A Delphi Exploration of Toileting Activity Performance in Individuals With Cerebral Palsy Within the ICF-CY Framework: Unveiling Influential Factors.
Azade Riyahi, Malahat Akbarfahimi, Mehdi Rassafiani and 3 others
PMID 39403109WHAT IT FOUND
Experts agreed that caregiver awareness of a child's readiness and neuromusculoskeletal function are the top factors affecting toileting in cerebral palsy.
They also highlighted the critical role of toilet environment, communication feedback, and cultural attitudes toward menstruation and hygiene.
Key findings
01The most influential factor identified was the main caregiver's level of cognition and awareness about the child's readiness for toileting and generalization of strategies to home environments.
02Neuromusculoskeletal and movement-related functions were ranked as the most influential body functions impacting toileting execution, followed by sensory functions and pain.
03Attitudes related to menstruation were ranked as the most influential attitude factors affecting toileting activity performance, followed by attitudes toward personal hygiene and clothing management.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study relied on expert opinion and caregiver perspectives rather than direct reports from individuals with cerebral palsy, limiting the understanding of the patients' own experiences. There was a significant imbalance between national (Iran) and international participants, which may affect the generalizability of cultural findings. Recruitment was limited to professionals and caregivers, so the specific perspectives of adults with CP were not included. As a Delphi study, it establishes consensus on what factors are important but does not measure the actual effectiveness of interventions targeting these factors.
Declared interests
The authors declared no conflicts of interest. Ethical approval was obtained from the Research Ethics Committee of Iran University of Medical Sciences.
The easy way to misread this
Do not interpret these rankings as evidence that specific interventions targeting these factors improve toileting outcomes. This study identifies what experts believe are influential factors, but it does not test whether addressing them leads to clinical improvement.