| ObjectiveThe objectives of this study are to evaluate the inter-rater reliability of expert physiotherapists and novice physiotherapists rating patients’functioning using the Brief ICF Core Set for stroke with its original qualifier rating scale; to explore the effect of the different assessment method for information gathering methods on raters in rating ICF.MethodsTwo hundred and sixty-eight patients were screened for participating from the second affiliated hospital of Guangzhou University of Traditional Chinese Medicine and the first hosipital affiliated to JINAN University in this study. The 10 physiotherapists participating were rehabilitation therapists working in two rehabilitation in-patient settings. The first study involved eight raters with four had more experience and four had less experience. In each clinical setting, the two experienced raters formed two pairs (called expert) while the other two less experienced raters formed another pair (called novice). Both of them were in the method to independently administrate the ICF for the patients. The second study involved two individual novice raters, one in each clinical setting, whose assessment method was firstly administrated clinical instruments then ICF.Results(1) At the item score level, according to the kappa coefficients and respective confidence intervals, the Cohen kappa coefficients were 0.74 (overall average; 95% CI:0.71-0.76) and ranged from 0.50 (e310; 95% CI:0.33-0.58) to 0.85 (b114; 95% CI:0.79-0.89) for the expert rater-pair, and 0.44 (overall average; 95% CI:0.40-0.49) and from 0.18 (e355; 95% CI:-0.24-0.60) to 0.69 (e580; 95% CI:0.65-0.71) for the novice rater-pair.(2) At the component score level, according to the ICC coefficients and respective confidence intervals, the reliability within the expert rater-pair were significant higher than the novice rater-pair at the components of Body Function and Body Structure, except the components of Activity and Participation and Environment factors.(3) Covariance analysis results showed whether Body Function, Body Structure, activity and participation, the expert raters were significant higher than the novice raters in the same assessment method (P<0.05); Both in Body Function and Body Structure, the novice raters in the assessment method of firstly clinical instruments then ICF were significant higher than the novice raters who were in the method of only administrating ICF (P<0.05),while, no statistical difference in Participation and Activity (P>0.05); There was no statistical difference between three groups for the environment factor (P>0.05).(4) Pearson correlation analysis results showed Body Function was in moderate to high degree of negative correlation with the FMA, MBI, MoCA and SF-36, and moderate positive correlation with mRS; Body Structure was in low to moderate degree of negative correlation with MoCA, FMA, MBI, SF-36, and low positive correlation with mRS; the participation and activities was in high degree of negative correlation with FMA, MBI, SF-36, high positive correlation with mRS(0.40<|r|<0.85, P<0.05), whether experienced or inexperienced groups, there is only weak correlation between 6 clinical instruments and environment factor are (r<0.20, P>0.05)Conclusion(1) The raters’ clinical experience may promote a positive effect on interraters reliability of Brief ICF core set for stroke, and which could be improved by the expert raters.(2) It seemed in a upward tendency for the novice raters, who had a prior experience of clinical instrument assessment on the patients, generating a higher factor score than the novice raters and near the level of ICF performance of expert raters, especially in the Body Function and structure which were significant higher than the novice raters. |
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