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

Area of Science:

• Pediatric rehabilitation
• Disability assessment
• Health classification systems

Background:

• The International Classification of Functioning, Disability, and Health (ICF) provides a standardized framework for describing health and disability.
• Accurate coding of children's functional status is crucial for research, clinical practice, and policy.
• Standardized pediatric functional assessments are commonly used but their alignment with ICF coding requires investigation.

Purpose of the Study:

• To evaluate inter-rater reliability in assigning ICF Activities and Participation codes to children with disabilities.
• To determine if independent raters achieve consistent coding decisions based on standard functional assessment results.

Main Methods:

• Sixty children (9 months–17.75 years) with disabilities were assessed using the Vineland Adaptive Behavior Scales, Pediatric Evaluation of Disability Inventory (PEDI), or School Function Assessment (SFA).
• Two independent raters assigned ICF Activities and Participation codes based on assessment results.
• Cohen's kappa statistic was used to measure inter-rater reliability.

Main Results:

• Good agreement (kappa ≥ 0.70) was achieved for 23/40 ICF codes with the Vineland, 17/40 with PEDI, and 17/40 with SFA.
• Mean kappa reached ≥ 0.70 for the Self-care domain across all three tools.
• The Vineland demonstrated good agreement for Learning and Applying Knowledge and Mobility domains.

Conclusions:

• Developmentally structured assessment items that map to single ICF codes enhance rater agreement.
• For ICF domains beyond Self-care, alternative assessment strategies may be needed to improve coding accuracy for pediatric populations.
• This study highlights the importance of assessment tool design in reliable ICF code assignment for children.