Vander Zwart Karlijn E, Geytenbeek Joke J, de Kleijn Maaike, Oostrom Kim J, Gorter Jan Willem, Hidecker Mary Jo Cooley, Vermeulen R Jeroen
Department of Rehabilitation, Via Reva Rehabilitation Center, Apeldoorn, the Netherlands.
Department of Paediatric Rehabilitation Medicine, VU Medical Center, Amsterdam, the Netherlands.
Dev Med Child Neurol. 2016 Feb;58(2):180-8. doi: 10.1111/dmcn.12839. Epub 2015 Jul 1.
The aims of this study were to determine the intra- and interrater reliability of the Dutch-language version of the Communication Function Classification System (CFCS-NL) and to investigate the association between the CFCS level and (1) spoken language comprehension and (2) preferred method of communication in children with cerebral palsy (CP).
Participants were 93 children with CP (50 males, 43 females; mean age 7y, SD 2y 6mo, range 2y 9mo-12y 10mo; unilateral spastic [n=22], bilateral spastic [n=51], dyskinetic [n=15], ataxic [n=3], not specified [n=2]; Gross Motor Function Classification System level I [n=16], II [n=14], III, [n=7], IV [n=24], V [n=31], unknown [n=1]), recruited from rehabilitation centres throughout the Netherlands. Because some centres only contributed to part of the study, different numbers of participants are presented for different aspects of the study. Parents and speech and language therapists (SLTs) classified the communication level using the CFCS. Kappa was used to determine the intra- and interrater reliability. Spearman's correlation coefficient was used to determine the association between CFCS level and spoken language comprehension, and Fisher's exact test was used to examine the association between the CFCS level and method of communication.
Interrater reliability of the CFCS-NL between parents and SLTs was fair (r=0.54), between SLTs good (r=0.78), and the intrarater (SLT) reliability very good (r=0.85). The association between the CFCS and spoken language comprehension was strong for SLTs (r=0.63) and moderate for parents (r=0.51). There was a statistically significant difference between the CFCS level and the preferred method of communication of the child (p<0.01). Also, CFCS level classification showed a statistically significant difference between parents and SLTs (p<0.01).
These data suggest that the CFCS-NL is a valid and reliable clinical tool to classify everyday communication in children with CP. Preferably, professionals should classify the child's CFCS level in collaboration with the parents to acquire the most comprehensive information about the everyday communication of the child in various situations both with familiar and with unfamiliar partners.
本研究旨在确定荷兰语版沟通功能分类系统（CFCS-NL）的评分者内及评分者间信度，并调查CFCS水平与（1）口语理解能力以及（2）脑瘫（CP）患儿首选沟通方式之间的关联。
研究对象为93名CP患儿（男50名，女43名；平均年龄7岁，标准差2岁6个月，范围2岁9个月至12岁10个月；单侧痉挛型[n=22]，双侧痉挛型[n=51]，运动障碍型[n=15]，共济失调型[n=3]，未明确类型[n=2]；粗大运动功能分类系统I级[n=16]，II级[n=14]，III级[n=7]，IV级[n=24]，V级[n=31]，未知[n=1]），从荷兰各地的康复中心招募。由于一些中心仅参与了部分研究，因此针对研究的不同方面呈现了不同数量的参与者。家长和言语治疗师（SLT）使用CFCS对沟通水平进行分类。使用kappa系数确定评分者内及评分者间信度。使用Spearman相关系数确定CFCS水平与口语理解能力之间的关联，使用Fisher精确检验检查CFCS水平与沟通方式之间的关联。
家长与SLT之间CFCS-NL的评分者间信度为中等（r=0.54），SLT之间为良好（r=0.78），评分者内（SLT）信度非常好（r=0.85）。CFCS与口语理解能力之间的关联对于SLT而言较强（r=0.63），对于家长而言为中等（r=0.51）。CFCS水平与患儿首选沟通方式之间存在统计学显著差异（p<0.01）。此外，CFCS水平分类在家长与SLT之间也存在统计学显著差异（p<0.01）。
这些数据表明CFCS-NL是一种有效且可靠的临床工具，可用于对CP患儿的日常沟通进行分类。最好由专业人员与家长合作对患儿的CFCS水平进行分类，以便获取关于患儿在各种情况下与熟悉及不熟悉伙伴进行日常沟通的最全面信息。
