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Fluids and Barriers of the CNS

Open Access

Determinants of functional independence and quality of life in children with spina bifida

Cerebrospinal Fluid Research20041(Suppl 1):S63

Published: 23 December 2004


Lower ExtremityFunctional AbilitySpina BifidaKnee ExtensorMain Outcome Measure


To investigate determinants of functional independence and study which functional abilities were determinants for 'health related quality of life' in children with myelomeningocele.


Cross-sectional study by means of clinical assessment, 'disability' measurement, and questionnaires.


Outpatient spina bifida clinic at a university hospital.


122 children with myelomeningocele. Mean age 7.9; range 1–18 years.

Main Outcome Measures

Functional independence as measured by the 'Pediatric Evaluation of Disability Inventory' (PEDI), and 'Health Related Quality of Life Questionnaire' (HRQL). Uni- and multivariate logistic regression models were used to investigate factors that were determinants for these outcomes. Results were expressed as odds ratios and 95% confidence intervals (Cl).


Lesion level below L3 (OR: 0.4, Cl: 0.1–1.0), mental status of IQ > 80 (OR: 4.2, Cl: 1.2–14.9), having no contractures in lower extremities (OR: 3.4, Cl: 1.3–8.8), and having normal strength of knee extensor muscles (OR: 4.1, Cl: 1.4–11.5), were most strongly associated with independence in self-care. Mental status (OR: 16.1, Cl: 2.8–93.9), having no contractures in lower extremities (OR 1.5, Cl: 1.4–5.3), and normal strength in knee extensors (OR: 11.0, Cl: 1.3–97.0), were the most important determinants for independence in mobility. Concerning functional abilities, being independent with regard to mobility was the most important determinant for HRQL (OR: 5.3, Cl: 1.6–17.4).


In children with myelomeningocele, good muscle strength, mental ability and being independent in mobility, appeared to be much more important for daily life function and quality of life than other medical indicators of the disorder. This information is of clinical significance in planning a comprehensive and realistic rehabilitation program.

Authors’ Affiliations

Wilhelmina Children's Hospital, University Medical Center, Utrecht, Utrecht, The Netherlands


© The Author(s) 2004

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.