A Delphi Exploration of Toileting Activity Performance in Individuals With Cerebral Palsy Within the ICF-CY Framework: Unveiling Influential Factors.

Abstract

Introduction: Cerebral palsy (CP) is a common motor and postural developmental disability impacting daily activities like toileting. Despite its importance, toileting has often been undervalued in healthcare. This study is aimed at identifying and assessing the level of influence of various factors affecting toileting in individuals with CP using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) framework. Methods: The Delphi method was employed to reach a consensus on factors influencing toileting in individuals with CP. One hundred fifty-eight professionals from 17 countries, each with at least 3 years' experience in CP and/or toileting, participated in this two-round study. Ethical approval (IR.IUMS.REC.1400.1111) and informed consent were obtained. The questionnaire, available in Farsi and English, used a Likert scale (5 = very high impact to 1 = no impact). Factors with 75% agreement and a mean above 3.75 were included in the final list, while those with 50%-75% agreement or a mean between 2.5 and 3.75 proceeded to the second round. Factors were initially identified through a literature review and research team consultation and categorized according to the ICF-CY framework using the ICF 10 RULES. Validation and refinement were done through focus groups with caregivers and experienced professionals to ensure alignment with the framework and methodological rigor. Results: The study highlighted significant factors influencing toileting activities in individuals with CP. Within the ICF-CY framework, "neuromusculoskeletal and movement-related functions" scored highest at 94.5% in "body functions and structures." "Toilet environment" scored 90.5% in "environmental factors." Support and relationship factors scored 82.3%. Attitudes toward "menstruation" ranked highest at 92.9%. Associated deficits with CP ranked top in personal factors at 93.7%. Conclusion: The study identifies key factors influencing toileting activity performance in individuals with CP. "Main caregiver" emerges as a pivotal factor, followed by neuromusculoskeletal functions, personal factors, attitudes toward menstruation, the toilet environment, and support and relationships.