The International Classification of Functioning ,Disability and Health (ICF) was promulgated by the World Health Organization (WHO) in 2001, providing a theoretical basis and classification method for the understanding of disability and the development of rehabilitation [1]. The ICF considers environmental factors as one of the background factors and has a direct relationship with health status. The 2006 international definition of cerebral palsy [2] focuses more on the limitation of activities and low ability in the daily living environment of people with cerebral palsy than previous definitions. In the past, the classification and grading methods of cerebral palsy were mainly distinguished by the site of injury and the type of injury, but these methods could not well reflect the functional impairment of the children in daily life. The Gross Motor Function Classification System (GMFCS) is a classification method based on ICF theory [3, 4], which objectively reflects the impact of gross motor function impairment on daily living ability by evaluating the ability of children with cerebral palsy to sit and walk in daily life. The GMFCS has very good reliability and validity, and is now widely used internationally, and many institutions in China have started to adopt the GMFCS grading method in recent years [5]. Wang Hui, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine A large proportion of children with cerebral palsy have hand dysfunction, and impaired hand function will affect the development of other functions to varying degrees, such as sensory (especially tactile), fine motor ability, gross motor ability, cognitive ability and daily living ability, so it is important to strengthen the management of hand dysfunction in children with cerebral palsy [6, 7]. In 2006, Eliasson et al. published the Manual Ability Classification System (MACS) for children with cerebral palsy [8], which is a system for grading the ability of children with cerebral palsy to manipulate objects in daily life and aims to reflect the most The MACS is a system for grading the ability of children with cerebral palsy to manipulate objects in daily life, and is designed to reflect the most typical daily performance of the child at home, school, and in the community. Prior to the MACS, the classification of hand function disability focused more on hand posture and grip ability, such as the House Classification of Upper Extremity Functional Use [10], a nine-level classification that determines the level of upper extremity function and functional baseline. The Bimanual Fine Motor Function classification developed by Beckung and Hagberg is applicable to children with cerebral palsy of all ages and is mainly characterized by the ability to determine the function of both one and both hands [11]. The Mital and Sakellarides grading system is used to evaluate the spasticity and contracture status of the thumb’s adductor and flexor muscle groups [12], all of these classifications neglect to evaluate hand function in the daily environment, and no relevant reliability and validity have been reported.The MACS refers to the GMFCS grading method, which also has five levels, with level I being the highest and level V being the The MACS has been evaluated by professionals and parents of 168 children with cerebral palsy aged 4 to 18 years in Sweden and Australia, and it was determined that the MACS has good inter-rater reliability (ICC=0.97) among professionals and also good reliability (ICC=0.96) with parents [13].The MACS is currently gaining a great deal of international attention and It has been translated into 15 languages [14]. Morris et al. studied the reliability of the MACS in children with cerebral palsy in the UK and showed that it maintained similar reliability to the developers, while suggesting that the environment may influence the evaluation of the MACS [15]. The purpose of this paper is to determine the reliability and validity of the Chinese version of the MACS and to provide a more reliable basis for conducting MACS ratings of children with cerebral palsy in China.1 Subjects and methods 1.1 One hundred and twenty-four children with cerebral palsy aged 4 to 18 years who underwent rehabilitation assessment from October 2007 to August 2008, from 2 cerebral palsy rehabilitation institutions in Shanghai, were used as the study population. The diagnosis was in accordance with the criteria established by the International Cerebral Palsy Conference in 2006 [2], while cerebral palsy typing was determined using the method recommended by the European Cerebral Palsy Monitoring Organization [16], and gross motor function evaluation was performed using the Chinese version of the GMFCS [17], excluding children with severe visual and auditory impairment. The general information of the study subjects is shown in Table 1.1.2 Study methods 1.2.1 Formation of the Chinese version of the MACS The Chinese version of the MACS was translated by a pediatric rehabilitation physician based on the original version (English) and proofread and modified three times by two other rehabilitation physicians and an occupational therapist, and then the Chinese version of the MACS was finalized by the group’s collective discussion (see Appendix). 1.2.2 Professional on-site evaluation method Since the MACS was evaluated by the performance of the hand function of children with cerebral palsy in daily life, eight physical scenarios related to daily life were set up to facilitate the evaluation by professionals in the treatment environment, including: drinking from a cup, using a spoon, opening and closing a small bottle, wiping the face, wringing a towel, flipping a book, and so on. Two occupational therapists evaluated the children through their on-site operations. A total of 124 children were evaluated on site, of which one occupational therapist evaluated 81 children and the other one evaluated 93 children. 1.2.3 Parental evaluation method Parents were asked to read the Chinese version of the MACS while the professionals were evaluating on site, and to retrospectively evaluate their child’s hand function in daily life, combined with direct observation of physical operations on site. The professional could explain the terms of the Chinese version of the MACS but did not discuss the determination of the MACS level with the parents. Ninety-three parents evaluated their children’s MACS, mainly parents and grandparents, and most of the parents who did not participate in the MACS evaluation were unable to understand the Chinese version of MACS due to their low literacy level. 1.2.4 Retest Reliability Testing All study subjects were videotaped while conducting the field operation evaluation, and each case took about 10 minutes to film. One week after the completion of the on-site evaluation of all study subjects, the occupational therapists and rehabilitation physicians conducted a retest by playing the video. Two of the occupational therapists re-evaluated all 124 children, and the evaluators did not discuss with each other. The re-test reliability of each of the two evaluators was analyzed by analyzing the results of the field operation evaluation and the video evaluation. 1.2.5 Inter-evaluator Reliability Test In the field operation evaluation, 78 subjects were evaluated simultaneously by one occupational therapist and the parents; 66 subjects were evaluated simultaneously by two occupational therapists; 11 subjects were evaluated simultaneously by two parents (both immediate family members who were familiar with the child’s daily living status). All evaluators did not discuss with each other and recorded the results of their evaluations. The inter-rater reliability of the field operation evaluation was determined by analyzing the inter-operational therapist and inter-parent evaluations. One rehabilitation physician evaluated 52 of the children in the videotaped evaluation, and the inter-rater reliability of the videotaped evaluation was determined by analyzing the results of the inter-operational therapist and rehabilitation physician evaluations. 1.2.6 Parallel validity testing The Fine Motor Function Measure scale (FMFM) was administered to all children in the study population at the same time as the on-site MACS evaluation [18], and 12 children had difficulty completing the FMFM test because they were in poor condition during the test, so a total of 112 The FMFM scale was developed by the Rehabilitation Center of the Affiliated Pediatric Hospital of Fudan University in Shanghai, and the FMFM scale, which was developed with a sample of more than 600 children with cerebral palsy, was established by the Rasch analysis method, with reasonable entry settings, many rating points, and isometric scales, which can reasonably determine the The FMFM scale was developed using the Rasch analysis method, with reasonable entries, many rating points, and isometric scales, which can reasonably determine the level of fine motor function in children with cerebral palsy and has good reliability and validity [19]. The scale is divided into five areas with 61 items, including visual tracking (5 items), upper limb joint mobility (9 items), grasping ability (10 items), manipulative ability (13 items), and hand-eye coordination (24 items), and uses a four-level scale of 0, 1, 2, and 3, with a full raw score of 183, and the fine motor ability scores with isometric characteristics can be obtained by checking the scale, with scores ranging from 0 to 100 points. The parallel validity of MACS and FMFM was determined by analyzing the relationship between MACS levels and fine motor ability scores.1.3 Statistical methods The interclass correlation coefficient (ICC) was used to compare the reliability test; the Spearman rank correlation coefficient was used to compare the parallel validity test. comparison. All analyses were performed using the SPSS 12.0 statistical package, P