Caynes Katy D, Rose Tanya A, Ware Robert S, Johnston Leanne M
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia and.
Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
Int J Speech Lang Pathol. 2025 Apr;27(2):296-308. doi: 10.1080/17549507.2023.2287991. Epub 2024 Feb 20.
To examine novice inter-rater agreement and clinical utility perspectives for speech and communication classification of children with cerebral palsy (CP).
Twenty-one clinicians (speech-language pathologists [SLPs] = 11; physiotherapists [PTs] = 5; occupational therapists [OTs] = 5) novice to the Viking Speech Scale (VSS), Functional Communication Classification System (FCCS), and Communication Function Classification System (CFCS) rated eight unfamiliar children with CP (8-16 years) following classification orientation. Inter-rater agreement was examined between (a) novices, (b) novice SLPs vs. PTs and OTs, and (c) novice vs. expert (kappa statistics). Utility perceptions were scored regarding classification terminology, ease of use, assistive decision-making resources, and construct validity and were analysed using Kruskal-Wallis -tests.
Rating agreement between novices was substantial (VSS, = 0.72, 95% CI [0.53-0.92]) to moderate (FCCS, = 0.44, 95% CI [0.23-0.65]; CFCS, = 0.45, 95% CI [0.18-0.71]), and almost perfect between novice and expert ratings (VSS, = 0.89, 95% CI [0.86-0.92]; FCCS, = 0.89, 95% CI [0.86-0.92]; CFCS, = 0.86, 95% CI [0.82-0.91]). Statistically significant differences, presented highest to lowest, were found for clinical utility: terminology (VSS, FCCS, CFCS; = 0.02), assistive decision-making resources (FCCS, VSS, CFCS; = 0.009), and construct validity (FCCS, CFCS, VSS; < 0.001).
Novice raters achieved substantial agreement for speech classification, supporting utilisation in clinical, research, and CP register activities. Orientation to communication classification constructs, content, and instructions is recommended for novice raters.
研究脑瘫（CP）儿童言语和沟通分类的新手评分者间一致性及临床效用观点。
21名对维京言语量表（VSS）、功能性沟通分类系统（FCCS）和沟通功能分类系统（CFCS）不熟悉的临床医生（言语治疗师[SLP] = 11名；物理治疗师[PT] = 5名；职业治疗师[OT] = 5名）在接受分类指导后，对8名不熟悉的CP儿童（8 - 16岁）进行评分。检验了（a）新手之间、（b）新手言语治疗师与物理治疗师及职业治疗师之间以及（c）新手与专家之间的评分者间一致性（kappa统计量）。对分类术语、易用性、辅助决策资源和结构效度的效用认知进行评分，并使用Kruskal - Wallis检验进行分析。
新手之间的评分一致性为中等（FCCS，κ = 0.44，95%可信区间[0.23 - 0.65]；CFCS，κ = 0.45，95%可信区间[0.18 - 0.71]）到较高（VSS，κ = 0.72，95%可信区间[0.53 - 0.92]），新手与专家评分之间几乎完全一致（VSS，κ = 0.89，95%可信区间[0.86 - 0.92]；FCCS，κ = 0.89，95%可信区间[0.86 - 0.92]；CFCS，κ = 0.86，95%可信区间[0.82 - 0.91]）。在临床效用方面发现了具有统计学意义的差异，从高到低依次为：术语（VSS、FCCS、CFCS；P = 0.02）、辅助决策资源（FCCS、VSS、CFCS；P = 0.009）和结构效度（FCCS、CFCS、VSS；P < 0.001）。
新手评分者在言语分类方面达成了较高的一致性，支持在临床、研究和CP登记活动中的应用。建议对新手评分者进行沟通分类结构、内容和指导方面的培训。
