Peer-reviewed article
Thumbs-out classification: a novel tool for detection of thumb-in- palm deformity in children and youth with cerebral palsy
Jenny Hedberg‐Graff, Lena Krumlinde‐Sundholm, Fredrik Granström, Izabela Blaszczyk, Sara Nordell et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study developed a simple three-level screening tool, the Thumbs-Out Classification, to spot thumb-in-palm deformity in children with cerebral palsy during routine check-ups. Cut-offs were set using thumb measurements from 20 typically developing children. The tool was then tested on 61 children with cerebral palsy, with a median age of 9 years. Different raters and repeat assessments gave very consistent results. Agreement with measurements taken with a goniometer (an angle-measuring device) was only moderate.
Key points
- The tool has three levels of radial thumb abduction: normal (green), slightly reduced (yellow) and severely reduced (red).
- Agreement with goniometric measurements was moderate for active (κw = 0.59) and passive (κw = 0.54) abduction, with 79% and 81% percentage agreement.
- Inter-rater reliability was almost perfect for active (κw = 0.93) and passive (κw = 0.89) abduction.
- Test-retest reliability was almost perfect (active κw = 0.84; passive κw = 0.93).
- The authors conclude the tool is a reliable screening aid that may support earlier detection and timely intervention.
Limitations
This is an abstract of a tool-reliability study, not an evaluation of an intervention, so it cannot show whether using the tool improves hand function or child outcomes. The cut-offs came from only 20 typically developing children, and the abstract does not state the study setting. The country (Sweden) is taken from the metadata hint.
Abstract
Purpose To develop a simple screening tool, the Thumbs-Out Classification (TOC), for detecting thumb-in-palm deformity during clinical follow-ups of children with cerebral palsy (CP), and to evaluate its reliability.Methods The TOC was developed through expert consensus and consists of three levels of radial thumb abduction: normal (green), slightly reduced (yellow), and severely reduced (red). Classification cut-offs were established using goniometric measurements from 20 typically developing children. These cut-offs were then applied to classify active and passive radial thumb abduction in 61 children with CP (median age 9 years). Inter-rater, intra-rater, and test-retest reliability were assessed using Cohen’s weighted kappa (κw) and percentage agreement.Results Agreement between goniometric measurements and TOC levels was moderate for both active (κw = 0.59) and passive (κw = 0.54) radial abduction, with substantial percentage agreement (79% and 81%, respectively). Inter-rater reliability was almost perfect for active (κw = 0.93) and passive (κw = 0.89) radial abduction. Test-retest reliability was also almost perfect (active κw = 0.84; passive κw = 0.93).Conclusions The TOC is a reliable screening tool for monitoring thumb positioning in children with CP. It may facilitate detection of thumb-in-palm deformity and support timely interventions aimed at optimising hand function.