title: Inter-rater agreement in the assessment of response to motor and cognitive rehabilitation of children and adolescents with epilepsy.
abstract: BACKGROUND
  To assess inter-rater agreement among child neurologists and psychiatrists on evaluation of response to physical and cognitive rehabilitation of children and adolescents with epilepsy.
  
  
  METHODS
  Five child neurologists/psychiatrists ("raters") were invited to draw 2-3 short case reports among those most commonly seen. 14 case histories were presented and raters used a structured questionnaire to report changes after selected rehabilitation programs. Response was coded as "Yes", "No", or "Uncertain" in different functional domains (Motor, Social, Alimentary, Communication, Personal Autonomy). Inter-rater agreement was measured using the kappa statistic. Raters where then asked to discuss any reason for disagreement. The test was repeated with different cases (16 case histories) adding a sixth rater, who had participated to the discussion.
  
  
  RESULTS
  Even with this small number of cases, the agreement mostly ranged from poor to good in the first test (worse for Social, Personal Autonomy and Communication). Training improved agreement in almost all domains. There were no frank outliers. The agreement was lower with a specific approach (i.e. grouping "Uncertain" to "No") than with sensitive approach (i.e. grouping "Uncertain" to "Yes").
  
  
  CONCLUSIONS
  The interpretation of patients' response to physical and cognitive rehabilitation tends to vary among Italian child neurologists/psychiatrists depending on measures and training procedures. Discussion and training improves agreement, although this is only a pilot study conducted using a non standardized questionnaire.
authors.affiliation: Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
authors.forename: Matteo
authors.initials: M
authors.lastname: Chiappedi
authors.forename: Oreste
authors.initials: O
authors.lastname: Ferrari-Ginevra
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ghezzo
authors.forename: Emanuela
authors.initials: E
authors.lastname: Maggioni
authors.forename: Flavia
authors.initials: F
authors.lastname: Mattana
authors.forename: Patrizia
authors.initials: P
authors.lastname: Spelta
authors.forename: Maria C
authors.initials: MC
authors.lastname: Stefanini
authors.forename: Paolo
authors.initials: P
authors.lastname: Biserni
authors.forename: Pietro
authors.initials: P
authors.lastname: Tonali
mesh_terms: D000293:Adolescent; D002648:Child; D002665:Child Psychiatry / Q000592:standards*; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy / Q000592:standards*; D004827:Epilepsy / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D009069:Movement Disorders / Q000503:physiopathology / Q000534:rehabilitation; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000379:methods*; D026741:Physical Therapy Modalities / Q000592:standards*; D010865:Pilot Projects; D011795:Surveys and Questionnaires / Q000592:standards