Original Research
Paediatric Rehabilitation

Malaysian Parents’ Feedback on Three Proxy-Rated Assessments Used in Pediatric Rehabilitation

Background and Context

Assessing a child’s functional abilities and limitations provides essential information for occupational therapists to develop individualised intervention plans. In paediatric rehabilitation, proxy-rated assessments—instruments completed by parents or caregivers on behalf of their children—are widely used to evaluate domains including sensory processing, executive function, and functional performance. However, these assessments were predominantly developed in English-speaking Western countries, and their applicability in culturally and linguistically diverse settings such as Malaysia requires careful evaluation.

Malaysia’s multicultural population, comprising Malay, Chinese, Indian, and indigenous communities, presents unique challenges for the implementation of standardised assessment tools. Parents must be able to understand the assessment content and instructions to rate their child accurately. Language comprehension, cultural interpretation of behaviours, and familiarity with assessment formats all influence the reliability of parent-reported data.

Study Design and Methodology

This study employed a mixed-methods approach to gather Malaysian parents’ feedback on three proxy-rated assessments used in paediatric rehabilitation: the Sensory Profile (SP), the Sensory Processing Measure (SPM), and the Behavior Rating Inventory of Executive Function (BRIEF). The BRIEF is a parent-rated measure that has been validated for use by Malaysian parents.

The study integrated quantitative assessment of psychometric properties with qualitative feedback from parents regarding their experience completing the instruments. Internal consistency reliability was calculated using Cronbach’s alpha, and parents were asked to identify any items that were unclear, ambiguous, or culturally inappropriate.

The sample included parents of children receiving occupational therapy and rehabilitation services at the UKM Medical Centre. The demographic profile showed twice as many boys as girls, a distribution consistent with the higher prevalence of neurodevelopmental conditions among males observed internationally.

Principal Findings

The psychometric analysis demonstrated good internal consistency for the three assessment tools. The BRIEF subscales achieved Cronbach’s alpha values of 0.92, 0.82, and 0.87 for the Behavior Regulation Index, Metacognitive Index, and overall composite respectively, indicating excellent reliability in the Malaysian sample.

Qualitative feedback revealed that Malaysian parents encountered only minor problems with the SP, SPM, and BRIEF. Issues identified were primarily related to specific terminology rather than fundamental comprehension barriers. For example, some parents had difficulty interpreting culturally specific terms or activity descriptions that did not correspond to common Malaysian childhood experiences.

The findings indicate that these standardised assessment tools have satisfactory clinical utility for use with Malaysian parents, although minor modifications or supplementary explanations may enhance accuracy. The multi-ethnic and multilingual nature of Malaysia—where parents may speak Bahasa Melayu, English, Mandarin, Tamil, or other languages—means that providing assessments in the internationally accepted English language works for many but not all parents.

Implications for Clinical Practice

For occupational therapists and rehabilitation professionals working in Malaysia, these findings support the continued use of the SP, SPM, and BRIEF as part of comprehensive paediatric assessment batteries. The demonstrated reliability in the Malaysian sample provides confidence that scores obtained from Malaysian parents are psychometrically sound and can inform clinical decision-making.

However, practitioners should remain attentive to potential comprehension issues, particularly when working with parents whose English proficiency is limited. The development of translated and culturally adapted versions of these instruments, accompanied by formal validation studies, remains an important priority for the field of paediatric rehabilitation in Malaysia.

Context Within Paediatric Services in Malaysia

Malaysia’s paediatric rehabilitation services have undergone significant development in recent decades, with occupational therapy, physiotherapy, and speech-language therapy increasingly available in government hospitals and community-based rehabilitation centres. The shift from a traditional child-focused approach to a family-centred service model—in which parents are viewed as active partners in assessment and intervention—has increased the importance of reliable proxy-rated assessments.

The availability of evidence supporting the use of these tools in the Malaysian context is particularly valuable as the profession continues to advance evidence-based practice. Assessment data from these instruments informs individualised education plans, therapy goals, and outcome measurement, making their accuracy essential for effective service delivery.

Limitations

The study sample was drawn from a single centre in Kuala Lumpur, limiting generalisability to rural or East Malaysian populations. The study did not stratify findings by parental education level, language preference, or ethnic group, all of which may influence assessment comprehension. Additionally, the cross-sectional design provides information about a single time point and does not address test-retest reliability in the Malaysian population.

Significance

This study fills an important gap in the paediatric rehabilitation literature by providing evidence on the clinical utility of widely used proxy-rated assessments in a Malaysian context. The findings support cross-cultural applicability while identifying areas for improvement, contributing to the broader goal of evidence-based, culturally responsive paediatric rehabilitation services in Southeast Asia.

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