrnent.8 Functional assessment
may provide the pediatric physical
therapist with essential information
for treatment and educational
planning.9JO
Despite the agreement that functional
assessments for infants and young
children are valuable, few standardized instruments have been developed
for this age group. Physical therapists
have often relied on developmental
milestone scales for indications of
functional status in young children.
However, inadequate sampling of functional and adaptive content: deficiencies in standardization on disabled
subject samples,6J1and lack of sensitivity to functional changelz-15 limit the
usefulness of developmental milestone
scales for functional assessment. A
number of other adaptive instruments
are available for examining functional
status, but are diagnosis specific,16
known to be clinically useful but not
standardized,l7 modified from adult
functional assessment instruments,lO or
developed primarily for social and
adaptive skill evaluations of older
children.lsl19Recently, new instruments have become available for the
functional assessment of young
children,20.21although conclusive technical data supporting their clinical use
have not been reported.
The PEDI is a new functional assessment instrument for chronically ill
and disabled children from 6 months
through 7 years of age. Item content
includes self-care, bowel and bladder
control, mobility and transfers, communication, and social function. The
PEDI was developed to 1) provide a
global evaluation tool for inpatient
pediatric rehabilitation programs; 2)
serve as an evaluation instrument for
outpatient therapy services, school
programs, and community agencies

serving pediatric clients; and 3) provide a uniform mechanism for reporting functional disability for data registries and health policy data banks.
The PEDI is designed to identify the
child's functional ability along three
scales: 1) typical functional skill level,
2) modifications o r adaptive equipment used (ie, braces, motorized
wheelchair), and 3) physical assistance typically required of the caregiver.
With the development of any new
assessment tool, validity must be
determined. Validity is investigated
during test development and confirmed through subsequent use.22
Although all forms of validity are
important in determining a test's usefulness, two forms of criterion-related
validity will be addressed in this anicle: 1) concurrent validity and 2) construct validity. Concurrent validity
refers to the similarity between the
target measure and another measure
for which validity is known.23 Concurrent validity is obtained by correlating
two or more measures given to the
same subjects at approximately the
same time. Construct validity refers to
accumulated evidence that a test performs as expected when measuring
an underlying trait or concept. In this
study, we examined the ability of the
PEDI to discriminate between healthy
children and a group of children it
was designed to assess (children with
functional disabilities).22
The Battelle Developmental Inventory
Screening Test (BDIST)24was chosen
as a comparison measure to the PEDI.
The BDIST includes items from five
domains: 1) personal-social, 2) adaptive, 3) motor, 4) communication, and
5) cognitive. Although the BDIST has
a developmental framework, it Samples essential functional content such
as dressing, toileting, and mobility.
The BDIST is appropriate to use in
this study as the PEDI was designed
to assess similar adaptive content
areas. In contrast to the PEDI, the
BDIST assesses the child's skill level
and does not include a scale that
takes into account the need for adaptive equipment or physical assistance.

The purposes of this study were to

examine the concurrent validity of the
PEDI with an already validated test
instrument, the BDIST, in groups of
disabled and nondisabled children
and to determine the construct validity of the PEDI by examining its ability
to discriminate between groups. Specifically, we sought to determine the
concurrent correlations between the
PEDI and the BDIST scores. Furthermore, we sought to determine
whether the PEDI outcome scores
would be significantly different
between the disabled and nondisabled groups and, if so, which test
instrument best classifies the children
according to group status.

The subjects were 40 children

between the ages of 2 and 8 years
whose scores on the cognitive
domain of the BDIST were no more
than 1.50 standard deviations below
the mean for their age group. This
exclusion criterion eliminated from
the sample children with major cognitive impairments. The disabled group
(n = 20) included 10 children (7
female, 3 male) with arthritic conditions who were recruited from the
Rheumatology Clinic at The Floating
Hospital, New England Medical Center
(Boston, Mass). The other 10 children
(4 female, 6 male) in this group had
spina bifida; 9 of these subjects were
recruited from the Birth Defects
Clinic at The Floating Hospital, and
1 subject was recruited through a
Boston-area special needs preschool.
The nondisabled group (n = 20) consisted of children with no identified
illness o r developmental delay who
were selected by convenience from
the community and were matched for
age, sex, and cognitive status with the
disabled group subjects. Informed
consent was obtained from all subjects' parents prior to data collection.
Varying levels of functional disability
were represented in the clinical sample (Tab. 1). Ninety-five percent of the
subjects in each group were Caucasian. There were no significant differ-

Physical Therapyllrolume 70, Number 10/0ctober 1990

Table 1 Description of Subjects with Disabilities (N = 20)

SubJectNumber

Age

Sex

Dlagnosls

Children with arthritic conditions

1

Pauciarticular JRAa

Monoarticular JRA

Polyarticular JRA

Pauciarticular JRA

Polyarticular JRA

Scleroderma

Dermatomyositis

Pauciarticular JRA

Polyarticular JRA
Pauciarticular JRA, in remission

10
Children with spina bifida
11

L-5 myelodysplasia, shunted hydrocephalus

12

L-4 myelodysplasia, shunted hydrocephalus

13

L-5 myelodysplasia, shunted hydrocephalus

14

S-1 myelodysplasia, shunted hydrocephalus

15

L-2 myelodysplasia, shunted hydrocephalus

16

T-1 myelodysplasia, shunted hydrocephalus,

prolapsed intestine requiring colostomy

17

5 yr 10 rno

L-2 myelodysplasia, shunted hydrocephalus,

Arnold-Chiari deformity symptoms
L-3 myelodysplasia, shunted hydrocephalus
L-3 myelodysplasia, shunted hydrocephalus
Lipomeningocele

OJRA = juvenile rheumatoid arthritis.

ences between the groups in age or

in cognitive domain ageequivalent
scores on the BDIST (Tab. 2). Families of the disabled group subjects
scored significantly lower on socioeconomic status than families of the
nondisabled group subjects (AB Hollingshead, unpublished manuscript,
1985) (t = 3.62, df = 18, P < .005).
As expected, total BDIST ageequivalent scores (t = -4.06, df =
19, P < .(MI)and BDIST gross motor
domain age-equivalent scores (t =
-3.83, df = 19, P < ,005) were significantly lower in the disabled group
than in the nondisabled group.

Test Instruments
The PEDI is a parental-report, or
structured-inte~ew,instrument used
by pediatric physical therapists and
other rehabilitation professionals to

assess functional abilities of young

children. The current version of the
PEDI is known as the Development
Edition (pilot version). The creation
of the Development Edition provides
the opportunity to assess initial reliability and validity data prior to formal standardization of the instrument.
A formal content-validitystudy including feedback from over 30 experts in
the fields of pediatric rehabilitation
and test development has been completed (SM Haley, R Faas, WJ Coster;
unpublished data; 1990). Reliability
studies are currently underway. Standardization on a normative sample is
planned after analyses of the data
fi-om the reliability and validity studies
of the Development Edition. This preliminary validity study is intended to
examine the usefulness of the PEDI
for describing functional deficits in
children with disabilities and for

Physical TherapyNolume 70, Number 10/0ctober 1990

examining its ability to discriminate

between groups of disabled and nondisabled children.
The items on the PEDI are grouped
into three domains: self-care, mobility,
and social function (Tab. 3). For each
domain, three independent scale
scores are calculated: 1) functional
skill level, 2) caregiver assistance, and
3) modifications. Total scores are also
calculated for each scale across
domains. In the Development Edition,
as for the current analyses, scores are
obtained by summing items within
domains for each measurement scale.
Potential exists for the misinterpretation of scores when ordinal data are
added to create summary sc0res.~5
However, with the lack of a normative
sample and with no hierarchical
model yet defined, no other summary
score method is currently available.

Table 2. Means and Standard Deviations for CbiWFamily Characteristics

Nondlsabled

Matching variables
Child's age (yr)
BDISTacognitive domain ageequivalent scores
Other variables
BDIST age-equivalent scores
BDISTb total
Personal-social domain

4.8

1.5

Adaptive domain

4.4

1.8

45.5

9.5

Motor domain
Gross motorC
Fine motor
Communication domain
Receptive
Expressive
Family socioeconomic statusC
aBDIST = Battelle Developmental Inventory Screening Test.
b~

< ,001.

Higher scores for functional skill level

and caregiver assistance indicate better performance and increased independence. Higher scores for the modifications scale denote more
extensive modifications are used to
perform the skill. No formal reliability
checks were conducted on the PEDI
items; however, the primary author
(ABF) did observe and conduct a
number of structured interviews
supervised by the developers of the
PEDI prior to data collection.
The BDIST was developed from the
Battelle Developmental Inventory
(BD1),24which consists of 341 test
items from five domains: 1) personalsocial, 2) adaptive, 3) motor, 4) communication, and 5) cognitive. Excellent technical data have been
reported for the BDI, including the
ability to discriminate between disabled and nondisabled children.2c28
Major advantages of the BDI over
other available developmental tests
are the inclusion of relevant functional and adaptive test items and pro18/ 605

cedures for evaluating children with

motor, visual, and hearing
impairments.6 Although the BDI is not
commonly used by physical therapists,
a recent article in the physical therapy
literature related the use of the BDI
to examine different delivery models
of physical therapy and occupational
Limitatherapy in a school ~etting.~9
tions of the BDI are its large item
pool and the estimated amount of
time required to complete the test
(2 hours). Because of practical time
limitations of administering two concurrent tests, the BDIST was used in
this study.
The BDIST consists of 96 items, with
a completion time of approximately
20 to 35 minutes (Tab. 3). The BDIST
covers the same domains as the BDI
and was validated clinically with a
sample of healthy children (N = 164),
thus making the BDIST a strong predictor of performance on the BDI.
The stated purposes of the BDIST are
1) to identrfy children who are handicapped o r developmentally delayed

and areas for more comprehensive

testing, 2) to identify strengths and
weaknesses of normally developing
children, and 3) to document the
progress of groups of children with
disabilities.24 Similar administration
instructions as well as similar scoring
procedures to the BDI were used in
this study. Items on the BDIST can be
scored by structured administration,
observation, o r caregiver interview.
Interrater reliability of BDIST scores
was established prior to data collection. Six children, aged 4 to 6 years,
with suspected developmental delay
were simultaneously tested by the
primary author and an experienced
user of the BDIST. The intraclass cor- .
relation coefficients (ICC[2,1])for the
BDIST total raw score and domain
scores were all above .90. The standard error of measurement of the
BDIST total raw score was less than
.80; standard errors of measurement
of domain scores were proportionally
small. Intrarater reliability of the
BDIST scores was estimated by testing

Physical TherapyNolume 70, Number 10/0ctober 1990

Table 3. Domain Content of the Pediatric Evaluation of Disability Inventory

(PEDI) and the Battelle Developmental Inventory Screening Test (BDIST)
PEDl Item Content

BDlST Item Content

Self-care domain

Adaptive domain

Feeding

Eating

Grooming

Attention

Bathing

Dressing

Dressing upper body

Toileting

Dressing lower body

Personal responsibility

Bladder management
Bowel management
Toileting
Independent routines
Mobility domain

Motor domain

Tub transfer

Body coordination/milestones

Chair tra~nsfer

Perceptual motor

Bed tran:sfer

Locomotion

Locomotion within a room

Fine motor

Locomotion belween rooms

Locomot~onoutdoors

Data Analysls

Stair-clirnbing ability
Social function domain
Comprehension
Expression

Communication domain
Receptive
Expressive
Personal-social domain

Social interaction

Self-concept

Play with peers

Adult interaction
Peer interaction
Coping
Social role
Expression of feelings
Cognitive domain
Memory
Perceptual discrimination
Reasoning and academic skills
Conceptual development

three healthy children, aged 2, 4, and

6 years, on two test occasions within a
2-week interval. All tests were administered by the primary author. The
Pearson product-moment correlation
coefficient for intrarater agreement
was high (r = .96), and the standard
error of measurement was within two
points for the total score and proportionally srnall for the domain scores.

The parents of the remaining 30 subjects completed the PEDI while the
primary author was present, either at
the clinic or in the child's home.
Questions regarding the PEDI were
answered according to instructions
and samples provided by the test
developers. All parents completed a
demographic form as part of the PEDI
questionnaire. The BDIST was administered to all of the children according to the standardized procedures in
the test manual. The BDIST was
administered to the 10 children with
arthritic conditions and to 2 of the
children with spina bifida while they
were waiting at the clinic to be seen
by various health care professionals; it
was administered to the remaining
children with spina bifida and to the
20 nondisabled children at each
child's home. The differences in test
site administration occurred because
of time limitations in the clinic and
convenience to the families.

Procedure
The PEDI was administered as a
parental-report questionnaire to the
parents of all children in the study.
Because of time limitations during
inpatient clinic visits, the parents of 10
of the subjects took the PEDI home to
complete. They were called within 2
to 4 days by the primary author to
answer any questions and were asked
to return the questionnaire by mail.

Physical Therapyllrolume 70, Number 10/0ctober 1990

First, Pearson product-moment correlations to estimate concurrent validity

were calculated using summary scores
of the PEDI and BDIST for the total
group of children (N = 40), for the
disabled group (n = 20), and for the
nondisabled group (n = 20).
Domains on the PEDI were related to
domains on the BDIST that were
thought to assess similar areas. Second, Student's paired t tests were
used to determine whether significant
differences in PEDI scores existed
between groups. Finally, a discriminant analysis was performed with the
following independent variables: PEDI
functional skill level, PEDI modifications, PEDI caregiver assistance, and
BDIST total score to determine the
relative power of each scale to differentiate between the groups.

Results
Concurrent Valldlty
Correlations were moderately high
and positive for both the PEDI functional skill level summary score and
the PEDI caregiver assistance summary score with the BDIST total score

Table 4. Pearson Product-Moment Cowelations (r) Between Pediam'c Evaluation of Disability Inventory (PEDI) and Battelle
Developmental Inventory Screening Test (BDIST) Summary Scale and Domain Scores

Total Sample
(N = 40)

Dlsabled
Group (n =
20)

Nondlsabled
Group (n = 20)

PEDI summary scale scores

Functional skill level vs BDlST total score
Caregiver assistance vs BDiST total
score
PEDI self-care domain
Functional skill level vs BDIST adaptive
domain
Caregiver assistance vs BDlST adaptive
domain
PEDI mobility domain
Functional skill level vs BDIST motor
domain (gross motor)
Caregiver assistance vs BDlST motor
domain (gross motor)
PEDI social function domain
Functional skill level vs BDIST
personal- social domain
Funct~onalskill level vs BDIST cognitive
domain
Functional skill level vs BDlST
communi cation domain (expressive)
Functional skill level vs BDIST
communi cation domain (receptive)
Caregiver assistance vs BDlST
personal- social domain
Caregiver assistance vs BDlST cognitive
domain
Caregiver assistance vs BDlST
communi cation domain (expressive)
Caregiver assistance vs BDIST
communi cation domain (receptive)

(Tab. 4). The PEDI self-care domain

had a moderately high correlation
with the BDIST adaptive domain. The
PEDI mobility domain had a
moderately high correlation with the
BDIST gross motor domain except for
the nondisabled group of children.
The magnitude of correlations of the
PEDI social function domain was
variable with the personal-social,
cognitive, and communication
(expressive and receptive) domains of
the BDIST. Overall, with the
20 / 607

exception of the PEDI social function

domain with the BDIST
personal-social domain, these results
support the concurrent validity of the
PEDI with the BDIST.

Construct Validity
Table 5 presents results from a series
of Student's paired t tests using the
PEDI summary scale and domain
scores. The disabled group scored
significantly lower than the nondis-

abled group in the content domain

scores of self-care and mobility and in
the total scale scores of functional
skill level, caregiver assistance, and
modifications. This finding suppons
the construct validity of the PEDI in
that the PEDI is able to effectively discriminate between disabled and nondisabled children.
A discriminant analysis using the four

summary scale scores-PEDI functional skill level, PEDI modifications,

Physical Therapy/Volume 70, Number 10/0ctober 1990

Table 5. Results of Student's Paired t Testsfor Pediatric Evaluation of Disability Inventory (PEDI) Summary Scale and Domain
Scores Between Groups
Dlsabled
Group @)

Nondlsabled
Group @)

PEDl sumrnary scale scores

Functior~alskill level
Caregiver assistance
Modifica~tions
PEDl self-care domain scores
Function~alskill level
Caregiver assistance
PEDl mobility domain scores
Functional skill level
Caregiver assistance
PEDl social function domain scores
Functional skill level
Caregiver assistance

PEDI caregiver assistance, and BDIST

total-showed the PEDI modifications
score to be the best discriminator
between groups (disabled and nondisabled) (Tab. 6). When the modifications scale was removed from the
analysis, !:he PEDI functional skill level

Table 6. Results of Discriminant

Analysis to Identifj, Group Status

Independelit variables
PEDla modifications
PEDl fun8:tional

skill level

13.06

<.001

1.28

NS

PEDl caregiver assistance

0.70

NS

BDISTb total score

0.34

NS

Independent variables
(with modificationsscale
removed)
PEDl fun~ztionalskill level

10.21

<.001

BDlST total score

0.85

NS

PEDl caregiver assistance

0.00

NS

aPEDI = Pe.diatric Evaluation of Disability

Inventory.
= Elattelle Developmental Inventory
Screening Test.

b~~~~~

score was the next best discriminator

between groups. With the PEDI modifications scale entering the equation
first, the group status of 72.5% of the
children was correctly identified. Nine
of the disabled children were incorrectly identified as nondisabled. One
of the nondisabled children was incorrectly identified as disabled. When
the PEDI modifications scale was removed from the analysis and the PEDI
functional skill level score entered the
equation first, the group status of 75%
of the children was correctly identified. According to the PEDI functional
skill level scale, 8 of the disabled children were incorrectly identified as
nondisabled and 2 of the nondisabled
children were incorrectly identified as
disabled. The ability of the PEDI to
discriminate between disabled and
nondisabled groups of children, in
this case better than the BDIST, further supports its construct validity.

The purpose of this study was to assess the validity of the Development
Edition of the PEDI by examining the
relationship between children's scores
on a developmental test with adaptive
content and a new functional test.

Physical TherapyNolume 70, Number 1010ctober 1990

Overall, the results support the concurrent and construct validity of the
PEDI.
Moderately high correlations of PEDI
scores with the BDIST scores support
the concurrent validity of the PEDI.
Although moderately high correlations between the PEDI self-care and
mobility domains and the BDIST were
demonstrated by the total sample and
the disabled group, lower correlations
were found for the nondisabled
group. This finding may be explained
by a ceiling effect in the PEDI as
many of the nondisabled children
scored maximum scores on the PEDI
mobility scales, but did not on the
BDIST gross motor domain. Apparently the nondisabled children were
independent in the most difficult
functional items of the PEDI mobility
domain (eg, stair-climbing ability), but
were unable to perform the hardest
items on the BDIST gross motor domain (ie, jump rope three consecutive
times, tandem walk 1.83 m [6 ft], and
stand on each foot alternately with
eyes closed for 3 seconds).
Similar low correlations were noted
with the assistance score in the nondisabled children. A ceiling effect and

608 121

considerable variability of the nondisabled children's mobility assistance

scores may be responsible for these
results. The amount of assistance
given may depend on the parenting
style and time available to the parent
to allow the child to complete the
task without assistance. Many parents
expressed concern about their individual parenting style on the amount
of assistance given and about their
quickness to give assistance when
time is limited. These concerns may
not be true for disabled children because allowing the child to complete
the task, regardless of time, may be
essential in a parent-supported intervention program. For the purposes of
this study, however, strong correlations in the mobility domain between
tests for the disabled group support
the validity of the PEDI with this population.
Construct validity of the PEDI was
supported by the results of paired
t tests. Group domain scores were
found to be significantly different for
most of the PEDI scales (Tab. 5). As
was expected for the disabled group,
the most significant differences in
PEDI scores were found in the PEDI
mobility and self-care domains. There
were no differences between the disabled and nondisabled children on
the non-motor-based PEDI scale of
social function, suggesting these children were no different in social interaction, comprehension, expression,
and play skills. Results of this study
are limited to this sample of children
with neurologic and musculoskeletal
involvement and with mild to no cognitive impairments. A sample of more
cognitively o r severely physically impaired children may have shown important differences in the PEDI social
function domain.
Construct validity was further supported by the results of the discriminant analysis. As expected, the PEDI
modifications scale was the strongest
independent variable to discriminate
between the two groups. This difference occurred primarily because nine
of the children with spina bifida and
two of the children with arthritic conditions needed modifications. With

modifications as the first variable entered, children with disabilities who

did not use modifications were incorrectly identified as nondisabled. When
the modifications scale was removed
from the analysis, the PEDI functional
skill level scale continued to be a better predictor than the BDIST. With the
PEDI functional skill level scale entering the equation first, eight of the disabled children were incorrectly identified as nondisabled (one child in the
spina bifida group [diagnosed with
lipomeningocele] and seven of the
children with arthritic conditions
were relatively high functioning).
The ability of the functional skill level
scale to better discriminate between
the groups than the BDIST can be
explained primarily as a difference in
test content. Although some content
of each test was similar (eg, stairclimbing ability, performance of
household chores, use of buttons,
knowledge of address), the PEDI
functional skill level content includes
more items of basic functional ability,
such as locomotion and transfers.
These items are particularly important
for disabled children and mly be important indicators of developmental
progress. The inclusion of these relevant functional items make the PEDI a
useful tool for pediatric physical
therapists.
In addition to having different content, the functional skill level scale of
the PEDI has finer increments of
progress than the BDIST. This finer
skill breakdown allows for more sensitivity to detect meaningful clinical
changes. Surprisingly, the caregiver
assistance scale did not discriminate
as well between groups as did the
functional skill level or modifications
scale; perhaps with a more impaired
sample of children, it would act as a
stronger discriminant variable. In this
study, the discrepancy in caregiver
assistance became greater between
groups as age increased and as parental expectation for independence became greater.
In general, the disabled and nondisabled groups were well matched in
terms of age, sex, and cognitive status.

However, the uncontrolled difference

in family socioeconomic status between the groups may have contributed to differences in functioning between the groups. Caution must be
taken not to generalize the results
beyond this sample of children with
physical disabilities (arthritic conditions and spina bifida). Future work
with the PEDI should include a
greater spectrum of disability types
and ranges of cognitive and social
competence.
It should also be noted that comparisons were made from scores from an
administered test with scores from a
parental-report questionnaire. The
BDIST consisted of professional observation, structured administration,
and parent-interview items, whereas
the PEDI consisted solely of parentalresponse items. Several a~thors30.3~
have reported that parents give higher
average scores on their child's developmental achievements than professionals. Therefore, because the PEDI
was administered solely by parental
report in this study, the scores may
be higher than if therapists o r teachers were to observe and score the
child. All PEDIs were administered by
parental report; therefore, no systematic bias is likely to have occurred.

Cllnlcal lmpllcatlons
Pediatric physical therapists should
consider the use of a variety of standardized tests in their clinical practice. The value of the assessment of
developmental milestones in an evaluation cannot be overlooked. Often,
the inability to perform a milestone
skill, such as balance on one leg for 6
seconds, affects the child's ability to
perform a functional task, such as
climb into the bathtub. However, assessment for treatment planning o r
for the evaluation of therapy effectiveness for children with disabilities
should not be based solely on developmental skills. The content of a
physical therapy assessment should be
relevant to the educational and treatment goals of the child. Measuring
progress in terms of a child's functional status is often in greater accordance with the physical therapist's and

Physical TherapyNolume 70, Number 10IOctober 1990

the family's goals than discrete skills.

The physical therapy intervention
should ultimately result in movement
changes that lead to independence in
functional daily activities, which may
o r may rlot include achievement of
developmental milest0nes.3~The results of this study suggest the PEDI
can be a useful standardized assessment for the description of functional
status in young children.

This stucly provides preliminary evidence for concurrent and construct

validity of the Development Edition of
the PEDI. Moderately high correlations were found with the BDIST for
the PEDI self-care and mobility domains and for the PEDI total scale
scores of functional skill level, caregiver assistance, and modifications.
The PEDI modifications and functional skrll level scales were better
discrimirlators of group status than
the BDISIT.The results support the
impetus for further development and
standardazation of the final version of
the PEDI.
Acknowledgments

We acknowledge the Rheumatology

Clinic and the Birth Defects Clinic at
New England Medical Center, Boston,
Mass, anti the Anne Sullivan Center in
Tewksbuty, Mass, for their assistance
in subject recruitment. Appreciation is
also extended to Ruth Faas for her
help in preparing the PEDI and to
Scott O d ~ e r gfor his technical assistance in clata reduction and analysis.
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