Methods for conceptualising 'visual ability' as a measurable construct in children with cerebral palsy.
Vision influences functioning and disability of children with cerebral palsy, so there is a growing need for psychometrically robust tools to advance assessment of children's vision abilities in clinical practice and research. Vision is a complex construct, and in the absence of clarity about this construct it is challenging to know whether valid, reliable measures exist. This study reports a method for conceptualising 'visual ability' as a measurable construct.



Using the items from 19 assessment tools previously identified in a systematic review, this study used a two-phase process: first, deductive content analysis linked items to the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY), and second, vision-specific 'Activity'-level items were explored using inductive thematic analysis.



The linking and content analysis identified that existing assessment tools are measuring vision across the ICF-CY domains of Body Functions, Activities and Participation, and Environmental and Personal Factors. Items specifically coded to vision at the Activity level were defined as measuring 'how vision is used', and these items form the basis of the conceptualisation that 'visual ability' is measurable as a single construct. The thematic analysis led to the identification of 3 categories containing 13 themes that reflect a child's observable visual behaviours. Seven abilities reflect how a child uses vision: responds or reacts, initiates, maintains or sustains looking, changes or shifts looking, searches, locates or finds, and follows. Four interactions reflect the contexts in which a child uses their vision to purposefully interact: watches and visually interacts with people and faces, objects, over distance, and with hands. Finally, two themes reflect a child's overall use of vision in daily activities: frequency of use, and efficiency of use.



This study demonstrates an approach to exploring and explaining a complex topic utilising World Health Organization language and building on existing research. Despite the complexity of vision, the concept of 'how vision is used' can be clearly defined as a measurable construct at the Activity level of the ICF-CY. This study has identified observable visual behaviours that may be developed into items assessing how vision is used in daily activities.
Australian Catholic University, School of Allied Health, Level 9, 33 Berry Street, North Sydney, NSW, 2060, Australia. belinda.deramoredenver@myacu.edu.au.
Belinda
B
Deramore Denver
Jönköping University, CHILD, School of Education and Communication, Box 1026, 551 11, Jönköping, Sweden.
Margareta
M
Adolfsson
Australian Catholic University, School of Allied Health, Level 9, 33 Berry Street, North Sydney, NSW, 2060, Australia.
Elspeth
E
Froude
McMaster University, IAHS Building, Room 408, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
Peter
P
Rosenbaum
Australian Catholic University, School of Allied Health, Level 2, Daniel Mannix Building, 17 Young Street, Fitzroy, VIC, 3065, Australia.
Christine
C
Imms
D000203:Activities of Daily Living; D002547:Cerebral Palsy / Q000503:physiopathology*; D004185:Disability Evaluation; D006233:Persons with Disabilities; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011594:Psychometrics / Q000379:methods*; D011788:Quality of Life; D014787:Vision Tests / Q000379:methods*; D014785:Vision, Ocular / Q000502:physiology*