The inter-rater reliability of categories of auditory performance-II (CAP)-II

Abstract

The aim of the present study was to validate a modified version of the Categories of Auditory Performance (CAP) rating scale, the CAP-II. The CAP is a hierarchy rating scale which assesses a child?s functioning in everyday situations. It covers a range of auditory performance and also takes into consideration different developmental rates of children. Inter-rater reliability was assessed by participants rating benefits young children receive with cochlear implants (CI). Volunteers watched video recordings of staff describing hypothetical cases of children who wear CIs.

Children are difficult to assess using conventional methods, requiring their cooperation, thus there is need for additional assessment methods. The CAP has been validated and can provide additional information on disability reduction beyond that provided by audiological tests, as it illustrates the benefits that children now receive with CIs. The original CAP scale consists of 8 categories. There is evidence of ceiling effects as it does not address the more complicated listening skills achievable with CIs. Therefore it has been proposed that two new additional categories are added to the original scale to form the CAP-II.

Inter-rater reliability was assessed using video recordings of rehabilitative staff describing behaviour and listening skills of children with CIs. Thirty-three participants, volunteers from the University of Southampton watched 6 video recordings and assigned ratings based on how each child was doing. High inter-rater reliability was found between all participants. The percent of overall agreement (PO) was 0.76% and no significant difference was found between the ratings (p>0.05). There was also a strong relationship between all participants, as there was a statistically significant correlation between participants when they were compared (p<0.05).

Overall the results indicate that the modified CAP has good reliability. It is proven to be a relatively reliable and useful method. Specific findings about the CAP-II especially categories 7 (use of telephone with known speaker), 8 (follow group conversation in a reverberant room or where there is some interfering noise such as in a classroom or restaurant) and 9 (use of telephone with unknown speaker in unpredictable context) suggest that they need to be reordered. Categories 7 and 9 should be optional. Young children may not yet have developed these listening skills due to their age. Once these modifications are made the CAP-II could prove to be a valid tool in clinical use, as it addresses the additional benefits now achievable with CIs whilst avoiding ceiling effects. Although more research involving a larger population needs to be conducted in order to assess whether ceiling effects are evident.

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