Inter-rater reliability in assigning ICF codes to children with disabilities

The Reliability of Expert Diagnosis of Childhood Apraxia of Speech

PURPOSE

The current standard for clinical diagnosis of childhood apraxia of speech (CAS) is expert clinician judgment. The psychometric properties of this standard are not well understood; however, they are important for improving clinical diagnosis. The purpose of this study is to determine the extent to which experts agree on the clinical diagnosis of CAS using two cohorts of children with mixed speech sound disorders (SSDs).

METHOD

Speech samples of children with SSDs were obtained from previous and ongoing research from video recordings of children aged 3-8 years (n = 36) and audio recordings of children aged 8-17 years (n = 56). A total of 23 expert, English-speaking clinicians were recruited internationally. Three of these experts rated each speech sample to provide a description of the observed features and a diagnosis. Intrarater reliability was acceptable at 85% agreement.

RESULTS

Interrater reliability on the presence or absence of CAS among experts was poor both as a categorical diagnosis (κ = .187, 95% confidence interval [CI] [0.089, 0.286]) and on a continuous "likelihood of CAS" scale (0-100; intraclass correlation = .183, 95% CI [.037, .347]). Reliability was similar across the video-recorded and audio-only samples. There was greater agreement on other diagnoses (such as articulation disorder) than on the diagnosis of CAS, although these too did not meet the predetermined standard. Likelihood of CAS was greater in children who presented with more American Speech-Language-Hearing Association CAS consensus features.

CONCLUSIONS

Different expert raters had different thresholds for applying the diagnosis of CAS. If expert clinician judgment is to be used for diagnosis of CAS or other SSDs, further standardization and calibration is needed to increase interrater reliability. Diagnosis may require operationalized checklists or reliable measures that operate along a diagnostic continuum.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23949105.

The ICF has made a difference to functioning and disability measurement and statistics

AIMS

Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics.

METHODS

In a scoping review, we investigated research published 2001-2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge.

RESULTS

The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation.

CONCLUSION

The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes. Implications for Rehabilitation The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance. Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning. Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.

Validating the UNICEF/Washington Group Child Functioning Module for Fijian schools to identify seeing, hearing and walking difficulties

PURPOSE

This study investigated the seeing, hearing and walking questions of the UNICEF/Washington Group Child Functioning Module and the inter-rater reliability between teachers and parents as proxy respondents.

METHODS

Cross-sectional diagnostic accuracy study, two-gate design with representative sampling, comparing Module responses to reference standard assessments for 472 primary aged students in Fiji. Receiver operating characteristic curves were constructed to determine the area under the curve and optimal cut-off points.

RESULTS

Areas under the curves ranged from 0.823 to 0.889 indicating "good" diagnostic accuracy. Inter-rater reliability between parent and teacher responses was "good" to "excellent". The optimal cut-off determined by the Youden Index was "some difficulty" however a wide spread of impairment levels were found in this category with most children either having none or substantial impairments.

CONCLUSIONS

The diagnostic accuracy of the Module seeing, hearing and walking questions appears acceptable with either parents or teachers as proxy respondents. For education systems, use of the cut-off "some difficulty" with accompanying clinical assessment may be important to capture children who require services and learning supports and avoid potentially misleading categorization. Given the high proportion of the sample from special schools research is required to further test the Module in mainstream schools. Implications for rehabilitation Identification of children who are at risk of disability in Fiji is important to enable planning, monitoring and evaluating access to quality inclusive education. The UNICEF/Washington Group Child Functioning Module appears to be a practical and effective tool that can be used by teachers to identify children at risk of disability. Children identified on the UNICEF/Washington Group Child Functioning Module as having "some difficulty" or higher levels of difficulty in relation to vision, hearing or walking should be referred for further assessment and services. Rehabilitation services in Fiji need to prepare for greater numbers of referrals as the Ministry of Education increasingly rolls out the inclusive education policy, which includes identification by schools of children at risk of disability.

Examining young children's social competence using functional ability profiles

PURPOSE

To explore the use of International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY) based profiles of children's functional abilities in relation to their social competence. Subgroups based on shared profiles of functional ability were investigated as an alternative or complement to subgroups defined by disability categories.

METHODS

Secondary analysis of a nationally representative data set of young children identified for special education services in the United States was used for the present study. Using five subgroups of children with shared profiles of functional ability, derived from latent class analysis in previous work, regression analyses were used to examine the relationships between social competence and functional abilities profile subgroup membership. Differences among the subgroups were examined using standardized effect sizes. R² values were used to examine explained variance in social competence in relation to subgroup membership, disability category, and these variables in combination.

RESULTS

Functional ability profile subgroup membership was moderately related to children's social competence outcomes: social skills and problem behaviors. Effect sizes showed significant differences between subgroups. Subgroup membership accounted for more variance in social competence outcomes than disability category.

CONCLUSIONS

The results provide empirical support for the importance of functional ability profiles when examining social competence within a population of young children with disabilities. Implications for Rehabilitation The extent to which children with disabilities experience difficulty with social competence varies by their functional characteristics. Functional ability profiles can provide practitioners and researchers working young children with disabilities important tools to examine social competence and to inform interventions.

The Psychometric Properties of the Arabic Preschool Activity Card Sort

Background

The Preschool Activity Card Sort (PACS) is an interview-based assessment tool to measure participation of preschool children with age range from 3 to 6 years.

Objective of Study

The purpose of this study was to establish the psychometric properties of the recently translated Arabic PACS (A-PACS).

Methods

One hundred fifty-one Jordanian parents participated in the study representing different geographical areas. Children were almost equally distributed between males and females and into three age groups. Construct and concurrent validity were examined as well as the internal consistency of the scale and the test-retest reliability.

Findings

The A-PACS was able to differentiate between the participation level of young and old children in the domains of education, community mobility, and low demand leisure of the A-PACS giving evidence to its construct validity and it significantly correlated with some aspects of the Vineland Adaptive Behavior Scale (VABS) giving evidence to its concurrent validity. The A-PACS showed excellent overall internal consistency (α = .859) for all domains and good test-retest reliability (r = .976, p < .001).

Conclusion

The A-PACS can be considered as a valid and reliable tool to measure participation of preschool children with normal development from Arabic cultures. Future studies should focus on the validity of the A-PACS for use with children with disabilities.

Foetal surgery and using in utero therapies to reduce the degree of disability after birth. Could it be morally defensible or even morally required?

In 2008 the Human Fertilisation and Embryology Act amendments made deliberately choosing to bring disability into the world, using assisted reproduction, a criminal offence. This paper considers whether the legal prohibition above, should influence other policy areas concerning the welfare of future children such as new possibilities presented by foetal surgery and in utero gene therapy. If we have legal duties to avoid disability in one context should this influence our avoidance of disability in this other context? This paper investigates whether the State might have a stake in wider promotion of practices to reduce the degree of disability in foetuses that will come to exist (as opposed to those that will be aborted). Not selecting for disability does not affect the welfare of any future individual, whereas treating in utero abnormalities can optimize the eventual child's welfare; antenatal interventions stand to improve clinical outcomes and welfare should that specific child be born. I explore why the State may want to intervene in the antenatal setting and to what extent, if at all; the State should implement these technologies. I argue that if the State is justified in intervening to outlaw the choosing to create disabled lives using assisted reproductive techniques, it is also justified in putting pressure on prospective parents to accept therapies in utero to help their child be born less disabled. However, I qualify this with the argument that the State is not justified in using force or the criminal law in this situation during pregnancy.

Applying the International Classification of Functioning, Disability, and Health in children with low vision: differences between raters

BACKGROUND/AIM

This study was conducted to analyze the agreement between International Classification of Functioning, Disability, and Health (ICF) raters and to show its applicability in children with low vision.

MATERIALS AND METHODS

Twenty children (mean age: 11.70 ± 1.92 years) were included. To evaluate the independency of the sample, the Northwick Park Activities Daily Living questionnaire was used. The Low Vision Quality of Life Scale was used to evaluate quality of life. An ICF core set was developed to be used in this study. The core set consisted of 13 items for body functions, 3 items for body structures, 36 items for activity and participation, and 12 items for environmental factors.

RESULTS

High agreement was found between two raters in terms of subparameters of the ICF core set for activity and participation (r = 0.880, P = 0.000).

CONCLUSION

The findings indicate that the raters showed strong agreement in terms of the ICF core set used in this study. This shows that the core set can be used to evaluate activity and participation of children with low vision.

Assessments used to diagnose developmental coordination disorder: do their underlying constructs match the diagnostic criteria?

This study examined the constructs underlying the Movement Assessment Battery for Children-2 (M-ABC-2), Bruninks-Oseretsky Test of Motor Proficiency (BOTMP) and Vineland Adaptive Behavior Scale-2 (VABS-2) using the framework of the International Classification of Functioning Disability and Health-Child Youth version (ICF-CY) and the diagnostic criteria of developmental coordination disorder (DCD). Two independent raters coded and matched items to ICF-CY codes as per the eight ICF linking rules developed by Cierza and colleagues. Content density and inter-rater reliability were also calculated. The majority of codes assigned to the M-ABC-2 and BOTMP related to body functions (54% and 64% respectively). For the VABS-2, 91% of codes pertained to activities and participation. The M-ABC-2, BOTMP, and the VABS-2 emphasize the ICF-CY constructs differently. The VABS-2 may be useful in the evaluation of performance of daily life activities and participation in children with DCD.

Children with and without developmental disabilities: sedation medication requirements and adverse events related to sedation

OBJECTIVE

Our objective was to prospectively compare sedation medication requirements and adverse events related to sedation in children with and without developmental disabilities.

METHODS

We conducted a prospective, observational, age-matched, 1:2 case-control study of children (3-10 years) sedated for brain magnetic resonance imaging at a tertiary-care children's hospital. Developmental assessment was performed using the Vineland Adaptive Behavioral Scale and by a pediatric neurologist. Patients were sedated according to institutional sedation protocol. Patient demographics, type and dose of sedation medications, depth of sedation, and adverse events were collected. We defined hypoxia as oxygen saturation 90% or less for 30 seconds or longer and requiring airway maneuvers.

RESULTS

Seventy children were designated as cases (DD) and 140 as controls (DN). DD had a significantly lower mean Vineland Adaptive Behavioral Scale score than did DN (DD: 62.34 ± 9.70, DN: 103.0 ± 13.71; P < 0.001). A combination of pentobarbital and fentanyl (DD: 32/70 [45.7%], DN: 60/140 [42.9%]) and combination of pentobarbital and midazolam (DD: 28/70 [40%], DN: 43/140 [30.7%]) were the most common sedatives used in both groups. There was no difference in the mean dose of pentobarbital (DD:4.68 ± 1.63 mg/kg, DN:4.67 ± 1.69 mg/kg; P = 0.9), fentanyl (DD: 0.61 ± 0.65 μg/kg, DN: 0.64 ± 0.65 μg/kg; P = 0.7), and midazolam (DD: 0.15 ± 0.17 mg/kg, DN: 0.11 ± 0.14 mg/kg; P = 0.1). There was no difference in the overall adverse events (DD: 30%, DN: 32.9%; P = 0.7) as well as hypoxia (DD: 10%; DN: 9.3%, P = 0.9).

CONCLUSIONS

When compared with DN children, DD children do not require a higher dose of sedatives and do not have a higher incidence of adverse events.

Participation and environmental aspects in education and the ICF and the ICF-CY: findings from a systematic literature review

BACKGROUND

This paper presents findings from a systematic review of the literature related to participation and the ICF/ICF-CY in educational research.

OBJECTIVES

To analyse how and investigate the application of participation in educational research. Specifically, how participation is related to the environmental dimensions availability, accessibility, affordability, accommodability and acceptability.

METHODS

A systematic literature review using database keyword searches and refinement protocols using inclusion and exclusion criteria at abstract, full-text and extraction.

RESULTS

Four hundred and twenty-one initial works were found. Twenty-three met the inclusion criteria. Availability and accommodations are the most investigated dimensions. Operationalization of participation is not always consistent with definitions used.

CONCLUSION

Research is developing a holistic approach to investigating participation as, although all papers reference at least one environmental dimension, only four of the 11 empirical works reviewed present a fully balanced approach when theorizing and operationalizing participation; hopefully this balanced approach will continue and influence educational policy and school practice.

Professionals' views of children's everyday life situations and the relation to participation

PURPOSE

The aim was to determine professionals' views of everyday life situations (ELS) of importance for children and to explore how ELS correlate with the construct "Participation". This study was part of a larger work to develop a structured tool with code sets to identify child participation and support children with disabilities to describe what matters most for them in intervention planning.

METHOD

The study had a concurrent mixed methods design. Information from one open-ended question and questionnaires were linked to the ICF-CY component Activities and Participation. Two concurrent data sets were compared.

RESULTS

Proposed ELS were distributed across ICF-CY categories from low to high level of complexity and context specificity. The correlation with participation became stronger for the later chapters of the component (d7-d9). Differences between respondents due to working field, country, and children's ages were explored. Acts and tasks seemed most important for the youngest children, whereas ELS shifted towards societal involvement for adolescents.

CONCLUSION

Eleven categories related to ICF-CY chapters d3-d9 emerged as ELS. Two age groups (infants/preschoolers and adolescents) are required to develop code sets for the new tool. The results need triangulation with other concurrent studies to provide corroborating evidence and add a family perspective.

Exploring the relationship of family goals and scores on standardized measures in children with cerebral palsy, using the ICF-CY

AIM

To explore the relationships of family selected goals and scores on standardized measures using the ICF-CY as a classification system.

METHODS

Goal attainment scaling (GAS)-goals (n = 110) of 22 children, 11 girls, 1-6 years, bilateral or unilateral cerebral palsy, GMFCS I-IV and MACS I-IV were linked to the ICF-CY. The children had participated in goal-directed therapy during 12 weeks. GAS-goals, baseline assessments and change scores from PEDI and GMFM-66 were used to explore the relationships.

RESULTS

All GAS-goals were classified in the Activity and Participation domain within ICF-CY. The number of GAS-goals correlated to baseline scores in PEDI and GMFM-66. The change scores in PEDI and GMFM-66 correlated to goal attainment in the Mobility and the Self-Care chapter.

CONCLUSIONS

The family goals were reflected in standardized measures. The combined use of standardized and individual measures offers a possibility to explore the focus in therapy and the impact in children with cerebral palsy.

Inter-rater agreement in the assessment of response to motor and cognitive rehabilitation of children and adolescents with epilepsy

INTRODUCTION

To assess inter-rater agreement among child neurologists and psychiatrists on evaluation of response to physical and cognitive rehabilitation of children and adolescents with epilepsy.

MATERIALS AND METHODS

Five child neurologists/psychiatrists ("raters") were invited to draw 2-3 short case reports among those most commonly seen. 14 case histories were presented and raters used a structured questionnaire to report changes after selected rehabilitation programs. Response was coded as "Yes", "No", or "Uncertain" in different functional domains (Motor, Social, Alimentary, Communication, Personal Autonomy). Inter-rater agreement was measured using the kappa statistic. Raters where then asked to discuss any reason for disagreement. The test was repeated with different cases (16 case histories) adding a sixth rater, who had participated to the discussion.

RESULTS

Even with this small number of cases, the agreement mostly ranged from poor to good in the first test (worse for Social, Personal Autonomy and Communication). Training improved agreement in almost all domains. There were no frank outliers. The agreement was lower with a specific approach (i.e. grouping "Uncertain" to "No") than with sensitive approach (i.e. grouping "Uncertain" to "Yes").

DISCUSSION

The interpretation of patients' response to physical and cognitive rehabilitation tends to vary among Italian child neurologists/psychiatrists depending on measures and training procedures. Discussion and training improves agreement, although this is only a pilot study conducted using a non standardized questionnaire.

Comparison of the GMFM-66 and the PEDI Functional Skills Mobility domain in a group of Chinese children with cerebral palsy

BACKGROUND

Previous research has suggested there is a high level of comparability between the Gross Motor Function Measure-66 (GMFM-66) and the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Mobility domain. However, there are only a few studies that have examined the correlations between these instruments. The purpose of this study was to determine the correlation between the GMFM-66 and the PEDI Functional Skills Mobility domain scaled scores in a group of Chinese children with spastic cerebral palsy, at the ages of 12-70 months, in order to explore the feasibility of using them interchangeably.

METHODS

Secondary data analysis was conducted of data collected during a prospective international collaborative study that used the GMFM-66 and the PEDI to examine the impact of treatment. This study examined the Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain at six time points over the course of 28 consecutive weeks for 115 Chinese children who participated at baseline.

RESULTS

Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain ranged from 0.83 to 0.90 for the six time points of data collection, with statistically significant P-values <0.0001 for each correlation.

CONCLUSIONS

These results support previous research that the GMFM-66 and the PEDI Functional Skills Mobility domain are complementary assessments that may be used interchangeably when it is not possible to administer both.

Functional classification of pulmonary hypertension in children: Report from the PVRI pediatric taskforce, Panama 2011

The members of the Pediatric Task Force of the Pulmonary Vascular Research Institute (PVRI) were aware of the need to develop a functional classification of pulmonary hypertension in children. The proposed classification follows the same pattern and uses the same criteria as the Dana Point pulmonary hypertension specific classification for adults. Modifications were necessary for children, since age, physical growth and maturation influences the way in which the functional effects of a disease are expressed. It is essential to encapsulate a child's clinical status, to make it possible to review progress with time as he/she grows up, as consistently and as objectively as possible. Particularly in younger children we sought to include objective indicators such as thriving, need for supplemental feeds and the record of school or nursery attendance. This helps monitor the clinical course of events and response to treatment over the years. It also facilitates the development of treatment algorithms for children. We present a consensus paper on a functional classification system for children with pulmonary hypertension, discussed at the Annual Meeting of the PVRI in Panama City, February 2011.

Reliability and the measurement of activity limitations (ADLs) for children with special health care needs (CSHCN) living in the community

PURPOSE

Meeting the personal care challenges of children with special health care needs (CSHCN) living in the community demands a reliable assessment of their abilities to perform activities of daily living (ADLs). This research investigates factors affecting the inter-rater reliability of functional assessments of CSHCN conducted in the home.

METHODS

Dual-standardised assessments were conducted with 236 community-dwelling CSHCN seeking or receiving Medicaid Personal Care Services (PCS) in a single state in USA.

RESULTS

Analyses revealed that assessments of CSHCN with the greatest or least amount of activity limitations exhibited the greatest agreement. The greatest disagreement occurred when assessors faced children with moderate to moderately severe activity limitations. Specific ADLs, where the greatest and least agreements occurred, varied by the level of the child's overall activity limitation.

CONCLUSIONS

These results imply that the most serious challenges to the reliability of home-based assessment of ADLs among CSHCN occur in cases of children with moderate or moderately severe activity limitations.

Psychosocial issues in children and adolescents with HIV infection evaluated with a World Health Organization age-specific descriptor system

OBJECTIVES

After active antiretroviral therapy, children with HIV are clinically well, whereas psychosocial issues continue to influence their quality of life. The International Classification of Functioning, Disability and Health (ICF) of the World Health Organization evaluates health status and environmental and social factors associated with health. We investigated the efficacy of the ICF to describe the health status and needs of a cohort of children and adolescents with HIV seen at a reference center for pediatric AIDS in Europe.

METHODS

A quantitative analysis of structured interviews was performed. Caregivers of children and adolescents with HIV infection in follow-up at 2 reference centers for pediatric AIDS were enrolled. Four major areas included in the ICF instrument were investigated: impairments of body structures; impairments of body functions; environmental factors; and activity limitations and restrictions to social life.

RESULTS

Forty-one families of children with HIV were enrolled. Body structures and functions were marginally impaired, whereas environmental factors and psychosocial issues had a relevant impact on quality of life. Most families considered environmental factors to be "barriers"; these were poverty, unemployment, and single-parent family structure. Activity limitations and social restrictions were also reported in a few cases. Almost all parents reported problems in disclosing their child's HIV status because of the fear of social stigma.

CONCLUSION

Psychosocial issues are part of the well-being of children with HIV. The ICF is a standard tool to evaluate the clinical and psychosocial status of children and adolescents with HIV infection and to measure the impact of therapeutic interventions and strategies on psychosocial functioning.

Prevalence, nature, and correlates of sleep problems among children with fragile X syndrome based on a large scale parent survey

STUDY OBJECTIVES

This study reports on current child sleep difficulties reported by parents of children with Fragile X syndrome (FXS). We address prevalence and type of sleep problems (e.g., difficulty falling asleep, frequent awakenings); type and effectiveness of medical and behavioral treatments (e.g., medication, surgery, environmental changes); and explore specific child and family characteristics (e.g., child age, child gender, co-occurring conditions) as possible predictors of child sleep difficulties.

DESIGN/PARTICIPANTS

This study is part of a larger survey addressing needs of families with children with FXS. This article focuses on the families who responded to the survey sleep questions, had one or more children with the full mutation FXS, and who reside in the United States. The mean age for male and female children in this group was 15 years and 16 years respectively (N=1295).

RESULTS

Parents reported that 32% of the children with FXS currently experience sleep difficulties; 84% of those children are reported to have > or =2 current sleep problems. Problems falling asleep and frequent night awakenings were the most frequently reported difficulties; 47% of males and 40% of females received > or =1 medication to help with sleep. Children with more problematic health or behavioral characteristics had a higher likelihood of having current sleep problems.

CONCLUSIONS

Our survey provides the most representative sample to date of sleep problems in children with FXS or any other neurodevelopmental disability. This large scale survey establishes a foundation for the prevalence of sleep disorders in children with FXS.

Development of the FOCUS (Focus on the Outcomes of Communication Under Six), a communication outcome measure for preschool children

AIM

Our aim was to develop an outcome measure, called Focus on the Outcomes of Communication Under Six (FOCUS), that captures real-world changes in preschool children's communication. Conceptually grounded in the World Health Organization International Classification of Functioning, Disability and Health framework, the FOCUS items were derived from observations of change provided by parents and clinicians after speech-language therapy.

METHOD

Participating families (n=165) were drawn from a convenience sample at partner institutions in Ontario, Newfoundland and Labrador, and Nova Scotia. All children had speech, language comprehension, and/or language production disorders and were receiving speech-language therapy. The age of the children ranged from 1 year 2 months to 5 years 6 months (mean=3.8y; SD=0.91y), and 119 children were male. Three test phases were completed. The measure was revised according to item analysis and parent/clinician feedback after phase 1 (n=74) and phase 2 (n=65). In phase 3 (n=26), the Pediatric Quality of Life Inventory (PedsQL), a health-related quality of life measure, was added to establish construct validity.

RESULTS

In phase 1, item analysis revealed high internal consistency for both parents (Cronbach's alpha=0.87) and clinicians (Cronbach alpha=0.97). These values indicated redundancy, so 31 items were cut. Five items for young children were added. In phase 2, internal consistency remained high for both parents (Cronbach alpha=0.98) and clinicians (Cronbach alpha=0.83), indicating redundancy of items. Twenty-seven items were removed. In phase 3, parents and clinicians reliably scored the FOCUS in 10 minutes. They stated that it provided an accurate snapshot of the child's communication. Internal consistency for parents remained high (Cronbach alpha=0.96). Children with higher FOCUS scores at the end of treatment had higher PedsQL total scores (r=0.466, p=0.029).

INTERPRETATION

The FOCUS is a usable measure of a child's ability to communicate and participate in his or her community. It demonstrates high internal consistency and construct validity.

The utility of ICF for describing interaction in non-speaking children with disabilities – caregiver ratings and perceptions

PURPOSE

The purpose of the study is to explore the utility of the International Classification of Functioning, Disability and Health (ICF) when assessing caregivers' perceptions of interaction and factors related to interaction in non-speaking children with disability.

METHOD

A questionnaire with focus on interaction and related factors was constructed by linking questions in existing instruments to ICF and was completed by 208 professionals and parents of 195 non-speaking children with disabilities in Russia. Caregivers' descriptions of interaction in open-ended questions were qualitatively analysed and compared to selected caregivers' ratings of children's functioning and environment in the questionnaire based on ICF.

RESULTS

In the open-ended questions about interaction the caregivers described modes of communication children used, situations in which interactions took place, positive and negative aspects of interactions. Thirty eight respondents described interaction with children negatively, 66 neutrally, and 76 positively. Statistical analyses revealed significant differences among the three groups of respondents concerning their ratings of children's functioning and environment in the ICF-based questionnaire.

CONCLUSIONS

The ICF-related items in the questionnaire corresponded to caregivers' perceptions of interaction, which shows their relevance for the description of interactions. ICF is feasible in describing of interaction and interaction-related factors in non-speaking children with disabilities in Russia.

Reliability in assigning ICF codes to children with special health care needs using a developmentally structured interview

PURPOSE

The purpose of this study was to determine if two teams of raters could reliably assign codes and performance qualifiers from the Activities and Participation component of the International Classification of Functioning, Disability, and Health (ICF) to children with special health care needs based on the results of a developmentally structured interview.

METHOD

Children (N = 40), ages 11 months to 12 years 10 months, with a range of health conditions, were evaluated using a structured interview consisting of open-ended questions and scored using developmental guidelines. For each child, two raters made a binary decision indicating whether codes represented an area of need or no need for that child. Raters assigned a performance qualifier, based on the ICF guidelines, to each code designated as an area of need. Cohen's kappa statistic was used as the measure of inter-rater reliability.

RESULTS

Team I reached good to excellent agreement on 39/39 codes and Team II on 38/39 codes. Team I reached good to excellent agreement on 5/5 qualifiers and Team II on 10/14 qualifiers.

CONCLUSIONS

A developmentally structured interview was an effective clinical tool for assigning ICF codes to children with special health care needs. The interview resulted in higher rates of agreement than did results from standardized functional assessments. Guidelines for assigning performance qualifiers must be modified for use with children.

Assessing self-care component of activities and participation domain of the international classification of functioning, disability and health (ICF) among people living with HIV/AIDS

Disability experience of persons with HIV illness has shifted from issues related to physical well-being to those concerning performance of daily life activities. This study aimed to find out the nature of self-care among people living with HIV/AIDS (PLWHA) in rural tertiary care center. The objectives were to determine reported self-care by performance qualifier of PLWHA and to find out reported self-care by capacity qualifier of PLHIV. A cross sectional study was conducted among the 194 PLHIV in rural tertiary care hospital. The Self-Care (d5) component of Activities and Participation domain (d) of the International Classification of Functioning, Disability and Health (ICF) was used. Among the 194 PLHIV patients studied, 82% were male. The average age was 36.87 years (SD+/-9.01) with a median of 35 years, varying from 15 to 65 years. Over 65% of the study group experienced one or more impairments. As HIV disease has become a more lifelong, unpredictable, but medically manageable condition, there is a need for more collaboration with other disability groups in order to identify commonalities in their experiences and to share collective concerns.

Transparency and tuning of rehabilitation care for children with cerebral palsy: a multiple case study in five children with complex needs

PURPOSE

Generally, there is a lack of knowledge whether and how parent-identified problems, treatment goals and treatment activities are tuned in the treatment of children with cerebral palsy. This study aimed to observe whether parent-identified problems and treatment goals were documented ('transparency' of the rehabilitation process), and to examine the relationship ('tuning') of parent-identified problems to treatment goals and to treatment activities of children with cerebral palsy in pediatric rehabilitation in the Netherlands.

METHOD

Five school-aged subjects with cerebral palsy were observed in detail during physical, occupational, and speech therapy, and their written reports were studied. Parent-identified problems, treatment goals, and treatment activities were linked to the ICF components, domains and categories and the amount of agreement was determined by code comparison.

RESULTS

Only two children with a total of six parent-identified problems could be documented. Forty-five treatment goals were identified and 72 treatment activities were observed. The analyses indicated some tuning of parent-identified problems, goals and activities in all subjects, but only four of the treatment activities were perfectly tuned to treatment goals as well as to parent-identified problems.

CONCLUSIONS

We conclude that transparency and tuning of the pediatric treatment process described in the present study could be improved substantially. Several suggestions for improving the transparency and tuning of the treatment process are discussed.

Identifying children with neurological impairment and disability in resource-poor countries

BACKGROUND

The burden of neurological impairment (NI) in children living in resource-poor countries (RPCs) is unknown. This lack of data is caused by inappropriate case detection techniques. In RPCs, the most appropriate method should be inexpensive, simple, rapid and accurate. This article reviews methods used to identify children with NI and disability in RPCs, evaluating their effectiveness and suitability.

METHODS

A search of relevant articles was performed using the National Library of Medicine via PubMed and Medline search engines. In addition, bibliographies of reviews were also browsed to identify additional articles, particularly those from World Health Organization and United Nations sources and from government and unpublished reports. Key phrases used included impairment, disability or handicap and the following terms: identification, screening, prevalence and developing countries. Studies included were those that fulfilled the following criteria; performed in RPCs, presented data in detail to allow reanalysis and provided data on cost and validity of the methods.

RESULTS

Use of the national census, key informants and methods using rapid rural appraisal have low sensitivity and are not able to provide adequate information on diagnostic categories or risk factors. House-to-house surveys using questionnaires have high sensitivities (63-100%) in the detection of impairment, but this approach remains relatively expensive and cannot be applied to an entire population (e.g. a region or country) and is thus less useful for assessing the needs of disability. Furthermore, the sensitivity is decreased in the detection of some domains, e.g. cognition.

CONCLUSIONS

Most of the approaches used for identifying individuals with NI or disability suffer from inadequacies, the main ones being low sensitivity and underreporting. To assess the burden, nationwide censuses combined with surveys in selected areas of the country may be useful. These systems, however, require validation to establish their suitability.

Using the International Classification of Functioning, Disease and Health in Attention-Deficit/Hyperactivity Disorder: Separating the Disease From Its Epiphenomena

This paper discusses the description of attention-deficit/hyperactivity disorder (ADHD) as a possible "disease entity" and the "disabilities" associated with it. It builds on the nosological descriptions of ADHD from International Classification of Disease (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) perspectives and introduces the distinct disability dimension from the International Classification of Functioning, Disability and Health (ICF) perspective. It advocates for separating assessment of disease and disability dimensions and then utilizing these constructs jointly by using both the ICD and ICF classifications. The ICF analyzes functioning in relation to a health condition in terms of 1) body functions and body structures, 2) activities of the person and participation of the person in society, and 3) contextual factors such as environmental factors and personal factors. The separation of signs/symptoms and consequences permits better understanding of the disease pathophysiology on the one hand and the consequences (eg, its impact on the person, family, peers, school, work, and social life) on the other hand. It will therefore enable us to better understand the nature of ADHD because the core body functions associated with the disorder will be better delineated. In addition, capturing environmental factors may help people with ADHD by modifying their environments. The ICF provides a good outcome monitoring and evaluation tool for the assessment of treatment response. As in many other disorders, diagnosis alone is not a sufficient predictor of health care needs, utilization, costs, or outcomes. When one adds disability as a predictor, our capacity to predict these parameters is increased dramatically. It is therefore suggested that the ICF framework be considered in future ADHD research activities.

Consequential Validity of an Assistive Technology Supplement for the School Function Assessment

Educators and therapists implement assistive technology to maximize educational outcomes of students with disabilities. However, few measure the outcomes of interventions because of a lack of valid measurement tools. This study investigated whether an assistive technology supplement for the School Function Assessment demonstrates an important aspect of construct validity. Specifically, the study examined a type of consequential validity. Twenty-eight school-based therapists participated in the study. Two t tests compared a group using the School Function Assessment (n = 13) to a group using the assistive technology supplement to the School Function Assessment (n = 15). The first t test examined the difference in confidence therapists perceived in their ability to develop assistive technology interpretations. The second t test compared the number of assistive technology interpretations matching those of an expert panel. The first t test did not achieve significance (p = .998). The second t test achieved significance (p = .001). These results suggest, with certain limitations, that the assistive technology supplement for the School Function Assessment exhibits this important aspect of construct validity.

Human and automated coding of rehabilitation discharge summaries according to the International Classification of Functioning, Disability, and Health

OBJECTIVE

The International Classification of Functioning, Disability, and Health (ICF) is designed to provide a common language and framework for describing health and health-related states. The goal of this research was to investigate human and automated coding of functional status information using the ICF framework.

DESIGN

The authors extended an existing natural language processing (NLP) system to encode rehabilitation discharge summaries according to the ICF.

MEASUREMENTS

The authors conducted a formal evaluation, comparing the coding performed by expert coders, non-expert coders, and the NLP system.

RESULTS

Automated coding can be used to assign codes using the ICF, with results similar to those obtained by human coders, at least for the selection of ICF code and assignment of the performance qualifier. Coders achieved high agreement on ICF code assignment.

CONCLUSION

This research is a key next step in the development of the ICF as a sensitive and universal classification of functional status information. It is worthwhile to continue to investigate automated ICF coding.

ICF and ICD codes provide a standard language of disability in young children

BACKGROUND AND OBJECTIVES

The aim of this study was to examine the utility of a hierarchical algorithm incorporating codes from the International Classification of Functioning, Disability and Health--ICF (WHO, 2001) and the International Statistical Classification of Diseases-ICD (WHO, 1994) to classify reasons for eligibility of young children in early intervention.

METHODS

The database for this study was a nationally representative enrollment sample of more than 5,500 children in a longitudinal study of early intervention. Reasons for eligibility were reviewed and matched to the closest ICF or ICD codes under one of four major categories (Body Functions/Structures, Activities/Participation, Health Conditions, and Environmental Factors).

RESULTS

The average number of reasons for eligibility provided per child was 1.5, resulting in a population summary exceeding 100%. A total of 305 ICF and ICD codes were used with most (77%) of the children having codes in the category of Body Function/Structures. Forty-one percent of the sample had codes of Health Conditions, whereas the proportions with codes in the Activities/Partipication and Environmental Categories were 10 and 5%, respectively.

CONCLUSIONS

The results demonstrate that ICD and ICF can be jointly used as a common language to document disability characteristics of children in early intervention.

Diagnosis to function: classification for children and youths

This article provides an overview of a newly approved World Health Organization framework and classification system for human functioning. The International Classification of Functioning, Disability, and Health (ICF) identifies dimensions of human functioning and describes a common language for clinical practice, research, and policy development across disciplines and service systems. This presentation highlights the development of a version of the ICF for children and youths (ICF-CY) and its potential utility in developmental and behavioral pediatrics. Clinical, research, and policy dimensions are described. Limitations related to scope and clarity of the framework are also outlined. The article proposes that serious consideration be given the ICF-CY as an integrated system to clarify constructs, improve communication, and encourage coordination of health services for children and youths.

Health measurement using the ICF: test-retest reliability study of ICF codes and qualifiers in geriatric care

Background

The International Classification of Functioning, Disability and Health (ICF) was published by the World Health Organization (WHO) to standardize descriptions of health and disability. Little is known about the reliability and clinical relevance of measurements using the ICF and its qualifiers. This study examines the test-retest reliability of ICF codes, and the rate of immeasurability in long-term care settings of the elderly to evaluate the clinical applicability of the ICF and its qualifiers, and the ICF checklist.

Methods

Reliability of 85 body function (BF) items and 152 activity and participation (AP) items of the ICF was studied using a test-retest procedure with a sample of 742 elderly persons from 59 institutional and at home care service centers. Test-retest reliability was estimated using the weighted kappa statistic. The clinical relevance of the ICF was estimated by calculating immeasurability rate. The effect of the measurement settings and evaluators' experience was analyzed by stratification of these variables. The properties of each item were evaluated using both the kappa statistic and immeasurability rate to assess the clinical applicability of WHO's ICF checklist in the elderly care setting.

Results

The median of the weighted kappa statistics of 85 BF and 152 AP items were 0.46 and 0.55 respectively. The reproducibility statistics improved when the measurements were performed by experienced evaluators. Some chapters such as genitourinary and reproductive functions in the BF domain and major life area in the AP domain contained more items with lower test-retest reliability measures and rated as immeasurable than in the other chapters. Some items in the ICF checklist were rated as unreliable and immeasurable.

Conclusion

The reliability of the ICF codes when measured with the current ICF qualifiers is relatively low. The result in increase in reliability according to evaluators' experience suggests proper education will have positive effects to raise the reliability. The ICF checklist contains some items that are difficult to be applied in the geriatric care settings. The improvements should be achieved by selecting the most relevant items for each measurement and by developing appropriate qualifiers for each code according to the interest of the users.

Child or family assessed measures of activity performance and participation for children with cerebral palsy: a structured review

BACKGROUND

There is a need to measure children's 'activity performance and participation' as defined in the World Health Organization's International Classification of Functioning, Disability and Health for Children and Youth (WHO ICF). The aim of this review is to identify instruments that are suitable for use in postal surveys with families of children with cerebral palsy.

METHODS

We conducted a structured review of instruments that use child or family self-assessment of 'activity performance and participation'. The review involved a systematic search for instruments using multiple published sources. Appraisal of the instruments used the predefined criteria of appropriateness, validity, reliability, responsiveness, precision, interpretability, acceptability and feasibility.

RESULTS

There are relatively few child or family assessed instruments appropriate for measuring children's activities and participation. Seven instruments were identified that could potentially be administered by mail. The Assessment of Life Habits for Children (LIFE-H) was the most appropriate instrument as assessed by its content but the reliability of child or family self-assessment is not known. If the LIFE-H were shown to be a reliable self-report measure then the LIFE-H would be the recommended choice. Currently, the Activities Scale for Kids and the condition-specific Lifestyle Assessment Questionnaire for cerebral palsy (LAQ-CP) provide the broadest description of what and how frequently children with cerebral palsy perform a range of activities and thereby indicate participation. The LAQ-CP also provides additional contextual information on the impact of any disability on the participation of the family unit.

CONCLUSION

There remains much scope for developing valid and reliable self-assessed measures corresponding to the WHO ICF dimensions of activities and participation.