Measurement in Occupational Therapy: Scientific Criteria for Evaluation

Measurement Instruments are used by occupational therapists to describe patients, predict recovery and evaluate immediate treatment effect within their clinical practice. An instrument's development and methodological properties are guided by the purpose of the instrument. In this paper, criteria are proposed for evaluating the utility of measurement tools used by occupational therapists. These criteria are discussed within the framework of the intended use of the instrument. The criteria include the instrument's purpose, clinical utility, construction and scaling, standardization, reliability, validity and responsiveness. An algorithm to guide therapists' appraisal of measurement instruments is included.

Using the World Health Organization's International Classification of Impairments, Disabilities, and Handicaps in Occupational Therapy

Health status, although commonly defined in terms of the presence or absence of disease, can also be defined in terms of performance or functional status. Loss of performance results in disablement. The authors summarize the conceptual framework and categorization in the World Health Organization's International Classification of Impairments, Disabilities and Handicaps (ICIDH) (1980) and the Model of Occupational Performance in the Guidelines for the Client-Centred Practice of Occupational Therapy (Health and Welfare Canada and the Canadian Association of Occupational Therapists, 1983; 1986). Complementary elements of the ICIDH and the Model of Occupational Performance appear to be recognition that performance is an element of holistic health influenced by the social, physical and cultural environment. Also, the ICIDH categories of disablement appear to be conceptually mirrored in the model's categories of occupational performance. The authors use client and service data to illustrate three uses of the ICIDH in occupational therapy:

communication with other health professionals; program planning and management; and, clinical evaluation and research.

Prevention of hepatitis C virus infection using a broad cross-neutralizing monoclonal antibody (AR4A) and epigallocatechin gallate

The anti-hepatitis C virus (HCV) activity of a novel monoclonal antibody (mAb; AR4A) and epigallocatechin gallate (EGCG) were studied in vitro using a HCV cell culture system and in vivo using a humanized liver mouse model capable of supporting HCV replication. Alone, both exhibit reliable cross-genotype HCV inhibition in vitro, and combination therapy completely prevented HCV infection. In vitro AR4A mAb (alone and combined with EGCG) robustly protects against the establishment of HCV genotype 1a infection. EGCG alone fails to reliably protect against an HCV challenge. In conclusion, AR4A mAb represents a safe and efficacious broadly neutralizing antibody against HCV applicable to strategies to safely prevent HCV reinfection following liver transplantation, and it lends further support to the concept of HCV vaccine development. The poor bioavailability of EGCG limits HCV antiviral activity in vitro.

Are you doing what you want to do? Leisure preferences of adolescents with cerebral palsy

OBJECTIVE

This study aimed at describing leisure activity preferences of adolescents with cerebral palsy (CP) and their relationship to participation and to identify factors associated with greater interest in particular leisure activities.

METHODS

A cross-sectional design was used. Participants were adolescents (n = 127; 59.5% male; ages 12-19 years old; mean = 15.3; SD = 2.01 years) with CP (GMFCS levels: I 40%, II 33%, III-IV 26%), who could complete the Preferences for Activities of Children (PAC) and other self-report questionnaires.

RESULTS

Social (2.53; 0.38) and active-physical activities were most preferred (2.10; 0.42), and self-improvement activities were least preferred (1.93; 0.49). Preference for certain activities was not strongly associated with actual involvement in these activities. Family activity-orientation, family expressiveness, and adolescent's motivation explained 15% of the variance in preferences for social activities, and 37% of the variance in preferences for self-improvement activities.

CONCLUSION

Family factors, personal factors, and functional abilities influence leisure preferences. Rehabilitation interventions should consider adolescents' preferences and family dynamics to promote leisure participation.

Cross-cultural validation and psychometric evaluation of the Participation and Environment Measure for Children and Youth in Korea

PURPOSE

To develop the Korean version of the Participation and Environment Measure for Children and Youth (KPEM-CY) and examine its psychometric properties.

METHOD

The PEM-CY was cross-culturally translated into Korean using a specific guideline: pre-review of participation items, forward/backward translation, expert committee review, pre-test of the KPEM-CY and final review. To establish internal consistency, test-retest reliability and construct validity of the KPEM-CY, 80 parents of children with disabilities aged 5-13 years were recruited in South Korea.

RESULTS

Across the home, school and community settings, 76% of participation items and 29% of environment items were revised to improve their fit with Korean culture. Internal consistency was moderate to excellent (0.67-0.92) for different summary scores. Test-retest reliability was excellent (>0.75) in the summary scores of participation frequency and extent of involvement across the three settings and moderate to excellent (0.53-0.95) in all summary scores at home. Child's age, type of school and annual income were the factors that significantly influenced specific dimensions of participation and environment across all settings.

CONCLUSIONS

Results indicated that the KPEM-CY is equivalent to the original PEM-CY and has initial evidence of reliability and validity for use with Korean children with disabilities. Implications for rehabilitation Because 'participation' is a key outcome of the rehabilitation, measuring comprehensive participation of children with disabilities is necessary. The PEM-CY is a parent-report survey measure to assess comprehensive participation of children and youth and environment, which affect their participation, at home, school and in the community. A cross-cultural adaptation process is mandatory to adapt the measurement tool to a new culture or country. The Korean PEM-CY has both reliability and validity and can therefore generate useful clinical data for Korean children with disabilities.

Focusing on the Environment to Improve Youth Participation: Experiences and Perspectives of Occupational Therapists

The environment plays a key role in supporting children's participation and can serve as a focus of intervention. This study aimed to elicit the perceptions and experiences of occupational therapists who had applied the PREP approach--Pathways and Resources for Engagement and Participation. PREP is a novel 12-week intervention for youth with physical disabilities, aimed at improving participation in leisure community-based activities by modifying aspects of the environment. Using a qualitative post-intervention only design, 12 therapists took part in individual semi-structured interviews, in which the therapists reflected on their experience using PREP to enable participation. A thematic analysis was conducted. Four themes emerged from the data; two of which were informative in nature, describing elements of the PREP intervention that target multi-layered composition of the environment and use strategies that involve leveraging resources and problem solving. The two remaining themes were reflective in nature, illustrating a new take on the Occupational Therapy role and re-positioning the concept of participation in therapy practices. Results emphasize aspects of the environment that can serve as effective targets of intervention, guided by the PREP approach. Findings can broaden the scope and focus of occupational therapy practice by redefining views on participation and the environment.

Hot Topics in Research: Preventive Neuroradiology in Brain Aging and Cognitive Decline

Preventive neuroradiology is a new concept supported by growing literature. The main rationale of preventive neuroradiology is the application of multimodal brain imaging toward early and subclinical detection of brain disease and subsequent preventive actions through identification of modifiable risk factors. An insightful example of this is in the area of age-related cognitive decline, mild cognitive impairment, and dementia with potentially modifiable risk factors such as obesity, diet, sleep, hypertension, diabetes, depression, supplementation, smoking, and physical activity. In studying this link between lifestyle and cognitive decline, brain imaging markers may be instrumental as quantitative measures or even indicators of early disease. The purpose of this article is to provide an overview of the major studies reflecting how lifestyle factors affect the brain and cognition aging. In this hot topics review, we will specifically focus on obesity and physical activity.

Understanding advocacy in action: A qualitative study

Introduction

Occupational therapists advocate with/for people with disabilities. In the occupational therapy literature, advocacy is mentioned within the context of specific populations or practice settings and thus there is no consistent way of describing advocacy itself. The objective of this article is to describe advocacy in action for occupational therapists who report engaging in advocacy with/for people with disabilities.

Method

In this hermeneutic phenomenological study, 13 occupational therapists were interviewed about their advocacy experiences. Data analysis was completed using a Gadamerian-based approach.

Findings

Advocacy is complex given that the specific tasks, the third party to whom advocacy is directed and the individual(s) advocating with the therapist vary greatly. Many skills used for advocacy are already part of the therapist’s practice, such as defining the problem, acquiring information, communicating and providing education. In this study, occupational therapists describe advocating as assisting clients who are struggling with access to equipment, services or funding. Also, they advocate by fostering the development of self-advocacy, rather than representing people with disabilities on an ongoing basis.

Conclusion

While these findings provide some insights about how advocacy is currently practiced, a detailed framework is needed to further guide therapists through this complex area of practice.

A Balanced Protocol for Return to School for Children and Youth Following Concussive Injury

BACKGROUND

Few protocols exist for returning children/youth to school after concussion. Childhood concussion can significantly affect school performance, which is vital to social development, academic learning, and preparation for future roles. The goal of this knowledge translation research was to develop evidence based materials to inform physicians about pediatric concussion.

METHODS

The Return to School (RTS) concussion protocol was developed following the National Institute for Health and Care Excellence procedures.

RESULTS

Based on a scoping review, and stakeholder opinions, an RTS protocol was developed for children/youth. This unique protocol focuses on school adaptation in 4 main areas: (a) timetable/attendance, (b) curriculum, (c) environmental modifications, and (d) activity modifications.

CONCLUSION

A balance of cognitive rest and timely return to school need to be considered for returning any student to school after a concussion. Implementation of these new recommendations may be an important tool in prevention of prolonged absence from school and academic failure while supporting brain recovery.

Patient-centered care and distal radius fracture outcomes: a prospective cohort study analysis

STUDY DESIGN

Prospective cohort.

INTRODUCTION

Effects of patient-centered care on distal radius fracture recovery lacks evidence.

PURPOSE OF THE STUDY

To understand from the perspective of a patient with a distal radius fracture: if the Patient Perception of Patient-Centeredness Questionnaire (PPPC) subscales apply to distal radius fracture populations; the strongest and weakest areas of patient-centered care; changes in patient perceptions of patient-centeredness during recovery; and, correlations between aspects of patient-centered care and patient reported pain and disability.

METHODS

Patients with distal radius fractures (n = 129; mean age = 54.03, SD = 14.63) completed the Patient Rated Wrist Evaluation (PRWE) and PPPC, at baseline (less than 10 days post-fracture) and at three months post-injury. Outcome measure responses were factor analyzed and tested for correlations.

RESULTS

Factors identified were titled Clinician-Patient Dialogue, representing communication components of patient-centered care, and Clinician-Patient Alliance, representing partnership components of patient-centered care. Small significant correlations (r = 0.22) between PRWE and PPPC responses were observed with Clinician-Patient Alliance more correlated at baseline and Clinician-Patient Dialogue at follow-up.

DISCUSSION

Important aspects of the patient-clinician dynamic were identified.

CONCLUSIONS

Communication between clinician and patient was perceived most favorably at baseline; and partnership improved by three months.

LEVEL OF EVIDENCE

1b.

Bibliometric Analyses of Physical and Occupational Therapy Faculty across Canada Indicate Productivity and Impact of Rehabilitation Research

PURPOSE

This study examines physical and occupational therapy faculty across Canada, using bibliometrics and federal funding as indicators of academic impact, and considers the validity of various bibliometric indices.

METHODS

Faculty members were identified and their rank, professional designation, and department obtained from faculty Web sites. Bibliometric indicators were determined using Publish or Perish software. An independent author (not a faculty member) inspected the data to remove any incorrectly attributed publications. The h-index, citation years, g-index, and total number of citations for each faculty member were retrieved. The Canadian Institutes of Health Research (CIHR) funding database was used to determine the amount of research funding provided to each faculty member as a principal investigator (PI) and his or her total CIHR funding received. Mean faculty indicators by university, rank, gender, and profession were determined. Analysis of variance (ANOVA) was used to detect differences by rank and gender, and measures of association (Pearson correlation coefficients and multiple regression) were used to identify factors that affected h-index and PI funding received.

RESULTS

A total of 347 physical and occupational therapy faculty were identified. The median h-index was 5 (inter-quartile range [IQR] 2-8) for assistant professors, 11 (IQR 7-15) for associate professors, and 18 (IQR 12-26) for full professors. ANOVA indicated no significant differences between male and female faculty in terms of h-index or funding received. Regression analysis indicated that 58% of h-index variance could be explained by gender (p=0.039), appointment within a department that provides a (rehabilitation science) PhD programme (p<0.001), rank (p<0.001), CIHR PI funding (p=0.001), or total CIHR funding (p<0.001). Significant predictors of the amount of CIHR funding received as a PI included h-index (p<0.001) and total number of citations (p=0.023), which together explained 27% of the variation in funding received.

CONCLUSION

The h-index, although not without flaws, provides a useful metric that indicates that physical and occupational faculty in Canada are productive scientists having a measurable impact and that this impact increases with rank and greater funding.

Focus on participation for children and youth with disabilities: Supporting therapy practice through a guided knowledge translation process

Introduction

Participation in community leisure occupations of children with disabilities is important, yet poorly integrated into practice. This knowledge translation strategy tested an intervention to increase clinicians' awareness and to bring about change in practice toward a focus on participation.

Method

During this qualitative study, 14 clinicians participated in six learning sessions facilitated by a knowledge broker. Three months post-intervention, clinicians were individually interviewed, by drawing on the Professional Evaluation and Reflection on Change Tool, to evaluate potential change in practice. Two researchers independently performed thematic data analysis.

Results

Impact on practice emerged in both the personal and professional levels (for example, empowerment, validation of clinical wisdom, change in thinking and behavior). Clinicians suggested strategies for integrating participation in their day-to-day practice, illustrating a substantial intention for change, while describing barriers and facilitators for implementation (for example, organizational mandate). Two additional themes described the overall experience of the intervention: motivation to learn (for example, desire to link research to practice) and elements of the learning environment (for example, meeting informational needs).

Conclusion

This strategy was effective in redirecting clinicians' focus toward the notion of participation and establishing readiness for change. This shift can potentially facilitate new programs in occupational therapy that are participation-based and community-focused.

The impact of preterm birth on participation in childhood occupation

Outcome studies of premature babies have focused their assessments predominately on neurodevelopmental impairments without relating these deficits to the impact they have on a child's everyday life. This study aims to determine whether very 'preterm birth alone' impacts on a child's ability to participate in and carry out childhood activities. Forty-four former premature infants between 6 months and 5 years 6 months, born in Galway University Hospital, Ireland, without physical or intellectual disability, were compared with 51 age-matched term-born infants. Study infants had an average gestation of 29 weeks and birth weight of 1,145 g. Functional skills were assessed using the Adaptive Behavior Assessment Scale-II and the Assessment of Preschool Children's Participation. Premature infants had significantly lower mean scores in overall adaptive behaviour compared to term infants, regardless of whether chronological (difference = 13.6, 95% (CI) = [8.2, 19.1]) or corrected (difference = 6.6, 95% CI = [1.4, 11.8]) age was used. Premature infants had lower mean scores in conceptual, social and practical skills, but no difference was found between the groups in intensity or diversity of participation.

CONCLUSION

Premature infants had significantly lower scores in adaptive behaviour than term infants. This measurable effect of preterm birth on 'childhood occupations' merits further investigation.

Traumatic brain injury imaging research roadmap

The past decade has seen impressive advances in the types of neuroimaging information that can be acquired in patients with traumatic brain injury. However, despite this increase in information, understanding of the contribution of this information to prognostic accuracy and treatment pathways for patients is limited. Available techniques often allow us to infer the presence of microscopic changes indicative of alterations in physiology and function in brain tissue. However, because histologic confirmation is typically lacking, conclusions reached by using these techniques remain solely inferential in almost all cases. Hence, a need exists for validation of these techniques by using data from large population samples that are obtained in a uniform manner, analyzed according to well-accepted procedures, and correlated with closely monitored clinical outcomes. At present, many of these approaches remain confined to population-based research rather than diagnosis at an individual level, particularly with regard to traumatic brain injury that is mild or moderate in degree. A need and a priority exist for patient-centered tools that will allow advanced neuroimaging tools to be brought into clinical settings. One barrier to developing these tools is a lack of an age-, sex-, and comorbidities-stratified, sequence-specific, reference imaging data base that could provide a clear understanding of normal variations across populations. Such a data base would provide researchers and clinicians with the information necessary to develop computational tools for the patient-based interpretation of advanced neuroimaging studies in the clinical setting. The recent "Joint ASNR-ACR HII-ASFNR TBI Workshop: Bringing Advanced Neuroimaging for Traumatic Brain Injury into the Clinic" on May 23, 2014, in Montreal, Quebec, Canada, brought together neuroradiologists, neurologists, psychiatrists, neuropsychologists, neuroimaging scientists, members of the National Institute of Neurologic Disorders and Stroke, industry representatives, and other traumatic brain injury stakeholders to attempt to reach consensus on issues related to and develop consensus recommendations in terms of creating both a well-characterized normative data base of comprehensive imaging and ancillary data to serve as a reference for tools that will allow interpretation of advanced neuroimaging tests at an individual level of a patient with traumatic brain injury. The workshop involved discussions concerning the following: 1) designation of the policies and infrastructure needed for a normative data base, 2) principles for characterizing normal control subjects, and 3) standardizing research neuroimaging protocols for traumatic brain injury. The present article summarizes these recommendations and examines practical steps to achieve them.

Development and evaluation of The KIT: Keeping It Together™ for Youth (the 'Youth KIT') to assist youth with disabilities in managing information

BACKGROUND

This article presents findings from the development and evaluation of The KIT: Keeping It Together™ for Youth (the 'Youth KIT'). The Youth KIT is a resource intended to assist youth with disabilities during their teenage years and during the transition to adulthood to give information to others about themselves, get from others about themselves, and organize their own information to the best of their ability.

METHODS

Thirty-six youth between the ages of 12 and 25 with physical and developmental disabilities were active participants in the development of the Youth KIT and partnered with a multidisciplinary team to conduct the qualitative evaluation. Focus groups and individual interviews were used in three phases of evaluation.

RESULTS

The results of qualitative content analysis found the Youth KIT to be useful for a variety of youth in different contexts. The themes that emerged about the utility and impact of the Youth KIT were: (1) self-discovery for youth; and (2) the importance of the 'fit' between youth and mentors to support youth as they started to use the Youth KIT.

CONCLUSION

Clinical implications for healthcare providers working with youth during the transition to adulthood include recognition that discussions about adult goals should be a continuous dialogue throughout adolescence rather than a 'special' conversation occurring at the time of discharge from paediatric services.

Improving the participation of youth with physical disabilities in community activities: An interrupted time series design

BACKGROUND/AIM

Youth with physical disabilities experience restrictions to participation in community-based leisure activities; however, there is little evidence about how to improve their involvement. This study examined whether an intervention to remove environmental barriers and develop strategies using a coaching approach improved youth participation in leisure activities.

METHODS

An Interrupted Time Series design was employed, where replication of the intervention effect was examined across individualised participation goals and across participants. Six adolescents with a physical disability participated in a 12-week intervention. An occupational therapist worked with each youth and his/her family to set three leisure goals based on problems identified using the Canadian Occupational Performance Measure (COPM). A coaching approach was used to collaboratively identify and implement strategies to remove environmental barriers. Interventions for each goal were introduced at different time points. Outcomes were evaluated using the COPM.

RESULTS

Improvements in COPM performance scores were clinically significant for 83% of the identified activities; an average change of 4.5 points in the performance scale (SD = 1.95) was observed. Statistical analysis using the celeration line demonstrated that the proportion of data points falling above the line increased in the intervention phase for 94% of the activities, indicating a significant treatment effect.

CONCLUSIONS

This study is the first to examine an intervention aimed at increasing leisure participation by changing only the environment. The results indicate that environment-focussed interventions are feasible and effective in promoting youth participation. Such findings can inform the design of a larger study and guide occupational therapy practice.