Responsiveness of the ACTIVLIM-CP Questionnaire: Measuring Global Activity Performance in Children With Cerebral Palsy

Dev Med Child Neurol. 2018 Nov;60(11):1178-1185. doi: 10.1111/dmcn.13927. Epub 2018 Jun 4.


Aim: To investigate the responsiveness of the ACTIVLIM-CP questionnaire after two evidence-based interventions for children with cerebral palsy (CP).

Method: Seventy-five children with CP either participated in an intensive motor-skill learning intervention (hand-arm bimanual intensive therapy including lower extremities [HABIT-ILE], n=47) or received botulinum neurotoxin-A (BoNT-A) injection(s) into lower extremities combined with conventional physical therapy (n=28). All children were assessed three times: at baseline (T0 ; before HABIT-ILE/the day of BoNT-A injection), at T1 (last day of HABIT-ILE/6wks after BoNT-A injection), and at follow-up (T2 ; 3-4mo after the beginning of intervention). Parents completed ACTIVLIM-CP and three other activity questionnaires. Responsiveness was analysed using group (based on intervention), subgroup (based on gross motor function level), and individual approaches.

Results: For the HABIT-ILE group, significant improvements in ACTIVLIM-CP were observed for the T0 -T1 period (p<0.001) but not for the T1 -T2 period. No significant changes were found in the BoNT-A group during assessments (p=0.84). In the subgroup analysis for the HABIT-ILE group (T0 -T1 ), greater changes were demonstrated for children in Gross Motor Function Classification System levels III and IV (p<0.001, effect size=1.36). The individual approach was congruent with the group approach.

Interpretation: ACTIVLIM-CP demonstrated high responsiveness after HABIT-ILE, showing that this scale may be used to investigate global activity performance in clinical trials focusing on improving daily life activities.

What this paper adds: Good responsiveness of ACTIVLIM-CP questionnaire during intensive motor-skill learning intervention. Higher responsiveness for children in Gross Motor Function Classification System (GMFCS) levels III and IV versus I and II after intensive intervention. ACTIVLIM-CP is useful to identify children improving their performance after botulinum neurotoxin-A injection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Botulinum Toxins, Type A / administration & dosage
  • Cerebral Palsy / diagnosis*
  • Cerebral Palsy / physiopathology
  • Cerebral Palsy / therapy*
  • Child
  • Evidence-Based Practice
  • Female
  • Follow-Up Studies
  • Humans
  • Injections
  • Male
  • Motor Activity*
  • Neuromuscular Agents / administration & dosage
  • Physical Therapy Modalities
  • Severity of Illness Index
  • Surveys and Questionnaires*
  • Treatment Outcome


  • Neuromuscular Agents
  • Botulinum Toxins, Type A