The Impact of Functional Classification Systems on Quality of Life in Children with Cerebral Palsy

Cerebral palsy (CP) is associated with heterogeneous functional limitations that influence children’s participation and quality of life (QOL). This study aimed to examine the predictive contributions of functional capacity classification systems, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Eating and Drinking Ability Classification System (EDACS), to multidimensional QOL outcomes in children with CP. This cross-sectional study included 125 children with CP aged 4-12 years. Caregivers completed the Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child). Functional classifications were determined through structured online observation and caregiver interviews. Correlation analyses and multiple linear regression models were used to evaluate the effects of functional capacity classifications on seven QOL domains. MACS emerged as the most consistent predictor, significantly contributing to six QOL domains: social well-being and acceptance (p = 0.006), participation and physical health (p <0.001), emotional well-being (p <0.001), access to services (p = 0.007), pain and impact of disability (p <0.001), and family health (p <0.001). GMFCS showed a domain-specific effect, predicting emotional well-being only (p<0.001). EDACS demonstrated limited predictive value, contributing significantly to functioning (p = 0.001) and participation and physical health (p = 0.003). Explained variance ranged from 12% to 44%, with emotional well-being showing the strongest model. Manual ability classification plays a central role in shaping QOL in children with CP. Rehabilitation should prioritize upper-extremity function alongside participation and family-centered approaches.