1466

Disability & Rehabilitation, 2013; 35(17): 14661471

2013 Informa UK, Ltd.
ISSN 0963-8288 print/ISSN 1464-5165 online
DOI: 10.3109/09638288.2012.737082
Purpose: Determining the psychometric properties such as
reliability and validity of Functional Independence Measure for
Children (WeeFIM) instrument would help health professionals
to understand the comprehensive assessment of children with
spastic cerebral palsy (CP). The purpose of this study was to
investigate the factor structure of the WeeFIM in children with
spastic CP. Methods: Two hundred seven children (138 boys,
69 girls) with spastic CP were recruited in this cross-sectional
study; their mean age (SD) was 9.10 (2.7) years. Data were
collected through a questionnaire that included the WeeFIM.
Of the 207 children, 57 (27%), 105 (51%), and 45 (22%) were
quadriplegic, diplegic, and hemiplegic, respectively. In each
of these groups, 49 (24%), 32 (15%), 31 (15%), 19 (9%), and
76 (37%) children were classied as Gross Motor Function
Classication System (GMFCS) levels IV, respectively. The
factor structure of the WeeFIM was analyzed by exploratory
factor analysis (EFA) and conrmatory factor analysis (CFA) by
using AMOS 20.0. The reliability of WeeFIM was assessed by
calculating the internal consistency of Cronbachs . Results:
The internal consistency of Cronbachs was 0.98. The 1- and
2-factor models did not demonstrate adequate t indices
according to CFA. However, the 3-factor structure (i.e. self-care,
motor, and cognitive factors) was supported by EFA and CFA,
which explained 87.12% of the variance. The self-care factor
included 6 items (eating, grooming, dressing upper, dressing
lower, bathing, and toileting), the motor factor included 7 items
(bladder and bowel management, bed/chair/wheelchair, toilet,
tub/shower, walk/wheelchair, and stairs), and the cognitive
factor included the same 5 items as the original cognitive
domain. Conclusion: In children with spastic CP, 3 factors of
the WeeFIM were determined by factor analysis. Therefore,
self-care, motor, and cognitive domains should be treated as
separate scales in children with spastic CP.
Keywords: WeeFIM, children with spastic CP, factor analysis
Introduction
Various models describe the health status of children with
disabilities, including the developmental and functional
disability models. Te functional model is advantageous for
assessing the daily living activities in natural environments
such as the home and community [1]. Assessment of children
with cerebral palsy (CP) is necessary for diagnosis, identify-
ing the cause, and evaluating motor function and associated
problems [24]. Assessment tools for measuring outcomes
make use of the functional performance of children with
CP for establishing a care plan [5]. Children with CP have
difculty performing daily activities including dressing and
walking [6]. Tus, recent studies on the rehabilitation of chil-
dren with CP have focused on independence of functionality
in daily living [7].
Because concern over the measurement of functioning has
increased, instruments for the functional measurement of CP
have been developed, including the Gross Motor Function
Measure [8]. Pediatric Evaluation of Disability Inventory
(PEDI) [9], Functional Mobility [10], and Functional
Independence Measure for Children (WeeFIM) [11]. At
present, WeeFIM and PEDI are the most popular instruments
RESEARCH PAPER
Factor analysis of the WeeFIM in children with spastic cerebral palsy
Eun-Young Park
1
, Won-Ho Kim
2
& Yoo-Im Choi
3
1
Department of Secondary Special Education, College of Education, Jeonju University, Jeonju, Republic of Korea,
2
Department of Physical Therapy, Ulsan College, Ulsan, Republic of Korea, and
3
Department of Occupational Therapy,
College of Health and Welfare, Howon University, Gunsan, Republic of Korea
Correspondence: Won Ho Kim, Department of Physical Terapy, Ulsan College, P.O. Box 682715, 1601 Hwajung-dong, Dong-gu, Ulsan, Ulsan
College, Republic of Korea. Tel: +82-052-230-0785; Fax: +82-052-230-0780. E-mail: whkim@uc.ac.kr
Disability & Rehabilitation
2013
35
17
1466
1471
2013 Informa UK, Ltd.
10.3109/09638288.2012.737082
0963-8288
1464-5165
Construct of WeeFIM in children with spastic CP1
October2012
Te reliability and validity of the 3-factor WeeFIM
were confrmed with spastic CP.
Findings suggest that the WeeFIM should not be used
as an overall summary score of activity daily living in
children with spastic CP.
It is recommended that those working in the feld of
rehabilitation assess self-care, motor, and cognitive
domains separately and develop an appropriate inter-
vention programs for each domain.
Implications for Rehabilitation
(Accepted October 2012)
E.-Y. Park et al.
Construct of WeeFIM in children with spastic CP1 1467
2013 Informa UK, Ltd.
for measuring functional ability in children with CP [12,13],
possibly because they measure the childs level of independence
and participation in activities of daily living. Te WeeFIM
includes 18 items and requires a 20-min administration time.
Because WeeFIM is shorter and faster to administer, it is likely
to be more useful in pediatric rehabilitation [1]. Te WeeFIM
is recommended for assessing functional independence in
children aged 6 months to 7 years [14,15]. It can be used for
children with developmental disabilities aged 6 months to 21
years and for individuals without disabilities aged <7 years [16].
With respect to construct, the WeeFIM contains 6 domains;
it has 6 self-care, 2 sphincter control, 3 transfer, 2 locomo-
tion, 2 communication, and 3 social cognition items. Also, the
WeeFIM is based on the conceptual and organizational format
of the adult Functional Independence Measure (FIM) (Guide
for the uniform data set for medical rehabilitation, 1993) [17].
As with the FIM, the items can be categorized into two sub-
scales: motor subscale (13 items: domains of self-care, sphinc-
ter control, transfer, and locomotion) and cognitive subscale
(5 items: domains of communication and social cognition)
[18]. Similarly, the WeeFIM scale contains 2 factors (motor
and cognition) [1]. Recently, the WeeFIM Clinical Guide sug-
gested score sheet that motor factor divided into self-care and
mobility. New score sheet consisted of three factors including
self-care, mobility, and cognition [19]. However, there is lack
of studies on the construct of the WeeFIM subscales.
Te increasing use of the WeeFIM for assessing functional
ability of children with CP demonstrates its validity in this
group. Because the importance of assessing children with
CP has increased, researchers have tried to develop a highly
reliable and valid standardized instrument [13]. Despite the
widespread use of the WeeFIM and evidence of its utility in
children with CP, insufcient number of studies has been per-
formed to examine its construct validity. It is possible that it
has a diferent factor structure in children with CP. Tur et al.
[1] suggested that the WeeFIM motor scale in its present form
does not satisfy the requirements of the Rasch measurement
model. Tis means that the construct of the WeeFIM in chil-
dren with CP may difer from that in normal children.
Te main method for examining the construct of the
WeeFIM is factor analysis, which is a statistical approach to
test the adequacy of a conceptual model. Exploratory factor
analysis (EFA) is used to determine the underlying structure of
related variables. Confrmatory factor analysis (CFA) may be
used to investigate whether the established dimensionality and
factor-loading pattern fts a sample from a new population.
Despite the possibility of diferent constructs of the WeeFIM
in children with CP, there are no data confrming a specifc
construct. In particular, factor analysis of the WeeFIM for chil-
dren with CP has not been conducted previously. Terefore,
the purpose of this study was to examine the construct of the
WeeFIM by using factor analysis in children with spastic CP.
Methods
Participants
A total of 207 children (138 boys and 69 girls) were recruited
in this study. Tere was no missing data. All the children were
diagnosed with spastic CP by a physician and attended an
elementary school for physical disabilities or received hos-
pital-based rehabilitation therapy in Korea. Teir mean age
was 9 years 10 months (SD = 2 years 7 months). Of the 207
children, 57 (27%), 105 (51%), and 45 (22%) were quadriple-
gic, diplegic, and hemiplegic, respectively. In all the groups,
49 (24%), 32 (15%), 31 (15%), 19 (9%), and 76 (37%) children
were classifed as Gross Motor Function Classifcation System
(GMFCS) levels IV, respectively.
Consent to participate in the study was obtained from the
parents of all the children. Te GMFCS level, distribution
of motor impairment, and co-morbidities of all the partici-
pants are summarized in Table I. Approval for this study was
granted by the Ethics Committee of Korea Academy of Neural
Rehabilitation. Tere are two recommendations for determin-
ing of sample size in factor analysis: one is that the absolute
number of cases is important, while the other emphasizes on
the subject-to-variable ratio. MacCallum et al. [20] suggested
that the absolute number of cases should be at least 200. Kunce
et al. [21] recommended that the subject-to-variable ratio
should be at least 10 cases for each item in the instrument
being used. Terefore, the adequate sample size was consid-
ered to be 200 because 18 items were measured; hence, we
measured 207 children with CP to increase statistical power.
Measurements
Te original version of the WeeFIM for children with CP was
administered. Te WeeFIM contains 18 items for the func-
tional assessment of children. Te items are categorized into
6 functional domains. Te self-care subscale has 6 items: eat-
ing, grooming, bathing, dressing upper, dressing lower, and
toileting. Sphincter control includes bowel management and
bladder management. Mobility includes bed/chair/wheel-
chair, toilet transfer, and tub transfer. Locomotion includes
walking/wheelchair and stair-climbing. Communication
includes comprehension and expression. Lastly, social cog-
nition includes social interaction, problem solving, and
memory. Te WeeFIM II
TM
assessment coding form provided
Table I. Characteristics of participants (n = 207).
Characteristic
Number of
participants
Percentage of
participants
GMFCS level
I 49 24
II 32 15
III 31 15
IV 19 9
V 76 37
Type of cerebral palsy
Quadriplegia 57 27
Diplegia 105 51
Hemiplegia 45 22
Comorbidity conditions
Hearing problems 3 1
Vision problems 43 21
Speech disorders 54 26
Seizures, epilepsy 20 10
1468 E.-Y. Park et al.
Disability & Rehabilitation
fve blank for total scores including self-care, mobility, motor,
cognition, and WeeFIM. Motor total score was sum of self-
care and mobility total and motor and cognition total scores
was summated into WeeFIM total.
Te kappa values for items range from 0.44 to 0.82, and
intraclass correlation coefcients (ICC) for the six subscales
range from 0.73 to 0.98 in children with developmental dis-
abilities [11]. Cronbachs is reported to be 0.93 and 0.98
on the motor and cognitive subscales in children with CP,
respectively. Te inter-rater reliability is excellent with ICC
values of 0.98 and 0.93 for the motor and cognitive subscales,
respectively [1]. In this study, Cronbachs of the WeeFIM
ranged from 0.97 to 0.98.
Measurements were carried by 10 therapists (6 physi-
cal therapists and 4 occupational therapists) with at least 3
years experience in providing therapy for children with CP.
Terapists were familiar with the usual functional abilities
and WeeFIM instrument. Researcher provided information
of WeeFIM clinical guide to therapists and checked adminis-
tration process when therapists requested. Permission to use
the WeeFIM was obtained from the Uniform Data System for
Medical Rehabilitation. Researcher passed the Mastery Test
for the Licensed Instruments prior to using WeeFIM to con-
duct the research.
Data analysis
Te reliability of the WeeFIM was assessed by calculating
the internal consistency of Cronbachs . Te structure of the
WeeFIM was analyzed by EFA and CFA.
CFA is a type of factor analysis used to test the hypoth-
esis that a relationship between observed variables and their
underlying latent construct exists. Several options are avail-
able to assess the ft of the models to the data [22]. Fit indices
can be classifed as incremental, absolute, or comparative.
Te
2
, root mean square error of approximation (RMSEA),
comparative ft index (CFI), Tucker-Lewis Index (TLI), and
Normed Fit Index (NFI) are commonly used measures of ft.
Te incremental ft indices measure how better a model fts
as compared to a baseline model. Meanwhile, the absolute ft
indices measure how well a model fts the data without com-
parison to a baseline model. Te comparative ft indices are
only interpretable when comparing two diferent models. Te

2
and RMSEA are absolute ft indices, whereas the NFI, TLI,
and CFI are incremental ft measures. Te Akaike information
criterion (AIC) is a comparative measure of ft. RMSEA values
<0.05, 0.060.08, 0.080.10, and >0.1 indicate good, reason-
able, mediocre, and poor ft, respectively. NFI and TLI > 0.90
also indicate a good ft. Te CFI is independent of sample
size and quantifes the amount of variation and covariation
accounted for by the hypothesized model by comparing its
ft to that of an independent model of uncorrelated variables.
Te upper limit of the CFI is 1.00, and a value exceeding
0.90 indicates a good ft. Lower AIC values indicate a better
ft. Goodness-of-ft indices were used to determine the ade-
quacy of the models [23]. Te Analysis of Moment Structure
(AMOS) 20.0 statistical program was employed to perform
the CFA for obtaining maximum-likelihood estimates of
model parameters and provide goodness-of-ft indices.
EFA is uses to identify the number of factors and the pat-
tern of factor loadings. Principle component analysis was
applied for factor extraction method. Rotation was employed
to improve the meaningfulness and interpretation of the
generated factors. Tere are two rotation methods, orthogo-
nal and oblique. Because the factors were expected to be
correlated, an oblique rotation was used [24]. Factors were
selected if they had eigenvalues of 1 with loadings on that
factor exceeding 0.30 [25]. Te correlations between factors
and internal consistency reliability for each factor were also
calculated. EFA was performed using SPSS 20.0.
First, CFA was performed for calculating model ft indices
for each 1- and 2-factor model. And then EFA was performed
for identifying the number of factors and factor loadings.
Lastly, CFA was used again for examining the construct of
WeeFIM based EFA.
Results
Internal consistency of the WeeFIM
As shown in Table II, the overall scale reliability of the
WeeFIM was good. Cronbachs coefcient was 0.98 with a
95% confdence interval (range, 0.970.98). Table II presents
Cronbachs coefcients according to the three factors of the
WeeFIM.
CFA of the WeeFIM based on original 1- and 2-factor
models
Table III presents the ft indices for each 1- and 2-factor
model. A 1-factor model posits the entire 18-item load on
1-factor. In the 2-factor model, items are hypothesized to load
on 2 factors: motor and cognitive factors. Te ft indices did
not support for any of the models for the WeeFIM among
children with spastic CP.
EFA of the WeeFIM
Table IV shows the factor structures based on eigenvalues
of 1. Bartletts test for a signifcant correlation matrix in this
sample produced a value of p < 0.01. Te KaiserMyerOlkin
test measuring the sample adequacy was 0.93, which is excel-
lent. Te analysis revealed three factors (self-care, motor, and
cognitive), explaining 87.12% of the variance.
Table II. Reliability according to the three factors of the WeeFIM.
Factor Cronbachs 95% CI
Self-care 0.97 0.960.97
Motor 0.96 0.950.97
Cognitive 0.97 0.970.98
ADLs 0.98 0.970.98
ADL, activities of daily living; CI, confdence interval.
Table III. Comparison of the two models of the WeeFIM.
Factor df
2
NFI TLI CFI RMSEA AIC
1-factor 126 936.46 0.85 0.84 0.87 0.18 1062.46
2-factor 125 770.99 0.88 0.87 0.89 0.16 898.98
AIC, Akaike Information Criterion; CFI, Comparative Fit Index; NFI, Normed Fit
Index; RMSEA, Root mean square error of approximation; TLI, Tucker-Lewis Index.
Construct of WeeFIM in children with spastic CP1 1469
2013 Informa UK, Ltd.
In the 3-factor model of the EFA, items loaded on the
frst factor were nested with the original cognitive factor of
the item. Only the eating item of the original motor factor
was loaded on the cognitive factor. Te items comprising the
original motor factor were subdivided into two factors. Toilet,
bed/chair/wheelchair, tub/shower, walk/wheelchair, stair,
bowel, and bladder were loaded on the second factor. Dressing
upper, dressing lower, bathing, toileting, and grooming were
loaded on the third factor. In the EFA, factors are determined
on the basis of factor loading and interpretability. Te eating
items have high factor loading on the frst and third factors.
First and third factor loading of eating item were 0.80 and
0.79, respectively. Considering factor loading and interpret-
ability, eating was interpreted as an item of the third factor.
Te frst, second, and third factors were cognitive, motor, and
self-care, respectively.
CFA of the WeeFIM based on EFA
In this study, the absolute ft indices included the
2
and
RMSEA. Incremental ft measures included the NFI and
CFI. Te AIC was used for a comparative measure of ft. As
shown in Table V, the 3-factor model showed good ft indices.
RMSEA scores <0.05 indicate a good model ft. Te scores
for the NFI and CFI were >0.9, which also indicates a good
model ft. Te AIC was lower than the original 1- and 2-factor
models. Correlation matrix of factors and regression weights
are presented in Tables VI and VII, respectively.
Discussion
Although the WeeFIM is used to identify changes in func-
tional outcomes afer intervention, there is lack of studies on
the structure of the WeeFIM. Terapists must not only deter-
mine the changes in the total score of the WeeFIM, but also
examine the changes according to the domains to confrm
treatment efects. Tus, it is important to identify the struc-
ture of the WeeFIM.
Te results of the present study suggest that the WeeFIM
has good internal consistency for measuring functional
outcomes in children with spastic CP. In this study, the
Cronbachs was 0.98; according to the rule of thumb for
describing internal consistency, values above 0.90 are consid-
ered excellent [26].
CFA was selected to verify the factor structure, and EFA
was employed to determine the factor structure. Te 1- and
2-factor models suggested in the previous study and a theo-
retical model were tested by CFA. Because these models did
not exhibit adequate ft indices, EFA was executed to deter-
mine the ft model in children with spastic CP. Te 3-factor
models suggested from the results of EFA were tested by CFA
across the sample. Te results support the 3-factor structure
of self-care, motor, and cognition. Te internal consistency
and construct validity of the 3-factor model were verifed.
Terefore, the 3-factor WeeFIM is a useful measurement tool
in children with CP.
Table IV. Factor structure based on eigenvalue of n = 207.
Items Cognitive Motor Self-care Communalities
Memory 0.95 0.55 0.64 0.92
Social interaction 0.94 0.54 0.66 0.90
Problem solving 0.93 0.55 0.66 0.89
Expression 0.93 0.57 0.70 0.89
Comprehension 0.90 0.50 0.62 0.83
Eating 0.80 0.66 0.79 0.79
Toilet 0.55 0.95 0.69 0.92
Bed, chair, wheelchair 0.57 0.94 0.70 0.91
Tub, shower 0.55 0.93 0.74 0.90
Walk/wheelchair 0.60 0.92 0.59 0.84
Stair 0.41 0.86 0.59 0.78
Bowel 0.79 0.81 0.44 0.87
Bladder 0.79 0.81 0.42 0.88
Dressing upper 0.68 0.68 0.93 0.90
Dressing lower 0.64 0.66 0.93 0.88
Bathing 0.65 0.64 0.91 0.85
Toileting 0.66 0.72 0.91 0.87
Grooming 0.74 0.61 0.89 0.85
Explained variance (%) 70.37 10.44 6.31 87.12
ADLs (M SD) 73 33.15
ADL, activities of daily living.
Table V. Fit indices of the 3-factor model of the WeeFIM.
df
2
NFI TLI CFI RMSEA AIC
123 514.45 0.92 0.92 0.94 0.12 646.49
AIC, Akaike Information Criterion; CFI, Comparative Fit Index; NFI, Normed Fit
Index; RMSEA, Root mean square error of approximation; TLI, Tucker-Lewis Index.
Table VI. Correlation matrix of factors.
Factors Cognitive Motor Self-care
Cognitive
Motor 0.79**
Self-care 0.78** 0.67**
**p < 0.01
Table VII. Regression weights.
B
a

b
SE
c
CR
d
MemoryCognition 1.00 0.93
Problem solvingCognition 0.96 0.93 0.03 31.86**
Social interactionCognition 0.97 0.93 0.03 31.36**
ExpressionCognition 1.04 0.95 0.04 23.57**
ComprehensionCognition 0.92 0.89 0.05 19.87**
EatingSelf-care 1.00 0.86
GroomingSelf-care 1.00 0.92 0.05 19.22**
BathingSelf-care 0.93 0.90 0.05 18.49**
Dressing UpperSelf-care 1.00 0.92 0.05 19.58**
Dressing lowerSelf-care 1.00 0.90 0.05 18.60**
ToiletingSelf-care 1.07 0.92 0.06 19.33**
BladderMotor 1.00 0.74
BowelMotor 1.02 0.74 0.03 35.51**
Bed, chair, wheelchairMotor 1.27 0.94 0.09 14.06**
ToiletMotor 1.32 0.95 0.09 14.05**
Tub, showerMotor 1.25 0.92 0.09 13.74**
Walk/wheelchairMotor 1.13 0.91 0.08 13.66**
StairMotor 1.08 0.85 0.09 12.61**
a
Unstandard regression weight.
b
Standard regression weight.
c
Standard error.
d
Critical
ratio.
**p < 0.001.
1470 E.-Y. Park et al.
Disability & Rehabilitation
Originally, the WeeFIM had a 2-factor structure: motor
and cognitive. In this study, the results for the 3-factor model
showed that the model ftted reasonably with the data. Most
researchers do not rely strictly on cutof values. Hayduk et al.
[27] argue that cutofs for a ft index can be misleading and
subject to misuse. Te
2
-test is widely used to analyze model
ft. Nevertheless, it was not used as a ft statistic because it
is sensitive to sample size. Moreover, RMSEA is commonly
used to measure ft. However, researchers can never know the
appropriate population size for RMSEA. It is not optimal to
strive for single-test accept/reject decisions because the nature
of such tests is very diferent from conventional hypothesis
tests such as the t-test. Hence, it is important to use other
goodness-of-ft measures to determine global model ft and
attend to diagnostics for the sources of model misft [28]. In
addition, if the sample size is <250, RMSEA is less preferable
[29]. We accepted the 3-factor model of the WeeFIM even
though the RMSEA ft index was >0.10. Te ft indices of the
3-factor model of the WeeFIM such as the NFI, TLI, and CFI
were at acceptable levels.
Te PEDI and WeeFIM are frequently used measures of
functional outcomes. Te items of the PEDI were developed
to ft the Rasch model, which estimates item difcultly and
personal ability and indicates a 1-dimensional construct [30].
Moreover, CFA has been used to estimate factor scores [31]. In
contrast, the WeeFIM was adapted from the adult FIM
TM
. Te
items of the WeeFIM were developed to use traditional testing
methods. Te construct validity of the WeeFIM was examined
while comparing other developmental assessments such as the
Vineland Adaptive Behavior Scales, Battelle Developmental
Inventory, and Clinical Linguistic Auditory Milestone Scale
[30]. For this reason, Rasch analysis has been performed
on the items of the WeeFIM to examine its construct valid-
ity in many studies [1,30,32]. Te conventional method of
determining the construct validity of measurement is factor
analysis. However, no study evaluating the construct validity
of the WeeFIM through factor analysis has been performed.
In this study, EFA and CFA were employed to determine the
construct validity of the WeeFIM in children with spastic CP,
and the results of this study recommend the 3-factor model.
Previous researchers have suggested that the motor domain
is not unidimensional. Chen et al. [30] performed Rasch anal-
ysis and reported that bladder and bowel management of the
motor domain do not ft well. Tey also suggested that blad-
der and bowel management measure a distinct aspect of func-
tion. Tur et al. [1] report that the motor factor rather than the
one-dimensional model is divided into several dimensions in
children with CP. Moreover, it is reported that other items do
not load on motor or cognitive scales and do not ft well. A
validity study for the internal construct of the WeeFIM was
conducted to determine factors by using principal compo-
nent analysis. In that study, stair-climbing, eating, grooming,
walking, and bathing items did not load into any factor; the
remaining motor items were loaded into the frst factor; and
all cognitive items were loaded into the second factor [33].
Tsuju et al. [32] administered the WeeFIM to 225 children
aged 6 months to 7 years without developmental delays. Te
scores were converted to an interval scale by Rasch analysis,
which assumes unidimensionality of the measurement items,
for determining the ft index of the assumption and decide
item difculty. Te results show that when the WeeFIM items
were divided into motor and cognition to minimize misft,
the degree of misft was acceptable except for eating, bladder
management, tub/shower transfer, and comprehension. Tis
suggests that items of the WeeFIM should not only be divided
into motor and cognitive domains.
In factor analytic theory, it is of primary interest to deter-
mine the underlying constructs that give rise to collected data.
Traditionally, EFA is used to explore the possible underlying
factor structure of a set of observed variables without impos-
ing a preconceived structure on the outcome. By performing
EFA, the underlying factor structure is identifed. CFA is a
statistical technique used to verify the factor structure of a
set of observed variables. In this study, the three underlying
constructs of the WeeFIM in children with spastic CP were
determined using EFA and supported though CFA.
Our analyses show that the WeeFIM has distinct self-care,
motor, and cognitive domains. Te self-care domain includes 6
items: eating, grooming, dressing upper, dressing lower, bath-
ing, and toileting. Te motor domain includes 7 items: blad-
der and bowel management, changing positions from chairs,
getting on and of the toilet, getting in and out of showers and
bathtubs, self-mobility indoors and outdoors, and ascending
and descending stairs. Te 5 items of the cognitive domain
are the same as those of the original cognitive domain. For
the 3-factor model, the results showed that the model ftted
the data reasonably well. However, the 1-factor and original
2-factor models were inadequate for children with spastic CP.
Recently, the WeeFIM Clinical Guide reported that the
bladder and bowel items are included in the self-care domain
[19]. However, the present results indicate that these items
were not loaded in the self-care domain. Tis result might
be because of the characteristics of these items. Te bladder
and bowel items can be rated both physiologically (i.e. con-
tinence) and according to performance [30]. Bladder and
bowel management is usually related to central neuromotor
control dysfunction and to the cognitive development status
of the child. Te results of EFA show that these items have
high factor loading on both the cognitive and motor domains.
As a result, it would not be meaningful to compare children
with spastic CP with nondisabled children.
Usefulness and responsiveness of the WeeFIM instrument
may be afected by subtotal scores. Te results of this study
suggest that the 3-factor WeeFIM is more acceptable than the
original 2-factor WeeFIM for children with spastic CP. Tus,
the self-care, motor, and cognitive domains should be treated
as separate scales in children with spastic CP. Tese results sup-
port the belief that the psychometric properties of a population
should be examined prior to the use of a given instrument.
Although the reliability and validity of the 3-factor
WeeFIM were examined in this study, further studies are
needed to determine additional psychometric properties. In
addition, comparative data should be accumulated using a
variety of methodologies. Because only children with spastic
CP participated in the present study, the present results may
not be representative of other types of CPs.
Construct of WeeFIM in children with spastic CP1 1471
2013 Informa UK, Ltd.
Declaration of Interest: Te authors report no conficts of
interest.
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