Speech and communication classification of children with cerebral palsy: Novice rater agreement and clinical utility

Katy D Caynes; Tanya A Rose; Robert S Ware; Leanne M Johnston

doi:10.1080/17549507.2023.2287991

Speech and communication classification of children with cerebral palsy: Novice rater agreement and clinical utility

Int J Speech Lang Pathol. 2024 Feb 20:1-13. doi: 10.1080/17549507.2023.2287991. Online ahead of print.

Authors

Katy D Caynes¹, Tanya A Rose¹, Robert S Ware², Leanne M Johnston¹

Affiliations

¹ School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia and.
² Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.

PMID: 38379211
DOI: 10.1080/17549507.2023.2287991

Abstract

Purpose: To examine novice inter-rater agreement and clinical utility perspectives for speech and communication classification of children with cerebral palsy (CP).

Method: Twenty-one clinicians (speech-language pathologists [SLPs] n = 11; physiotherapists [PTs] n = 5; occupational therapists [OTs] n = 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 H-tests.

Result: Rating agreement between novices was substantial (VSS, k = 0.72, 95% CI [0.53-0.92]) to moderate (FCCS, k = 0.44, 95% CI [0.23-0.65]; CFCS, k = 0.45, 95% CI [0.18-0.71]), and almost perfect between novice and expert ratings (VSS, k_w = 0.89, 95% CI [0.86-0.92]; FCCS, k_w = 0.89, 95% CI [0.86-0.92]; CFCS, k_w = 0.86, 95% CI [0.82-0.91]). Statistically significant differences, presented highest to lowest, were found for clinical utility: terminology (VSS, FCCS, CFCS; p = 0.02), assistive decision-making resources (FCCS, VSS, CFCS; p = 0.009), and construct validity (FCCS, CFCS, VSS; p < 0.001).

Conclusion: 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.

Keywords: Cerebral palsy; Communication Function Classification System (CFCS); Functional Communication Classification System (FCCS); Viking Speech Scale (VSS); children.