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Development and Validation of the Toileting Function Classification System for Children With Cerebral Palsy Ages 6-18
Azade Riyahi1, Afsoon Hassani Mehraban2, Mehdi Rassafiani3
1Azade Riyahi, PhD, is Assistant Professor of Occupational Therapy, Department of Occupational Therapy, School of Rehabilitation, Arak University of Medical Sciences, Arak, Markazi Province, Iran.
Insights
A new Toileting Function Classification System (TFCS) was developed for children with cerebral palsy (CP), offering a reliable way to document and address toileting challenges. This system improves communication and guides interventions to enhance quality of life for children with CP.
Area of Science:
- Pediatric Rehabilitation
- Developmental Disabilities
- Functional Classification Systems
Background:
- Children with cerebral palsy (CP) experience significant toileting challenges due to impairments and environmental factors.
- These challenges impact daily function and participation but are often overlooked in care planning.
- Existing classification systems do not adequately address specific toileting difficulties in children with CP.
Purpose of the Study:
- To develop and validate the Toileting Function Classification System (TFCS) for children with CP aged 6-18.
- To create a standardized tool for assessing and documenting toileting function.
- To facilitate tailored interventions and resource allocation for improved care.
Main Methods:
- A six-phase development approach including conceptualization, expert consultation, and stakeholder consensus.
- Delphi-based validation and reliability assessments (interrater and test-retest) were conducted.
- Involved 180 children with CP, 180 caregivers, and 24 CP and toileting experts.
Main Results:
- The TFCS achieved over 80% agreement on key components after two Delphi rounds.
- Reliability values ranged from .61 to 1.00, indicating substantial to almost perfect agreement.
- The system effectively classified toileting functions across five distinct levels.
Conclusions:
- The TFCS offers a reliable framework for documenting and managing toileting challenges in children with CP.
- Implementation of the TFCS enhances communication between families and professionals.
- The system supports rehabilitation programs, ultimately aiming to improve the quality of life for children with CP.
Importance:
Children with cerebral palsy (CP) and other neurodevelopmental conditions often face significant toileting challenges because of motor, sensory, cognitive, and behavioral impairments, as well as environmental factors such as limited caregiver awareness. These difficulties affect daily function and participation, yet they are often overlooked when documenting daily challenges in existing functional classification systems or care planning.
Objective:
To develop and validate the Toileting Function Classification System (TFCS) for children with cerebral palsy ages 6-18, enabling tailored interventions and resource allocation.
Design:
A six-phase approach: initial conceptualization and drafting, preliminary refinement, expert consultation through interviews, stakeholder consensus building through nominal and focus groups, Delphi-based content validation, and reliability assessments similar to those of other functional classification systems.
Setting:
Various clinical and research environments involving experienced professionals, caregivers, and children with CP.
Participants:
One hundred eighty children with CP, 180 caregivers, and 24 professionals with expertise in CP and toileting.
Outcomes And Measures:
Reliability (interrater and test-retest consistency) was measured using weighted κ; consensus was evaluated through Delphi surveys.
Results:
The Delphi survey achieved over 80% agreement on key TFCS components across two rounds. Reliability values ranged from .61 to 1.00, demonstrating substantial to almost perfect agreement. The system successfully classified toileting functions across five levels, supporting its clinical and research applications.
Conclusions And Relevance:
The TFCS provides a reliable framework for documenting and addressing toileting challenges in children with CP. Its implementation enhances family-professional communication and guides rehabilitation programs, ultimately improving quality of life. Plain-Language Summary: Toileting is a complex part of daily life that can be especially challenging for many children with disabilities. Difficulties with toileting are often linked to a combination of physical, sensory, and cognitive factors and may be even greater when conditions such as cerebral palsy occur alongside intellectual or developmental disabilities. This study focused on children with cerebral palsy and the development of a new classification system to describe their toileting function in a structured way. This tool can help occupational therapists and families better understand a child's needs and plan appropriate supports, contributing to improved care and quality of life.
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