Translation, reliability and validity of the Greek version of the Child Engagement in Daily Life in children with cerebral palsy

Rigas Dimakopoulos*, Μarianna Papadopoulou, Roser Pons, Arietta Spinou

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Participation in family, recreational activities and self-care is an integral part of health. It is also a main outcome of rehabilitation services for children and adolescents with disabilities. However, there are currently no available tools in Greek to assess participation in young children. Methods: The Child Engagement in Daily Life (CEDL) was cross-culturally translated into Greek using forward–backward translation, review by expert committee, pretest application and final review. Parents with children who have been diagnosed with cerebral palsy (CP) and were 18 months to 5 years old were recruited. Internal consistency was evaluated using the Cronbach alpha and test–retest reliability in 2 weeks using intra-class correlation coefficient (ICC) and Bland–Altman plot for the agreement of each domain score. Measurement error was assessed utilising the standard error of measurement (SEM) and the smallest detectable change (SDC) and interpretability was assessed using the floor and ceiling effects. Validity was evaluated using the ‘known groups’ method, that is, assessing parents of children with typical development (TD). Results: One hundred and seven children with CP (mean age 43.63 ± 13.5 months), Gross Motor Function Classification System (GMFCS) levels I–V and 97 children with TD (mean age 43.63 ± 14.4 months) were included. Significant differences (p < 0.01) between children with CP and children with TD were recorded for all CEDL domains. Mean ± standard deviation of the CEDL domains ‘frequency of participation’, ‘enjoyment of participation’ and ‘self-care’ were 58.8 ± 14.5, 3.9 ± 0.9 and 49.7 ± 23.5, respectively for children with CP and 62.3 ± 9.1, 4.4 ± 0.9 and 74.2 ± 15 for children with TD. Internal consistency of all domains was high; Cronbach alpha for ‘frequency of participation’ was 0.83, for ‘enjoyment of participation’ was 0.76 and for ‘self-care’ was 0.92. Test–retest reliability (ICC) was excellent for the ‘self-care’ (0.95) and good for ‘frequency of participation’ and ‘enjoyment of participation’ domains (0.90 and 0.88, respectively) while Bland–Altman analysis revealed no systematic differences or bias between the two measurements. SEM was 0.8, 0.05 and 1.6 for frequency of participation, enjoyment and self-care with SDC of 2.4, 0.16 and 4.5, respectively. No relevant floor and ceiling effects were observed. Conclusion: The Greek CEDL has good reliability, validity and interpretability. It can be used to evaluate participation in Greek young children with CP. Future studies should investigate the validity of this tool in longer periods and its responsiveness to intervention.

Original languageEnglish
Article numbere13202
JournalChild: Care, Health and Development
Issue number1
Early online date14 Nov 2023
Publication statusPublished - Jan 2024


  • child
  • Child Engagement in Daily Life
  • disabilities
  • participation


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