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The Clinical Functional Impairment Scale Development

Sandler, Adrian MD*; Wright, Mary Ellen PhD, APRN, CPNP; Denslow, Sheri PhD, MPH

Journal of Developmental & Behavioral Pediatrics: October 2017 - Volume 38 - Issue 8 - p 619–626
doi: 10.1097/DBP.0000000000000478
Original Articles
Watch video abstract

Objective: The purpose of the project was to review content validity and assess the span of responses for the newly developed Clinical Functional Impairment Scale (CFIS).

Methods: A cross-sectional, content validity process using focus groups of developmental, behavioral pediatric clinicians was conducted. After qualitative analysis of the focus group data, adjustments were made in the CFIS based on the recommendations of the content experts. A survey was conducted of clinicians participating in the online Society of Developmental and Behavioral Pediatrics Discussion Board. Clinicians reviewed 2 case studies and used the CFIS to score severity and interval change of predetermined functional impairments. The amount of spread in the answers was assessed by calculating the index of dispersion.

Results: Qualitative analysis of the focus groups resulted in adjustment to the CFIS to 20 functional impairments, with a 5-point Likert scale of severity and a 7-point Likert scale of interval change. Ninety-four clinicians participated in the survey. The index of dispersion ranged from 0.49 to 0.88. The interval ratings of severity and interval change had lower dispersion ranges.

Conclusion: The CFIS uses a mutual prioritization by the family and clinician of the child's functional impairments. The study demonstrated that the clinicians' ratings of the case studies were more variable in the initial symptom severity score than their ratings of symptom severity and interval change in symptoms. Further testing of the CFIS is planned using face-to-face clinical encounters and including parent/caregiver ratings of severity and interval change.

*Clemson University School of Nursing, Pickens, SC;

Nurse Researcher Women's and Children's Health, Mission Health System, Asheville, NC; and

Mission Health System, Asheville, NC.

Address for reprints: Mary Ellen Wright, PhD, APRN, CPNP, Nurse Researcher Women's and Children's Health, Mission Health, 509 Biltmore Avenue, Asheville, NC 28730; e-mail:

Presented at the First International Developmental Pediatrics Congress; December 3, 2015; Istanbul, Turkey.

Disclosure: The authors declare no conflict of interest.

See the video abstract at

Received October , 2016

Accepted May , 2017

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