Use of the Dyskinesia Impairment Scale in non-ambulatory dyskinetic cerebral palsy.
Helga Haberfehlner, Laura A Bonouvrié, Karin Boeschoten and 5 others
PMID 31784988WHAT IT FOUND
The Dyskinesia Impairment Scale detects changes in dystonia as well as the standard BADS in non-ambulatory children, but many required activities cannot be performed by this group.
It scores choreoathetosis, which the BADS misses, but takes longer to administer.
Key findings
01The DIS dystonia subscale showed similar responsiveness to the criterion standard BADS, with no floor or ceiling effects in the study population.
02Feasibility was limited because non-ambulatory participants could not perform key activities like active sitting, standing, or speaking, preventing assessment of trunk dystonia during movement.
03The DIS offers the advantage of assessing choreoathetosis, which the BADS does not measure, though the BADS items were easier to complete for all participants.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study population was highly impaired (GMFCS IV-V), meaning results do not apply to ambulatory children who could perform the full DIS protocol. The BADS was used as the criterion standard, but it has only moderate concurrent validity and was developed by the same group that conducted previous research, potentially introducing bias. Many DIS activity items could not be performed, leading to incomplete data for trunk and speech assessments. The effect sizes observed were small, and the study was not powered to detect large differences, limiting conclusions about the DIS's sensitivity to change compared to other outcomes. Patients and parents were told their group allocation after the assessments, which could have influenced performance through anticipation or stress.
Declared interests
The study was a secondary analysis of the IDYS trial. The authors declared no conflicts of interest. Funding details for the original trial are not explicitly restated in the provided text, but the analysis was conducted at Vrije Universiteit Medical Center and Maastricht University Medical Center.
The easy way to misread this
Do not assume the DIS is a superior replacement for the BADS in clinical practice for non-ambulatory patients. While it detects change similarly, it is often impossible to complete the full protocol due to motor limitations, whereas the BADS can be fully scored for every patient in this group.