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Visual Function Classification System for children with cerebral palsy: development and validation
Giovanni Baranello1,2, Sabrina Signorini3, Francesca Tinelli4
1UO Neurologia Dello Sviluppo, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Insights
The Visual Function Classification System (VFCS) is a validated tool for assessing how children with cerebral palsy (CP) use their vision. This reliable system aids in clinical communication and research for children with CP.
Area of Science:
- Ophthalmology
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) often impacts visual abilities, affecting daily life functioning.
- Standardized methods for classifying visual function in children with CP are needed for consistent clinical assessment and research.
- Existing assessments may not fully capture the functional use of vision in daily activities for this population.
Purpose of the Study:
- To develop and validate the Visual Function Classification System (VFCS).
- To create a reliable and meaningful system for classifying how children with CP utilize their visual abilities in everyday life.
- To ensure the VFCS is applicable in both clinical and research settings.
Main Methods:
- The VFCS was developed through literature review, clinical experience, nominal group processes, and international Delphi surveys.
- Construct validity was assessed by experts, and external validation involved various stakeholders, including patients and families.
- Interrater reliability among professionals and with caregivers, along with test-retest reliability, was evaluated using a sample of children with CP.
Main Results:
- The VFCS development involved multiple consensus-building phases with significant participant engagement.
- High interrater reliability (κ=0.88) was achieved among professionals, and excellent test-retest reliability (κ=0.97) was demonstrated.
- Moderate parent-professional interrater reliability (κ=0.51) was observed, indicating a need for clear communication protocols.
Conclusions:
- The Visual Function Classification System (VFCS) is a valid and reliable tool for classifying visual abilities in children with cerebral palsy.
- The VFCS can enhance communication among clinicians, identify patient needs, and facilitate patient stratification in research.
- This system provides a standardized approach to understanding and addressing visual function challenges in children with CP.
Aim:
To develop and validate the Visual Function Classification System (VFCS), which was created to classify how children with cerebral palsy (CP) use visual abilities in daily life.
Method:
The process of development and validation of the VFCS involved four phases: (1) drafting of the five levels from the analysis of literature and clinical experience; (2) validation of constructs and revision of the levels for concept meaningfulness, using nominal group process; (3) refinement by international Delphi survey; and(4) assessment of interrater reliability among professionals and with caregivers, and of test-retest reliability.
Results:
Five nominal groups involved 29 participants; 65 people completed the first round and 51 the second round of the Delphi survey. Construct validity was demonstrated within an expert group and external validation through several stakeholders, with the involvement of patients and families to ensure meaningfulness of the concept. Discussions continued until consensus was reached about the construct and content of the five levels. Participants in the reliability study included 29 professionals, 39 parents, and a total sample of 160 children with CP (mean age [SD] 6y 6mo [3y 4mo]; median 5y 7mo, range 1-19y). Absolute interrater agreement among professionals was 86% (weighted κ=0.88; 95% confidence interval [CI] 0.83-0.93). Test-retest reliability was high (weighted κ=0.97; 95% CI 0.95-0.99). Parent-professional interrater reliability on 39 children was moderate (weighted κ=0.51; 95% CI 0.39-0.63).
Interpretation:
The VFCS has been appropriately constructed and provides a reliable system to classify visual abilities of children with CP both in clinical and in research settings.
What This Paper Adds:
The Visual Function Classification System is a valid and reliable system. It classifies visual abilities of children with cerebral palsy in clinical and research settings. At a clinical level, it can be used to harmonize communication among professionals and identify patients' strengths and weaknesses. In research settings, it can be used to stratify patients, define natural history evolution, and interpret intervention studies.
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