Determining the inter-rater reliability of the SOFMER Activity Score (version 2) for subjects in rehabilitation centers

OBJECTIVES

To assess the inter-rater reliability of the SOFMER Activity Score (SAS, version 2, an 8-item -4 motor and 4 cognitive- and 5-level scale) and improve its scoring system before conducting further validation steps.

DESIGN

Cross-sectional, prospective, observational, non-interventional, and multicentric study.

SETTING

The study was conducted between November 2018 and September 2019 in four French rehabilitation centers (two public university hospitals for adults and two private not-for-profit rehabilitation centers for children).

PARTICIPANTS

The study included 101 subjects (mean age: 44.5 years; SD: 25.4; 28.7% under 18 and 18.8% over 65). The female/male sex ratio was 0.6. The causes for admission to the center were mainly neurological (65%) or orthopedic (24%).

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

Activity limitation was rated with the SOFMER Activity Score the same day by two independent multidisciplinary teams. The inter-rater reliabilities of the Score items were assessed using weighted kappa coefficients.

RESULTS

All weighted kappa coefficients ranged between 0.83 and 0.92 indicating 'good' to 'excellent' inter-rater reliability. Inter-team score disagreements occurred in 227 scores out of 808 (28%). The reason for most disagreements was unnoticed human or material aid during the observation period.

CONCLUSION

The results demonstrate the high inter-rater reliability of the SASv2 and allow carrying out further validation steps after minor changes to item scoring instructions and clearer definitions of some items that help improving scoring standardization. The SASv2 may then become a consistent measure of activity level for clinical research or burden of care investigations.

From congenial paralysis to post-early brain injury developmental condition: Where does cerebral palsy actually stand?

Cerebral palsy (CP), an umbrella term for a developmental motor disorder caused by early brain injury (EBI)/interference, remains debated. In this essay, we present a narrative, beginning with the original anatomical-clinical description of the so-called paralysie congéniale (congenial paralysis) by the French psychiatrist Jean-Baptiste Cazauvieilh. We then discuss how the concept has evolved over the last 2 centuries. We aim to illustrate these ideas with the biopsychosocial model of health, especially in light of the current neuroscientific and sociological knowledge of human development. We endeavour to integrate 3 connected but distinct entities: (1) the EBI as a seminal turning point of the individual's story; (2) the clinical findings we call CP, when motor impairment and activity limitation related to post-EBI (or other early non-progressive brain interference) appears, and; (3) a post-EBI developmental condition that encompasses the overall consequences of an EBI. This framework should guide individual, familial and collective care discussions and research strategies beyond the scope of CP.