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Child Activity Limitations Interview (CALI)
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Exploratory: Cerebral Palsy (CP) and Spinal Cord Injury (SCI)-Pediatric
Short Description of Instrument
The Child Activity Limitations Interview (CALI) is a subjective, validated, and reliable measure of functional impairment due to pain in children and adolescents with recurrent chronic pain (Palermo et al., 2004). The CALI-21 is comprised of 21 items: two items that capture the concept of sleep and rest; one item that refers to eating; three school-related items; three items that deal with ambulation; two items that refer to mobility; two work-related items; and 8 items that access physical, social and recreational interactions. The CALI-21 is the self- administered version (Palermo et al., 2008).
Comments/Special Instructions
Administration: The CALI is administered via individual interviews with children and parents. Time to administer is approximately 5-7 minutes (Palermo et al., 2004). The CALI-21 is administered as child or parent reported questionnaire (Palermo et al., 2008). The CALI-9 is a brief version of the CALI including 9 of the 21 items (4, 5, 12, 14, 16, 17, 18, 19, and 21) based on factor analysis (Holley et al., 2018).
Age range: 8-18 y
CP-specific Pain Category: Pain Interference
CP-specific ICF Domain: Activity and Participation (World Health Organization, 2001)
Scoring and Psychometric Properties
For the CALI, each respondent is read the 21-item activity list and asked to choose the eight activities that are most difficult or bothersome due to recurrent pain. Importance of each activity is rated on a 5-point scale from (0) 'not important' to (4) 'extremely important'. The primary score is derived from the difficulty ratings which are obtained on a 5-point scale: (0) 'not difficult' to (4) 'extremely difficult'. Difficulty ratings are summed and the total score ranges from 0 to 32, with higher scores indicating greater levels of difficulty (Palermo et al., 2004).
For the CALI-21, the child, or the parent rates all 21 items using the 5-point scale: (0) 'not difficult' to (4) 'extremely difficult' as the CALI and the scores are summed to tabulate a total difficulty score ranging from 0-84 (Palermo et al., 2008). For the CALI-9 the parent or the child rates the 9 items using the same 5-point scale from (0) 'not important' to (4) 'extremely important', but the 0-4 scores are converted to 0=0, 1=25, 2=50, 3=75, and 4=100 giving the overall score a range of 0-100. The scores are summed and divided by the number of items completed. Specifics on scoring the CALI-9 can be found in Appendix A and Appendix B in Holley et al., 2018.
Psychometric Properties: The CALI original version demonstrates internal consistency (alpha=0.88, child version; alpha=0.95, parent version); and reliability, (one-month test-retest reliability (r = 0.33, child report) and cross-informant reliability (r = 0.43) were moderate) (Palermo et al., 2004). The CALI-21 has a Cronbach's alpha coefficient: parent version a = 0.96; child version a=0.95. Item level analysis showed good psychometric properties. The CALI-21 showed no floor or ceiling effect and had acceptable skewness and kurtosis for 19 of the items (Palermo et al., 2004). The CALI-21 questionnaire demonstrates excellent internal consistency and high cross-informant reliability indicating that it is a reliable and valid measurement tool (Palermo et al., 2004). The CALI-9 has good internal consistency and high cross informant reliability (Holley et al., 2018).
Strengths: The CALI is appropriate for diverse pediatric pain populations, and suitable for retrospective and prospective daily assessment (Hainsworth et al., 2007; Palermo et al., 2008). The tool can be administered as an interview or as a patient reported outcome measure and it provides specific information on the impact of pain on active and routine physical function. The CALI is recommended for use for children with Gross Motor Function Classification System (GMFCS) levels I to III (Kingsnorth et al., 2015).
Weaknesses: The CALI has been used with a variety of diagnoses (abdominal pain, back pain, cancer, Duchene and Becker muscular dystrophy, juvenile chronic arthritis, neuropathic pain, migraine, musculoskeletal pain, myofascial pain, obesity, sickle cell disease), but it has not been validated in pediatric SCI or cerebral palsy (Kingsnorth et al., 2015). The difficulty of performance of the items may be confounded by other motor and nonmotor impairments.
Key References:
Palermo TM, Lewandowski AS, Long AC, Burant CJ. Validation of a self-report questionnaire version of the Child Activity Limitations Interview (CALI): The CALI-21. Pain. 2008 Oct 31;139(3):644-652.
Palermo TM, Witherspoon D, Valenzuela D, Drotar DD. Development and validation of the Child Activity Limitations Interview: a measure of pain-related functional impairment in school-age children and adolescents. Pain. 2004 Jun;109(3):461-470.
Additional References:
Hainsworth KR, Davies WH, Khan KA, Weisman SJ. Development and preliminary validation of the child activity limitations questionnaire: flexible and efficient assessment of pain-related functional disability. J Pain. 2007 Sep;8(9):746-52.
Holley AL, Zhou C, Wilson AC, Hainsworth K, Palermo TM. The CALI-9: A brief measure for assessing activity limitations in children and adolescents with chronic pain. Pain. 2018 Jan;159(1):48-56.
Kingsnorth S, Orava T, Provvidenza C, Adler E, Ami N, Gresley-Jones T, Mankad D, Slonim N, Fay L, Joachimides N, Hoffman A. Chronic pain assessment tools for cerebral palsy: a systematic review. Pediatrics. 2015 Oct 1;136(4):e947-60.
World health Organization (2001). International Classification of Functioning, Disability and Health (ICF) Retrieved 19August2021
Document last updated August 2022