R E S E A R C H A R T I C L E

Concurrent Validity and Reliability

of the Pediatric Evaluation of
Disability Inventory-Computer
Adaptive Test Mobility Domain
Helene M. Dumas, PT, MS; Maria A. Fragala-Pinkham, PT, DPT, MS
Research Center for Children with Special Health Care Needs, Franciscan Hospital for Children, Boston, Massachusetts.

Purpose: To examine concurrent validity, item-specific reliability, and score distributions of the new Pediatric
Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) Mobility domain with the original
PEDI Functional Skills (FS) Mobility Scale. Methods: Thirty-five parents of children with neurodevelopmental
disabilities completed the PEDI-CAT on a computer and the paper PEDI FS via interview. Results: Strength of
association between the PEDI-CAT Mobility domain and PEDI FS Mobility Scale scores was good to excellent
(r = 0.82; P < .001). Intraclass correlation coefficients ranged from .3390 to 1.000, and agreement ranged from
60% to 100% for 8 specific items. No child had the minimum score on either test, whereas 9 children (26%) had
a maximum score on the PEDI FS Mobility Scale. Conclusions: This study provides evidence for potential users
that the concurrent validity, reliability, and score distribution for the PEDI-CAT Mobility domain are adequate
for use with children with varied diagnoses and throughout the pediatric age span. (Pediatr Phys Ther
2012;24:171–176) Key words: activities of daily living/psychology, adolescent, child, preschool child, computer
assisted diagnosis/methods, disability evaluation, disabled children, female, health surveys, humans, male,
physical therapy/methods, reliability and validity, young adult

INTRODUCTION
The Pediatric Evaluation of DisabilityInventory-
Computer Adaptive Test (PEDI-CAT)1 is a new clinical
assessment for children and youth from birth to 20 years
of age that was developed on the basis of years of ex-
perience, feedback, and formal research with the origi-
nal PEDI.2-6 Completed by using preinstalled software on
any computer, the PEDI-CAT was designed to be used
across all diagnoses, conditions, and settings. The PEDI-
0898-5669/110/2402-0171
Pediatric Physical Therapy
Copyright C 2012 Wolters Kluwer Health | Lippincott Williams &
Wilkins and Section on Pediatrics of the American Physical Therapy
Association
Correspondence: Helene M. Dumas, PT, MS, Research Center,
Franciscan Hospital for Children, 30 Warren St, Boston, MA 02135
(hdumas@fhfc.org).
Grant Support: This study was supported by a Clinical Research grant
from the Section on Pediatrics, American Physical Therapy Association.
The authors declare no conflict of interest.
DOI: 10.1097/PEP.0b013e31824c94ca
CAT item bank contains 276 activities and measures func-
tion in 4 domains: (1) Daily Activities, (2) Mobility, (3) So-
cial/Cognitive, and (4) Responsibility. As with the original
PEDI, the PEDI-CAT can be completed by parent/caregiver
report or professional judgment of clinicians who are fa-
miliar with the child. The PEDI-CAT is intended to enable
clinicians to construct a description of a child’s current
functional status or progress in acquiring functional skills
that are part of everyday life.1
The PEDI-CAT software uses statistical models to es-
timate a child’s abilities from a minimal number of the most
relevant items or from a predetermined number of items
within each domain. All respondents begin with the same
item in each domain in the middle of the range of difficulty
or responsibility and the response to that item then dic-
tates which item will appear next (a harder or easier item),
thus customizing the items to the child and minimizing
the number of irrelevant items. With administration of
each subsequent item, the score is reestimated along with
the confidence interval and the computer algorithm deter-
mines whether the stopping rule (an acceptable level of
precision or a set number of items) has been satisfied. If
satisfied, the assessment ends. If not satisfied, new items

Pediatric Physical Therapy Validity and Reliability of the PEDI-CAT 171

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy
Association. Unauthorized reproduction of this article is prohibited.
 are administered until the stopping rule is satisfied. The TABLE 1
PEDI-CAT program then displays the results, including an Participant Characteristics (N = 35)
item map, a scaled score, and an age percentile, instantly.1 Respondent gender (female), n (%) 31 (89)
The original PEDI,2 published in 1992, is a functional Respondent race, n (%)
assessment used by physical therapists and other rehabil- White 29 (83)
itation professionals to measure self-care, mobility, and Black/African American 2 (6)
Hispanic 3 (9)
social function and can be administered using a paper-
Asian 1 (3)
and-pencil version or using the PEDI software program.2 Respondent’s highest school grade level
Strengthening its appeal as a clinical tool is the long history <Ninth grade 3 (9)
of published research examining the psychometric prop- High school graduate 5 (14)
erties including reliability2,7-9 and validity.2,8-11 Although Some college 3 (9)
College graduate 11 (31)
the PEDI is one of the most widely used measures of chil-
Graduate school 9 (26)
dren’s function worldwide,7,11-17 its limitations include a Not reported 4 (11)
small age range for normative scoring (6 months to 7.5 Child gender (female), n (%) 12 (34)
years), limited content, and the length of administration Child race, n (%)
time.18-20 White 23 (66)
Black/African American 5 (14)
The PEDI-CAT, just as the original PEDI, must offer
Hispanic 3 (9)
clear clinical value to clinicians and researchers if it is to be Asian 4 (11)
adopted for use, and thus, evaluation of its psychometric Child’s age, mean (SD), y 11.49 (4.89)
properties is imperative. To date, content and construct range = 3.93-19.87
validity of the PEDI-CAT have been reported.4 Discrimi-
nant validity has been evaluated using simulated versions,
based on the initial normative and disability samples,5 Instrumentation
in a prospective study of 102 children with and without Each of the PEDI-CAT domains (Daily Activities,
disabilities6 and in a study examining the scores of children Mobility, Social/Cognitive, and Responsibility) is self-
who use a walking aid or wheelchair.21 Test-retest relia- contained and can be used separately or in combination
bility was examined during a small prospective study in with the other domains. Using a 4-point response scale, the
which parent respondents completed the PEDI-CAT twice PEDI-CAT measures level of difficulty (easy, a little hard,
within 1 month.6 Additional validity and reliability studies hard, and unable) in the 3 functional domains of Daily
are warranted to determine that the PEDI-CAT Mobility Activities, Mobility, and Social/Cognitive. The PEDI-CAT
domain is consistent and measuring what is intended to Responsibility domain measures the extent to which the
be measured with varied samples and populations and at caregiver or child takes responsibility for managing com-
different times. plex, multistep life tasks. The PEDI-CAT Mobility domain
The purpose of this study was to (1) examine concur- addresses 5 content areas: Basic Movement and Trans-
rent validity of the new PEDI-CAT Mobility domain with fers, Standing and Walking, Steps and Inclines, Running
the original PEDI Functional Skills (FS) Mobility Scale, and Playing, and Wheelchair. Seventy-five items address
(2) evaluate item-specific reliability between the PEDI-CAT early mobility and physical functioning activities such as
Mobility domain and PEDI FS Mobility Scale and, and (3) head control, transfers, walking, climbing stairs, and play-
assess score distributions for floor and ceiling effects. ground skills, whereas an additional 22 items are specifi-
cally for children who use mobility devices such as walking
aids (canes, crutches, walkers) and/or wheelchairs. Pho-
METHODS tographs accompany each item to further depict the activ-
ity being assessed.1
Participants There are currently 2 versions of the PEDI-CAT: the
Parents of children with neurodevelopmental disabil- “Speedy CAT,” the quickest way to get a precise score
ities (n = 35) and with ages from birth to 20 years and estimate while administering 15 or fewer items per do-
who were English speaking were recruited to participate main, and the “Content-Balanced CAT,” in which approx-
in this study. Participants were generally mothers (89%), imately 30 items per domain are administered and include
and children ranged in age from 3.93 to 19.87 years. a balance of items from each of the content areas within
Children had the following diagnoses: autism (n = 4); each domain. Each version generates a summary (scaled)
cerebral palsy, Gross Motor Function Classification Scale score on a 20- to 80-point metric and a normative score in
levels I to V (n = 20); genetic disorders (eg, Down syn- percentiles.1
drome, Prader-Willi syndrome) (n = 5); and other neuro- The original PEDI has 2 scales, Functional Skills and
logic disorders (eg, attention deficit disorder, developmen- Caregiver Assistance, to assess capability and level of in-
tal delay) (n = 6). Twelve of the children used a walking dependence within the functional domains of Self-Care,
aid (crutches, cane, or walker), and 14 children used a Mobility, and Social Function. The PEDI FS Mobility
wheelchair some or all of the time. Demographic charac- Scale includes 59 items and is used to measure a child’s
teristics of the study sample are depicted in Table 1. capability with basic functional mobility skills in the

172 Dumas and Fragala-Pinkham Pediatric Physical Therapy

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy
Association. Unauthorized reproduction of this article is prohibited.
 following 13 item groups: toilet transfers, chair/wheelchair
transfers, car transfers, bed mobility/transfers, tub trans-
fers, method of indoor locomotion, distance/speed in-
doors, pulls/carries objects, method of outdoor locomo-
tion, distance/speed outdoors, outdoor surfaces, upstairs,
and downstairs. Items are scored as capable (1) or unable
(0). A raw score (sum of all item scores) is converted to
a normative score (based on chronological age using a t-
distribution) or a scaled score (not age-dependent) score
along a 0- to 100-point scale.2
Neither the PEDI nor the PEDI-CAT requires any spe-
cial environment, materials, or activities to administer. The
focus on typical performance at the present time is as-
sessed and, as such, the child’s parent(s) or professionals
who currently provide services for the child are the most
likely respondents. The PEDI and the PEDI-CAT can be
completed on multiple occasions for the same child (eg,
admission, interim assessment, discharge, and follow-up),
and there is no minimum time that must pass between
assessments (manuals).
Procedure
For this study, participating therapists were trained in
administering the PEDI-CAT Content-Balanced Mobility
domain and the PEDI FS Mobility Scale. Following Insti-
tutional Review Board approval, parents of children with
neurodevelopmental disabilities and ages from birth to 20
years were recruited through a private school for chil-
dren with special health care needs and outpatient clin-
ics in a pediatric rehabilitation hospital in the northeast
United States. Parents provided written informed consent
and completed a demographic form to provide informa-
tion about themselves and their child. Parent participants
then completed the PEDI-CAT Content-Balanced Mobility
domain (version 2.21) on a laptop computer as well as the
original paper PEDI FS Mobility Scale via caregiver inter-
view. Both tests were completed on the same day. Presenta-
tion was varied to avoid a test-order effect such as fatigue,
practice, or motivation. Parent participants received a small
honorarium in the form of a gift card to thank them for
their participation. Raw scores were converted to norma-
tive and scaled scores for the PEDI FS Mobility Scale using
the PEDI manual2 and combined in to a project-specific
database with the normative and scaled scores generated
by the PEDI-CAT software.
Data Analysis
Data analysis and interpretation of results was per-
formed using the Statistical Package for the Social Sci-
ences. Concurrent validity was assessed by examining the
strength of association between the 2 tests using Pearson
product moment correlations for the scaled scores. To ex-
amine item-specific reliability between the PEDI-CAT Mo-
bility domain and PEDI FS Mobility Scale, intraclass cor-
relation coefficients and percentage agreement (how often
respondents scored an item the same on both tests) were
Pediatric Physical Therapy
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy
Association. Unauthorized reproduction of this article is prohibited.
calculated. Each participant responded to all 59 items on
the PEDI FS Mobility Scale and 30 items on the PEDI-CAT
Content-Balanced Mobility domain. For this analysis, we
identified 17 items on the PEDI-CAT that were identical in
wording to the original PEDI or asked the participant about
the same functional mobility activity as an item on the orig-
inal PEDI. It should be noted, however, that because of the
nature of the CAT, not all 35 participants responded to all
17 of these items. Only 8 of these 17 items had 20 or more
responses, thus limiting the comparison. In addition, to
conduct this analysis, responses on the 4-point PEDI-CAT
response scale (0, unable; 1, hard; 2, a little hard; 3, easy)
were recoded (0, unable/hard; 1, a little hard/easy) as the
PEDI has a 2-point response scale (0, unable; 1, capable).
To analyze the score distribution for each test, percentages
of scaled scores less than and greater than 50 (midpoint for
each scale) were calculated. In addition, scaled scores for
each individual case were plotted and compared visually.
Finally, the number and percentage of children with min-
imum (floor) and maximum scores (ceiling) along each
scale were computed.
RESULTS
The strength of association between the PEDI-CAT
Mobility domain scaled scores and the PEDI FS Mobility
scaled scores and was good to excellent (r = .82; P < .001),
indicating a strong correlation between the scores on both
tests. Intraclass correlation coefficients ranged from .3390
to 1.000 and agreement results ranged from 60% to 100%
for the 8 items that had at least 20 responses on the PEDI-
CAT (Table 2).
Scores on the PEDI FS Mobility Scale ranged from
18.20 to 100 (maximum score). On the PEDI-CAT Mobil-
ity domain, scaled scores ranged from 33.07 to 76.75 (max-
imum score). Eight children (23%) had a scaled score less
than 50 on the PEDI FS Mobility Scale, whereas 27 children
(77%) had a score greater than 50 points. Three children
(9%) had a score less than 50 on the PEDI-CAT Mobility
domain, whereas 32 children (91%) had a score greater
than 50. No child had the minimum score on either test,
whereas 1 child (3%) had a maximum scaled score on the
PEDI-CAT and 9 children (26%) had a maximum scaled
score on the PEDI FS Mobility Scale (Figure).
DISCUSSION
There is a need for valid, reliable, and responsive func-
tional mobility measures appropriate for a wide age range
and varied diagnoses for use in clinical and research set-
tings. In addition, new tests must be efficient and capable
of integrating with electronic medical records. The PEDI-
CAT was developed to respond to these needs, and it is
thus imperative to determine whether the PEDI-CAT is
worthy of use. The purpose of this study was to examine
the concurrent validity, item-specific reliability, and score
distribution of the PEDI-CAT Mobility domain when com-
pared with the original PEDI FS Mobility Scale.
Validity and Reliability of the PEDI-CAT 173
 TABLE 2
Item-Specific Reliability

Total
PEDI FS Mobility Item PEDI-CAT Mobility Item N ICC Agreement

Gets on and off adult-sized toilet Gets on and off an adult-sized toilet 22 1.00 100%
Carries fragile or spillable objects Walks and carries a full glass without spilling 29 0.90 95%
Gets in and out of adult-sized chair/wheelchair Stands up from an adult-sized chair 35 0.83 89%
Gets in and out of car and opens and closes car door Gets in and out of a car 31 0.77 81%
Steps/transfers into and out of an adult-sized tub Gets in and out of bathtub 31 0.66 81%
Up and down incline or ramps Walks up and down ramp 22 0.57 77%
Walks down entire flight with no difficulty Walks down a flight of stairs without holding onto 22 0.42a 62%
handrail
Walks up entire flight with no difficulty Walks up a flight of stairs without holding onto 20 0.34a 60%
handrail

Abbreviation: ICC, intraclass correlation coefficient.

aP> .005.

Fig. Score distribution for the PEDI-CAT Mobility Domain the PEDI Functional Skills Mobility Scale. Abbreviations: PEDI-CAT, Pediatric
Evaluation of Disability Inventory-Computer Adaptive Test; PEDI FS, Pediatric Evaluation of Disability Inventory Functional Skills.

The strong correlation between scaled scores indicates
strong agreement between the original PEDI and the new
PEDI-CAT. Children who had a higher scaled score on the
PEDI-CAT also had a higher scaled score on the PEDI FS
Mobility Scale, and vice versa for lower scores. The PEDI
FS Mobility Scale has previously been shown to have con-
current validity with the Battelle Developmental Inventory
Screening Test,22 the Functional Independence Measure
for Children,10 and the Gross Motor Function Measure.17
Concurrent validity is particularly important for a new,
untested assessment such as the PEDI-CAT that is being
proposed as analternative to the current standard.
Both measures identified children with limitations in
functional mobility. This is encouraging, as physical thera-
pists will get similar results regardless whether they use the
PEDI FS Mobility Scale or the new PEDI-CAT for younger
children with physical disabilities. However, the PEDI-
CAT identified a larger percentage of older children with
limitations in functional mobility and may be more useful
to pediatric therapists who provide services to a wide age
range of children and youth. Normative standard scores
are also available but only for children younger than 7.5
years on the original PEDI. The PEDI-CAT broadens this
through the age of 20 years. In this sample, only 9 of the
35 children were 7.5 years or younger, making comparison
difficult and thus limited this analysis to scaled scores.
Seventeen PEDI-CAT Mobility items that were pre-
sented to respondents were similar to original PEDI FS
Mobility items.4 As the PEDI-CAT software selects which
items to administer, not all 35 participants responded to
all 17 identified items. We chose the 8 items for which we
had at least 20 responses on the PEDI-CAT to assess item-
specific reliability. Six of the 8 items had good to excellent
reliability. The 2 items that did not have strong agreement
were both related to stair climbing. It is possible that the
wording was dissimilar enough for participants to respond

174 Dumas and Fragala-Pinkham Pediatric Physical Therapy

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy
Association. Unauthorized reproduction of this article is prohibited.
 differently, as the original PEDI can include the use of
handrails and the PEDI-CAT specifies “without holding
on to handrail.”
The PEDI FS Mobility Scale has a score range of 0 to
100 points, whereas the PEDI-CAT score metric is 20 to
80, allowing for the addition of both lower- and higher-
level items over time. The scores on both the PEDI FS
Mobility Scale and the PEDI-CAT Mobility domain were
distributed along the score metrics for this sample of chil-
dren and youth. The majority of children, however, scored
above the midpoint on both scales. A large majority scored
between 55 and 65 points on the PEDI-CAT, whereas there
was a greater point spread on the PEDI FS Mobility Scale,
as illustrated in the Figure. Of note is that the standard
errors for the PEDI-CAT scores in this 55- to 65-point
score range are approximately 0.5, indicating a high level
of precision and a very small degree of sampling error,
whereas the standard errors for the PEDI FS Mobility Scale
are approximately 2.0 to 3.6 in this score range. Evalua-
tion of responsiveness of the PEDI-CAT Mobility domain
is needed to determine whether the PEDI-CAT scale is pre-
cise enough to show clinically relevant change over time.
Although no children had the lowest score on either
test, 9 children had maximum scores (100) on the PEDI FS
Mobility but not on the PEDI-CAT Mobility domain. This
is encouraging because one of the criticisms of the original
PEDI was the limited content of more challenging mobility
activities.3 This criticism appears to be addressed with the
PEDI-CAT. For example, on the original PEDI, the most
difficult mobility item is “Walks down full flight with no
difficulty.” On the PEDI-CAT, more challenging mobility
items include “Walks 3 miles/5 kilometers,” “Goes up and
down an escalator,” and “Climbs step ladder to put a heavy
box on a high shelf.” As we found no indication of a floor
effect, content coverage appears to have been adequate
on the PEDI-CAT Mobility domain versus the PEDI FS
Mobility Scale for this particular sample.
A threat to the validity of our study design was that the
respondents completed 2 tests in 1 day and this may not
generalize to a population in which only 1 test is given.23
In addition, respondents may have encountered the same
item(s) twice and thus this increases the potential for a
practice or memory effect. Although our sample was di-
verse in age and functional ability (which is indicative
of the intended population for use of the PEDI-CAT), it
was small. Further studies with larger samples are war-
ranted to establish the PEDI-CAT Mobility domain as a re-
liable, valid, and responsive assessment for physical ther-
apists. Also, as mathematical equations are developed to
link original PEDI scores to PEDI-CAT scores so that a
child’s progress over time may be tracked,1 comparability
studies should be conducted.
CONCLUSIONS
This study provides preliminary evidence for potential
users that the concurrent validity, reliability, and score dis-
tribution for the PEDI-CAT Mobility domain are adequate
Pediatric Physical Therapy
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy
Association. Unauthorized reproduction of this article is prohibited.
for use with children with varied diagnoses and throughout
the pediatric age span.
ACKNOWLEDGMENTS
This article is dedicated to Stephen M. Haley, PT,
PhD, FAPTA, primary author of the Pediatric Evaluation
of Disability Inventory (PEDI) and the Pediatric Evalua-
tion of Disability Inventory-Computerized Adaptive Test
(PEDI-CAT).
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CLINICAL BOTTOM LINE

Commentary on “Concurrent Validity and Reliability of the Pediatric Evaluation of Disability
Inventory-Computer Adaptive Test Mobility Domain”

“How should I apply this information?”

The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) expands the original
PEDI Functional Skills (FS) test to cover ages from birth to 20 years, allowing therapists to track progress
throughout childhood. The authors indicate that the new version can be used to assess children with a variety
of disabilities. The instrument can be administered quickly using a minimal number of customized items in any
setting where a computer is available. The new responsibility domain may prove a more effective measure of
the child’s capability and performance than the caregiver assistance scale used in the original PEDI FS, but this
study was restricted to examination of the mobility domain. A strong correlation between the measures provides
therapists an opportunity to continue tracking progress past 71/2 years for children initially assessed on the
PEDI FS.
“What should I be mindful about in applying this information?”
The reader needs to keep in mind that a small sample size may result in a biased estimate of a population value.
Although the authors demonstrate a good to excellent association between both measures on 5 of 8 items, this
may not be the case in a larger sample population. A second concern is that only 8 items were compared, which
may not provide adequate item sampling to determine concurrent validity. Another purpose of this study was
to determine the worthiness of the measure for assessing children with various disabilities; however, only small
numbers of children representing some of the disabilities were assessed. Further research is needed on larger
samples of each disability. A third concern is the different point scales used in the 2 measures. Is it feasible to
combine unable and hard in the PEDI-CAT and consider those categories equal to unable in the PEDI FS? Larger
sample sizes should be studied to confirm the results of this preliminary evidence. Overall, the authors should be
commended for developing an instrument that can be used beyond 7.5 years of age and one that keeps up with
modern technology.

Donna Redman-Bentley, PT, PhD

Western University of Health Sciences
Pomona, California
Dayle C. Armstrong, PT, MS, DPT
Western University of Health Sciences
Pomona, California
The authors declare no conflict of interest.
DOI: 10.1097/PEP.0b013e31824d8d9c

176 Dumas and Fragala-Pinkham Pediatric Physical Therapy

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