The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) and Speech-language Pathology: associations with sociodemographic and health care variables

Borges, Marina Garcia de Souza; Medeiros, Adriane Mesquita de; Lemos, Stela Maris Aguiar

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Original Article • CoDAS 32 (3) • 2020 • https://doi.org/10.1590/2317-1782/20202019058 copy

The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) and Speech-language Pathology: associations with sociodemographic and health care variables

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

Identify factors related to the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) representing more than one category and verify their association with sociodemographic and health care aspects in a speech-language pathology (SLP) outpatient clinic.

Method:

This is an observational, analytical, cross-sectional study based on a retrospective analysis of secondary data. One hundred eighty medical records of patients aged 5-16 years evaluated between 2010 and 2014 were included in the study. Sociodemographic and health care aspects were identified in these records, as well as presence of the ICF-CY Body Functions and Activities and Participation component categories. Analyses of the frequency distribution and measures of central tendency and dispersion of the variables, as well as Factor Analysis were carried out to create representative indicators of the ICF-CY categories identified. The Mann-Whitney and Kruskal-Wallis tests and the Spearman’s correlation were used to analyze the associations, adopting a statistical significance level of 5%.

Results:

Two factors that presented statistically relevant associations with the sociodemographic and health care variables were identified for the Body Functions component. As for the Activities and Participation component, three factors predominantly associated with the health care variables were identified.

Conclusion:

Items representative of the ICF-CY Body Functions and Activities and Participation categories and their respective factorial loads were identified. Statistically significant associations were verified between them and the sociodemographic and health care variables analyzed.

Keywords:
Speech; Language and Hearing Sciences; International Classification of Functioning; Disability and Health; Delivery of Health Care; Socioeconomic Factors; Child; Adolescent

	ICF-CY categories	Factor 1	Factor 2	Factor 3	Commonality
Body Functions
Factor 1 - Language/Speech/Hearing	Memory functions	0.71	0.08	x	0.51
	Perceptual functions	0.79	0.23	x	0.67
	Basic cognitive functions	0.87	-0.17	x	0.78
	Mental functions of Language	0.80	0.24	x	0.69
	Hearing	0.50	-0.30	x	0.34
	Articulation	0.44	0.10	x	0.21
Factor 2 - Motricity/Voice	Voice functions	0.18	0.53	x	0.32
	Respiration functions	-0.04	0.79	x	0.63
	Ingestion functions	0.05	0.82	x	0.67
Activities and Participation
Factor 1 - Socializing	Managing one’s own behavior
	- Capacity	0.66	0.29	-0.12	0.53
	- Performance	0.85	0.06	0.06	0.74
	Complex interpersonal interactions - Performance	0.79	-0.30	0.15	0.73
	Informal social relationships -	0.75	0.00	0.45	0.78
Factor 2 - Acquiring concepts	Acquiring concepts - Capacity	0.00	0.90	-0.01	0.82
Factor 3 - Family/Education	Family relationships - Performance	0.20	0.40	0.73	0.73
Factor 3 - Family/Education	School education - Performance	0.00	-0.25	0.77	0.65

Explanatory variables	Language/Speech/Hearing			Motricity/Voice
Explanatory variables	Mean	SE	p-value	Mean	SE	p-value
Gender			0.501¹			0.301¹
Female	0.42	0.04		0.32	0.05
Male	0.38	0.03		0.38	0.03
Patient education level			0.038²			0.764²
Early childhood education	0.41	0.08		0.32	0.09
Incomplete elementary school	0.40	0.02		0.37	0.03
Incomplete high school	0.04	0.04		0.42	0.11
Mother education level			0.239²			0.322²
No schooling/Elementary school	0.42	0.04		0.32	0.04
High school	0.41	0.04		0.35	0.04
Higher education	0.29	0.05		0.48	0.10
Father education level			0.744²			0.039²
No schooling/Elementary school	0.39	0.03		0.28	0.04
High school	0.37	0.05		0.36	0.05
Higher education	0.41	0.07		0.55	0.13
Place of residence			0.389²			0.368²
Belo Horizonte	0.36	0.03		0.35	0.04
Metropolitan region	0.42	0.04		0.35	0.04
Others (interior of the state)	0.43	0.10		0.55	0.13
Age (in years)			0.000³			0.557³
r – p-value	-0.29		0.000³	0.05		0.557³
N of siblings			0.030³			0.847³
r - p-value	0.18		0.030³	-0.02		0.847³
N of rooms in the house			0.006³			0.273³
r - p-value	-0.23		0.006³	-0.09		0.273³
N of people in the house			0.036³			0.097³
r - p-value	0.17		0.036³	-0.14		0.097³
Family income (in minimum wages)			0.068³			0.609³
r - p-value	-0.16		0.068³	-0.04		0.609³

Explanatory variables		Language/Speech/Hearing			Motricity/Voice
Explanatory variables		Mean	SE	p-value	Mean	SE	p-value
Previous issues				0.233¹			0.624¹
Complications in childhood	Yes	0.44	0.04		0.41	0.05
	No	0.37	0.03		0.34	0.03
Complaints
Changes in oral language acquisition/development	Yes	0.42	0.08	0.520¹	0.33	0.11	0.871¹
	No	0.39	0.02	0.520¹	0.36	0.03	0.871¹
Reading and writing changes /school difficulties	Yes	0.39	0.03	0.763¹	0.35	0.04	0.725¹
	No	0.41	0.04	0.763¹	0.36	0.04	0.725¹
Speech changes	Yes	0.46	0.03	0.004¹	0.38	0.04	0.464¹
	No	0.32	0.03	0.004¹	0.33	0.04	0.464¹
Fluency changes	Yes	0.37	0.08	0.666¹	0.46	0.10	0.281¹
	No	0.40	0.02	0.666¹	0.34	0.03	0.281¹
Orofacial motricity changes	Yes	0.33	0.05	0.198¹	0.53	0.06	0.001¹
	No	0.41	0.03	0.198¹	0.31	0.03	0.001¹
Swallowing changes/dysphagia	Yes	0.26	0.21	0.368¹	0.67	0.33	0.259¹
	No	0.40	0.02	0.368¹	0.35	0.03	0.259¹
Voice changes	Yes	0.34	0.08	0.694¹	0.54	0.14	0.142¹
	No	0.40	0.02	0.694¹	0.34	0.03	0.142¹
Hearing changes	Yes	0.37	0.08	0.574¹	0.37	0.11	0.830¹
	No	0.40	0.02	0.574¹	0.35	0.03	0.830¹
Auditory processing changes	Yes	0.00	x	0.119¹	0.00	x	0.240¹
	No	0.40	0.02	0.119¹	0.36	0.03	0.240¹
Social interaction issues	Yes	0.41	0.04	0.336¹	0.45	0.06	0.026¹
	No	0.39	0.03	0.336¹		0.03	0.026¹
Person responsible for the complaint
Parents or other family members		0.40	0.02		0.36	0.03	0.386²
Health professionals		0.33	0.09		0.42	0.11
School		0.25	0.07		0.5	0.13
Professional who referred the patient
Pediatrician		0.46	0.04		0.34	0.05	0.780²
Psychiatrist		0.37	0.05		0.37	0.07
Others		0.35	0.03		0.38	0.04
Diagnostic hypotheses
Changes in oral language acquisition/development	Yes	0.43	0.03	0.015¹	0.34	0.04	0.182¹
	No	0.33	0.03	0.015¹	0.40	0.04	0.182¹
Changes in written language	Yes	0.39	0.03	0.708¹	0.37	0.03	0.888¹
	No	0.39	0.04	0.708¹	0.35	0.05	0.888¹
Changes in cognitive aspects of language	Yes	0.55	0.03	0.000¹	0.42	0.04	0.111¹
	No	0.25	0.02	0.000¹	0.32	0.04	0.111¹
Speech changes	Yes	0.54	0.04	0.000¹	0.42	0.05	0.169¹
	No	0.32	0.02	0.000¹	0.34	0.03	0.169¹
Fluency changes	Yes	0.33	0.07	0.536¹	0.36	0.14	0.771¹
	No	0.40	0.02	0.536¹	0.36	0.03	0.771¹
Orofacial motricity changes	Yes	0.41	0.03	0.410¹	0.51	0.04	0.000¹
	No	0.37	0.03	0.410¹	0.20	0.03	0.000¹
Voice changes	Yes	0.43	0.04	0.235¹	0.57	0.04	0.000¹
	No	0.37	0.03	0.235¹	0.21	0.03	0.000¹
Auditory processing changes	Yes	0.49	0.04	0.002¹	0.38	0.05	0.599¹
	No	0.35	0.03	0.002¹		0.03	0.599¹
Conduct
Revaluation	Yes	0.14	0.03	0.120¹	0.13	0.13	0.281¹
	No	0.40	0.02	0.120¹	0.37	0.03	0.281¹
Guidance to person responsible	Yes	0.29	0.05	0.055¹	0.47	0.08	0.172¹
	No	0.41	0.03	0.055¹	0.35	0.03	0.172¹
Complete evaluation of auditory processing	Yes	0.48	0.04	0.007¹	0.37	0.05	0.866¹
	No	0.35	0.03	0.007¹	0.36	0.03	0.866¹
Speech-language Pathology therapy	Yes	0.40	0.02	0.010¹	0.37	0.03	0.371¹
	No	0.12	0.06	0.010¹	0.20	0.09	0.371¹
Referral to other professionals	Yes	0.38	0.03	0.884¹	0.43	0.04	0.040¹
	No	0.40	0.03	0.884¹		0.04	0.040¹

Explanatory variables	Socializing			Acquiring concepts			Family/School
Explanatory variables	Mean	SE	p-value	Mean	SE	p-value	Mean	SE	p-value
Gender			0.078¹			0.148¹			0.301¹
Female	0.13	0.03		0.13	0.05		0.29	0.05
Male	0.22	0.03		0.24	0.04		0.33	0.03
Patient education level			0.694²			0.875²			0.022²
Early childhood education	0.19	0.08		0.20	0.13		0.10	0.07
Incomplete elementary school	0.19	0.02		0.21	0.04		0.34	0.03
Incomplete high school	0.00	x		0.00	x		0.00	x
Mother education level			0.312²			0.317²			0.036²
No schooling/Elementary school	0.21	0.04		0.25	0.06		0.40	0.04
High school	0.18	0.03		0.18	0.05		0.28	0.04
Higher education	0.10	0.06		0.08	0.08		0.19	0.07
Father education level			0.470²			0.957²			0.000²
No schooling/Elementary school	0.20	0.03		0.19	0.05		0.40	0.04
High school	0.16	0.04		0.18	0.06		0.24	0.05
Higher education	0.08	0.05		0.14	0.14		0.00	0.00
Place of residence			0.368²			0.2582			0.037²
Belo Horizonte	0.20	0.03		0.16	0.04		0.37	0.04
Metropolitan region	0.18	0.04		0.27	0.06		0.24	0.03
Others (interior of the state)	0.10	0.05		0.13	0.13		0.44	0.15
Age (in years)			0.707³			0.2582			0.001³
r – p-value	0.03		0.707³	-0.13		0.2582	0.27		0.001³
N of siblings			0.778³			0.847³			0.162³
r - p-value	0.02		0.778³	0.08		0.847³	0.12		0.162³
N of rooms in the house			0.255³			0.355³			0.970³
r - p-value	-0.10		0.255³	-0.11		0.355³	0.00		0.970³
N of people in the house			0.626³			0.542³			0.867³
r - p-value	0.04		0.626³	0.05		0.542³	-0.01		0.867³
Family income (in minimum wages)			0.054³			0.603³			0.739³
r - p-value	0.17		0.054³	-0.05		0.603³	0.03		0.739³

Explanatory variables		Socializing			Acquiring concepts			Family/School
Explanatory variables		Mean	SE	p-value	Mean	SE	p-value	Mean	SE	p-value
Previous issues
Complications in childhood	Yes	0.21	0.04	0.599¹	0.23	0.06	0.664¹	0.36	0.04	0.242¹
	No	0.17	0.03	0.599¹	0.20	0.04	0.664¹	0.30	0.03	0.242¹
Complaints
Changes in oral language acquisition/development	Yes	0.13	0.08	0.395¹	0.00	0.00	0.144¹	0.19	0.09	0.167¹
Changes in oral language acquisition/development	No	0.20	0.02	0.395¹	0.22	0.04	0.144¹	0.34	0.03	0.167¹
Reading and writing changes/school difficulties	Yes	0.21	0.03	0.362¹	0.19	0.04	0.709¹	0.42	0.03	0.000¹
Reading and writing changes/school difficulties	No	0.16	0.04	0.362¹	0.22	0.06	0.709¹	0.18	0.04	0.000¹
Speech changes	Yes	0.17	0.03	0.435¹	0.31	0.06	0.001¹	0.28	0.04	0.027¹
	No	0.22	0.04	0.435¹	0.08	0.03	0.001¹	0.39	0.04	0.027¹
Fluency changes	Yes	0.07	0.05	0.098¹	0.27	0.14	0.554¹	0.18	0.08	0.087¹
	No	0.20	0.02	0.098¹	0.20	0.04	0.554¹	0.34	0.03	0.087¹
Orofacial motricity changes	Yes	0.20	0.04	0.436¹	0.18	0.07	0.721¹	0.23	0.05	0.062¹
Orofacial motricity changes	No	0.19	0.03	0.436¹	0.21	0.04	0.721¹	0.36	0.03	0.062¹
Swallowing changes/dysphagia	Yes	0.27	0.01	0.409¹	0.00	0.00	0.482¹	0.25	0.25	0.731¹
Swallowing changes/dysphagia	No	0.19	0.02	0.409¹	0.21	0.04	0.482¹	0.33	0.03	0.731¹
Voice changes	Yes	0.27	0.10	0.431¹	0.00	0.00	0.144¹	0.38	0.08	0.554¹
	No	0.19	0.02	0.431¹	0.22	0.04	0.144¹	0.33	0.03	0.554¹
Hearing changes	Yes	0.22	0.08	0.710¹	0.25	0.13	0.677¹	0.38	0.09	0.589¹
	No	0.19	0.02	0.710¹	0.20	0.04	0.677¹	0.33	0.03	0.589¹
Auditory processing changes	Yes	0.74	x	0.111¹	0.00	x	0.627¹	0.50	x	0.518¹
Auditory processing changes	No	0.19	0.02	0.111¹	0.21	0.04	0.627¹	0.33	0.03	0.518¹
Social interaction issues	Yes	0.30	0.04	0.000¹	0.37	0.08	0.003¹	0.37	0.05	0.417¹
	No	0.15	0.03	0.000¹	0.14	0.04	0.003¹	0.32	0.03	0.417¹
Person responsible for the complaint
Parents or other family members		0.19	0.02	0.942²	0.21	0.04	0.7692	0.33	0.03	0.112²
Health professionals		0.19	0.09		0.20	0.13		0.15	0.08
School		0.14	0.14		0.00	0.00		0.50	0.00
Professional who referred the patient
Pediatrician		0.19	0.04	0.523²	0.22	0.06	0.8752	0.23	0.05	0.000²
Psychiatrist		0.22	0.05		0.19	0.07		0.50	0.05
Others		0.17	0.03		0.18	0.05		0.50	0.04
Diagnostic hypotheses
Changes in oral language acquisition/development	Yes	0.20	0.03	0.650¹	0.25	0.05	0.080¹	0.32	0.03	0.922¹
Changes in oral language acquisition/development	No	0.18	0.04	0.650¹	0.13	0.05	0.080¹	0.32	0.04	0.922¹
Changes in written language	Yes	0.20	0.03	0.354¹	0.20	0.04	0.903¹	0.36	0.03	0.001¹
Changes in written language	No	0.14	0.04	0.354¹	0.21	0.08	0.903¹	0.16	0.05	0.001¹
Changes in cognitive aspects of language	Yes	0.24	0.03	0.021¹	0.36	0.06	0.000¹	0.33	0.04	0.771¹
Changes in cognitive aspects of language	No	0.15	0.03	0.021¹	0.07	0.03	0.000¹	0.31	0.04	0.771¹
Speech changes	Yes	0.20	0.04	0.996¹	0.30	0.07	0.061¹	0.26	0.05	0.087¹
	No	0.18	0.03	0.996¹	0.16	0.04	0.061¹	0.35	0.03	0.087¹
Fluency changes	Yes	0.23	0.12	0.744¹	0.29	0.18	0.597¹	0.14	0.09	0.107¹
	No	0.19	0.02	0.744¹	0.20	0.04	0.597¹	0.33	0.03	0.107¹
Orofacial motricity changes	Yes	0.17	0.03	0.502¹	0.27	0.05	0.039¹	0.27	0.04	0.039¹
Orofacial motricity changes	No	0.21	0.03	0.502¹	0.13	0.04	0.039¹	0.37	0.03	0.039¹
Voice changes	Yes	0.23	0.04	0.079¹	0.24	0.06	0.474¹	0.29	0.04	0.362¹
	No	0.16	0.03	0.079¹	0.19	0.04	0.474¹	0.34	0.03	0.362¹
Auditory processing changes	Yes	0.23	0.04	0.177¹	0.21	0.06	0.946¹	0.30	0.04	0.702¹
Auditory processing changes	No	0.17	0.03	0.177¹	0.20	0.04	0.946¹	0.33	0.03	0.702¹
Conduct
Guidance to the person responsible	Yes	0.27	0.09	0.415¹	0.07	0.07	0.194¹	0.39	0.08	0.302¹
	No	0.18	0.02	0.415¹	0.22	0.04	0.194¹	0.31	0.03	0.302¹
Complete evaluation of auditory processing	Yes	0.19	0.04	0.550¹	0.27	0.07	0.187¹	0.30	0.05	0.477¹
Complete evaluation of auditory processing	No	0.19	0.03	0.550¹	0.18	0.04	0.187¹	0.33	0.03	0.477¹
Speech-language Pathology therapy	Yes	0.19	0.02	0.699¹	0.21	0.04	0.478¹	0.31	0.03	0.074¹
	No	0.10	0.10	0.699¹	0.00	0.00	0.478¹	0.75	0.25	0.074¹
Referral to other professionals	Yes	0.21	0.04	0.351¹	0.28	0.06	0.130¹	0.34	0.04	0.493¹
Referral to other professionals	No	0.18	0.03	0.351¹	0.17	0.04	0.130¹	0.31	0.03	0.493¹

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[1] Correspondence address: Marina Garcia de Souza Borges Av. Alfredo Balena, 190, sala 249, Belo Horizonte, Minas Gerais, CEP 30130-100. E-mail: ninaborgesvh@hotmail.com