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Kaelin VC, Boyd AD, Werler MM, Parde N, Khetani MA. Natural Language Processing to Classify Caregiver Strategies Supporting Participation Among Children and Youth with Craniofacial Microsomia and Other Childhood-Onset Disabilities. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:480-500. [PMID: 37927374 PMCID: PMC10620347 DOI: 10.1007/s41666-023-00149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 07/18/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023]
Abstract
Customizing participation-focused pediatric rehabilitation interventions is an important but also complex and potentially resource intensive process, which may benefit from automated and simplified steps. This research aimed at applying natural language processing to develop and identify a best performing predictive model that classifies caregiver strategies into participation-related constructs, while filtering out non-strategies. We created a dataset including 1,576 caregiver strategies obtained from 236 families of children and youth (11-17 years) with craniofacial microsomia or other childhood-onset disabilities. These strategies were annotated to four participation-related constructs and a non-strategy class. We experimented with manually created features (i.e., speech and dependency tags, predefined likely sets of words, dense lexicon features (i.e., Unified Medical Language System (UMLS) concepts)) and three classical methods (i.e., logistic regression, naïve Bayes, support vector machines (SVM)). We tested a series of binary and multinomial classification tasks applying 10-fold cross-validation on the training set (80%) to test the best performing model on the held-out test set (20%). SVM using term frequency-inverse document frequency (TF-IDF) was the best performing model for all four classification tasks, with accuracy ranging from 78.10 to 94.92% and a macro-averaged F1-score ranging from 0.58 to 0.83. Manually created features only increased model performance when filtering out non-strategies. Results suggest pipelined classification tasks (i.e., filtering out non-strategies; classification into intrinsic and extrinsic strategies; classification into participation-related constructs) for implementation into participation-focused pediatric rehabilitation interventions like Participation and Environment Measure Plus (PEM+) among caregivers who complete the Participation and Environment Measure for Children and Youth (PEM-CY). Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00149-y.
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Affiliation(s)
- Vera C. Kaelin
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL 60612 − 7250 USA
- Department of Computer Science, University of Illinois Chicago, 851 South Morgan Street, Room 1132, Chicago, IL 60607-7042 USA
- Children’s Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL USA
| | - Andrew D. Boyd
- Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, IL USA
| | | | - Natalie Parde
- Department of Computer Science, University of Illinois Chicago, 851 South Morgan Street, Room 1132, Chicago, IL 60607-7042 USA
- Natural Language Processing Laboratory, University of Illinois Chicago, Chicago, IL USA
| | - Mary A. Khetani
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL 60612 − 7250 USA
- Children’s Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL USA
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON Canada
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Tacchino A, Podda J, Bergamaschi V, Pedullà L, Brichetto G. Cognitive rehabilitation in multiple sclerosis: Three digital ingredients to address current and future priorities. Front Hum Neurosci 2023; 17:1130231. [PMID: 36908712 PMCID: PMC9995764 DOI: 10.3389/fnhum.2023.1130231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Multiple sclerosis (MS) is a neurological chronic disease with autoimmune demyelinating lesions and one of the most common disability causes in young adults. People with MS (PwMS) experience cognitive impairments (CIs) and clinical evidence shows their presence during all MS stages even in the absence of other symptoms. Cognitive rehabilitation (CR) aims at reducing CI and improving PwMS' awareness of cognitive difficulties faced in their daily living. More defined cognitive profiles, easier treatment access and the need to transfer intervention effects into everyday life activities are aims of utmost relevance for CR in MS. Currently, advanced technologies may pave the way to rethink CR in MS to address the priority of more personalized and effective, accessible and ecological interventions. For this purpose, digital twins, tele-cognitive-rehabilitation and metaverse are the main candidate digital ingredients. Based on scientific evidences, we propose digital twin technology to enhance MS cognitive phenotyping; tele-cognitive-rehabilitation to make feasible the cognitive intervention access to a larger number of PwMS; and metaverse to represent the best choice to train real-world dual- and multi-tasking deficits in virtual daily life environments. Moreover, multi-domain high-frequency big-data collected through tele-cognitive-assessment, tele-cognitive-rehabilitation, and metaverse may be merged to refine artificial intelligence algorithms and obtain increasingly detailed patient's cognitive profile in order to enhance intervention personalization. Here, we present how these digital ingredients and their integration could be crucial to address the current and future needs of CR facilitating the early detection of subtle CI and the delivery of increasingly effective treatments.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Valeria Bergamaschi
- AISM Rehabilitation Center Liguria, Italian Multiple Sclerosis Society (AISM), Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.,AISM Rehabilitation Center Liguria, Italian Multiple Sclerosis Society (AISM), Genoa, Italy
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Kaelin V, Villegas V, Chen YF, Murphy N, Papautsky E, Litfin J, Leland N, Maheshwari V, McManus B, Khetani M. Effectiveness and scalability of an electronic patient-reported outcome measure and decision support tool for family-centred and participation-focused early intervention: PROSPECT hybrid type 1 trial protocol. BMJ Open 2022; 12:e051582. [PMID: 34983760 PMCID: PMC8728410 DOI: 10.1136/bmjopen-2021-051582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Early intervention (EI) endorses family-centred and participation-focused services, but there remain insufficient options for systematically enacting this service approach. The Young Children's Participation and Environment Measure electronic patient-reported outcome (YC-PEM e-PRO) is an evidence-based measure for caregivers that enables family-centred services in EI. The Parent-Reported Outcomes for Strengthening Partnership within the Early Intervention Care Team (PROSPECT) is a community-based pragmatic trial examining the effectiveness of implementing the YC-PEM e-PRO measure and decision support tool as an option for use within routine EI care, on service quality and child outcomes (aim 1). Following trial completion, we will characterise stakeholder perspectives of facilitators and barriers to its implementation across multiple EI programmes (aim 2). METHODS AND ANALYSIS This study employs a hybrid type 1 effectiveness-implementation study design. For aim 1, we aim to enrol 223 caregivers of children with or at risk for developmental disabilities or delays aged 0-3 years old that have accessed EI services for three or more months from one EI programme in the Denver Metro catchment of Colorado. Participants will be invited to enrol for 12 months, beginning at the time of their child's annual evaluation of progress. Participants will be randomised using a cluster-randomised design at the EI service coordinator level. Both groups will complete baseline testing and follow-up assessment at 1, 6 and 12 months. A generalised linear mixed model will be fitted for each outcome of interest, with group, time and their interactions as primary fixed effects, and adjusting for child age and condition severity as secondary fixed effects. For aim 2, we will conduct focus groups with EI stakeholders (families in the intervention group, service coordinators and other service providers in the EI programme, and programme leadership) which will be analysed thematically to explain aim 1 results and identify supports and remaining barriers to its broader implementation in multiple EI programmes. ETHICS AND DISSEMINATION This study has been approved by the institutional review boards at the University of Illinois at Chicago (2020-0555) and University of Colorado (20-2380). An active dissemination plan will ensure that findings have maximum reach for research and practice. TRIAL REGISTRATION NUMBER NCT04562038.
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Affiliation(s)
- Vera Kaelin
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Vivian Villegas
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yi-Fan Chen
- Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Natalie Murphy
- Health Systems, Management & Policy, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth Papautsky
- Biomedical & Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jodi Litfin
- Rocky Mountain Human Services, Denver, Colorado, USA
| | - Natalie Leland
- Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Varun Maheshwari
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Beth McManus
- Health Systems, Management & Policy, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Khetani
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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Kaelin VC, Valizadeh M, Salgado Z, Parde N, Khetani MA. Artificial Intelligence in Rehabilitation Targeting the Participation of Children and Youth With Disabilities: Scoping Review. J Med Internet Res 2021; 23:e25745. [PMID: 34734833 PMCID: PMC8603165 DOI: 10.2196/25745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/21/2021] [Accepted: 09/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In the last decade, there has been a rapid increase in research on the use of artificial intelligence (AI) to improve child and youth participation in daily life activities, which is a key rehabilitation outcome. However, existing reviews place variable focus on participation, are narrow in scope, and are restricted to select diagnoses, hindering interpretability regarding the existing scope of AI applications that target the participation of children and youth in a pediatric rehabilitation setting. OBJECTIVE The aim of this scoping review is to examine how AI is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with disabilities or other diagnosed health conditions in valued activities. METHODS We conducted a comprehensive literature search using established Applied Health Sciences and Computer Science databases. Two independent researchers screened and selected the studies based on a systematic procedure. Inclusion criteria were as follows: participation was an explicit study aim or outcome or the targeted focus of the AI application; AI was applied as part of the provided and tested intervention; children or youth with a disability or other diagnosed health conditions were the focus of either the study or AI application or both; and the study was published in English. Data were mapped according to the types of AI, the mode of delivery, the type of personalization, and whether the intervention addressed individual goal-setting. RESULTS The literature search identified 3029 documents, of which 94 met the inclusion criteria. Most of the included studies used multiple applications of AI with the highest prevalence of robotics (72/94, 77%) and human-machine interaction (51/94, 54%). Regarding mode of delivery, most of the included studies described an intervention delivered in-person (84/94, 89%), and only 11% (10/94) were delivered remotely. Most interventions were tailored to groups of individuals (93/94, 99%). Only 1% (1/94) of interventions was tailored to patients' individually reported participation needs, and only one intervention (1/94, 1%) described individual goal-setting as part of their therapy process or intervention planning. CONCLUSIONS There is an increasing amount of research on interventions using AI to target the participation of children and youth with disabilities or other diagnosed health conditions, supporting the potential of using AI in pediatric rehabilitation. On the basis of our results, 3 major gaps for further research and development were identified: a lack of remotely delivered participation-focused interventions using AI; a lack of individual goal-setting integrated in interventions; and a lack of interventions tailored to individually reported participation needs of children, youth, or families.
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Affiliation(s)
- Vera C Kaelin
- Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, IL, United States
| | - Mina Valizadeh
- Computer Science, College of Engineering, University of Illinois at Chicago, Chicago, IL, United States
- Natural Language Processing Laboratory, University of Illinois at Chicago, Chicago, IL, United States
| | - Zurisadai Salgado
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, IL, United States
- Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Natalie Parde
- Computer Science, College of Engineering, University of Illinois at Chicago, Chicago, IL, United States
- Natural Language Processing Laboratory, University of Illinois at Chicago, Chicago, IL, United States
| | - Mary A Khetani
- Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, IL, United States
- Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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Frata B, Souza JM, Montemezzo D, Henning E, Menegol NA, Okubo R, Sonza A, Sanada LS. Predictors for Screen Time Exposure among Children between 3 and 5 Years Old in Southern Brazil. J Trop Pediatr 2021; 67:6439025. [PMID: 34850228 DOI: 10.1093/tropej/fmab092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The use of technology is an increasingly common practice among preschoolers. Little is known about the relationship between screen time exposure (STE) and aspects related to family and the environment. AIM The aim is to characterize STE in Brazilian children aged between 3 and 5 years. Furthermore, the objective of this study is to associate the STE of children and of their parents with sociodemographic variables. METHODS Children aged between 3 and 5 years from southern Brazil and their parents participated in this study. To investigate STE, the researchers developed a specific questionnaire. To compare STE between age groups, the Kruskal-Wallis test was performed, followed by Dunn's post hoc test. Spearman's correlation and linear regression were used to correlate the variables. RESULTS Children (n = 237) spend an average of 3.7 ± 0.8 h/day in front of screens. The STE of children had a moderately positive correlation with the STE of their parents (r = 0.4; p-value < 0.001). Only the variables of the children's and parents' STE had a significant and positive association. The model is significant (F = 6164, p-value < 0.001) and the residuals of the model met the necessary assumptions, with normal distribution, constant variance and without the presence of outliers. CONCLUSION Children in southern Brazil remain in front of screens four times longer than the recommended amount of time. It was also found that the STE of parents directly influences that of their children.
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Affiliation(s)
- Bruna Frata
- Postgraduate Program in Physical Therapy, Santa Catarina State University, Florianopolis, SC 88080-350, Brazil
| | - Janaina M Souza
- Nursing Department, Federal University of Santa Catarina, Florianopolis, SC 88040-900, Brazil
| | - Dayane Montemezzo
- Postgraduate Program in Physical Therapy, Santa Catarina State University, Florianopolis, SC 88080-350, Brazil
| | - Elisa Henning
- Matemathic Department, Santa Catarina State University, Florianopolis, SC 88080-350, Brazil
| | - Natalia A Menegol
- Postgraduate Program in Physical Therapy, Santa Catarina State University, Florianopolis, SC 88080-350, Brazil
| | - Rodrigo Okubo
- Postgraduate Program in Physical Therapy, Santa Catarina State University, Florianopolis, SC 88080-350, Brazil
| | - Anelise Sonza
- Postgraduate Program in Physical Therapy, Santa Catarina State University, Florianopolis, SC 88080-350, Brazil
| | - Luciana S Sanada
- Postgraduate Program in Physical Therapy, Santa Catarina State University, Florianopolis, SC 88080-350, Brazil
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Tarakci E, Tarakci D, Hajebrahimi F, Budak M. Supervised exercises versus telerehabilitation. Benefits for persons with multiple sclerosis. Acta Neurol Scand 2021; 144:303-311. [PMID: 33961295 DOI: 10.1111/ane.13448] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the effectiveness of structured telerehabilitation on fatigue, health status, quality of life (QoL), and activities of daily living (ADL) and compare the possible effects with structured supervised exercise programs in patients with Multiple Sclerosis. MATERIALS AND METHODS This study was a randomized, single-blind trial. Thirty patients with relapsing-remitting Multiple Sclerosis were included in the study and randomly divided into two groups; structured supervised exercise group (Group 1) and telerehabilitation group (Group 2). Group 1 (n = 15) completed a 12 week structured supervised exercise program. Group 2 (n = 15) completed a 12 week structured home-based exercise program. Patients were evaluated with functional independence measure (FIM), first section of Nottingham Health Profile (NHP-I), fatigue severity scale (FSS), and quality of life scale (QoLS) before and after the intervention. RESULTS Significant differences were found in all parameters in both groups after the treatment (p < .05). No significant difference was found between groups regarding FIM-total, FIM-motor, FIM-cognitive, NHP sub-parameters, and QoLS (p > .05). Between-group differences revealed a significant difference in FSS and NHP total in favor of Group 1 (p < .05). CONCLUSION A structured home-based exercise program can be an alternative to supervised exercises with no side effects in patients with multiple sclerosis. Home-based rehabilitation exercises that are checked and controlled through telerehabilitation can help patients improve their health-related QoL and ADL. However, supervised exercises can be more beneficial regarding the fatigue and health profile compared to the home-based exercises.
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Affiliation(s)
- Ela Tarakci
- Department of Physiotherapy and Rehabilitation Faculty of Health Sciences Istanbul University Cerrahpaşa Istanbul Turkey
| | - Devrim Tarakci
- Department of Ergotherapy School of Health Sciences Istanbul Medipol University Istanbul Turkey
| | - Farzin Hajebrahimi
- Department of Physical Therapy and Rehabilitation School of Health Sciences Istanbul Medipol University Istanbul Turkey
| | - Miray Budak
- Department of Ergotherapy School of Health Sciences Istanbul Medipol University Istanbul Turkey
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Cornelis N, Buys R, Dewit T, Benoit D, Claes J, Fourneau I, Cornelissen V. Satisfaction and Acceptability of Telemonitored Home-Based Exercise in Patients With Intermittent Claudication: Pragmatic Observational Pilot Study. JMIR Rehabil Assist Technol 2021; 8:e18739. [PMID: 33749616 PMCID: PMC8108570 DOI: 10.2196/18739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Current guidelines recommend supervised exercise training (SET) as a first-line treatment in patients with intermittent claudication (IC). SET has been shown to be more effective than home-based exercise therapy (HBET). However, the lack of available SET programs hampers broad SET implementation in clinical practice. OBJECTIVE The aim of this study is to assess patient satisfaction and acceptability of a structured HBET program using wearable technology and elastic band resistance exercises. METHODS A total of 20 patients with IC (Rutherford 1-3) with internet access and currently not engaged in structured exercise training were recruited in a pragmatic observational pilot study. Participants were instructed to complete 3 walking sessions and 2 elastic band resistance exercise sessions per week in their home environment during a 4-week period. Patient satisfaction and acceptability were assessed using a 5-point Likert scale questionnaire (1-2=very unsatisfied, 3=neutral, and 4-5=very satisfied) evaluating the materials and intervention content. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal walking distance (MWD) and pain-free walking distance (PFWD), physical fitness, and patient-reported outcomes on quality of life, walking capacity, levels of kinesiophobia, and self-efficacy. Statistically significant changes were tested using paired t tests or Wilcoxon signed-rank tests. RESULTS All patients (15 men, 5 women; mean age 64.6, SD 10.6 years; range 41-81 years) completed the 4-week intervention and were highly satisfied with the program (mean overall score 4.5, SD 0.5). Patients' questionnaire responses documented willingness to recommend the exercise program to other patients (mean 4.5, SD 0.5; median 4.5) and preference for continuing the intervention (mean 4.3, SD 0.5; median 4). Furthermore, participants endorsed the use of the sports watches to track walking sessions (mean 4.25, SD 0.6; median 4), felt safe (mean 4.4, SD 0.6; median 4), and appreciated personal feedback (mean 4.55, SD 0.5; median 5) and flexibility of training (mean 4.1, SD 0.7; median 4). Resistance training was not preferred over walking training (mean 2.65, SD 0.8; median 3). In addition, PFWD (+89 m; P=.001), MWD (+58 m; P=.03), Walking Impairment Questionnaire distance score (+0.18; P=.01), activity-related scores (+0.54; P<.001), and total quality of life (+0.36; P=.009) improved following the intervention. Other patient-related outcomes, physical fitness, and physical activity remained to be statistically unaltered. CONCLUSIONS Patients with IC were satisfied and accepted technology to monitor and guide HBET, with observed short-term effectiveness regarding walking capacity and quality of life. However, elastic band resistance exercises as a part of HBET were not preferred over progressive walking. TRIAL REGISTRATION ClinicalTrials.gov NCT04043546; https://clinicaltrials.gov/ct2/show/NCT04043546.
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Affiliation(s)
- Nils Cornelis
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Roselien Buys
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Tijl Dewit
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Dries Benoit
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Cardiovascular Sciences, Vascular Surgery, KU Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
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MacDonald AM, Chafranskaia A, Lopez CJ, Maganti M, Bernstein LJ, Chang E, Langelier DM, Obadia M, Edwards B, Oh P, Bender JL, Alibhai SMH, Jones JM. CaRE @ Home: Pilot Study of an Online Multidimensional Cancer Rehabilitation and Exercise Program for Cancer Survivors. J Clin Med 2020; 9:jcm9103092. [PMID: 32992759 PMCID: PMC7600555 DOI: 10.3390/jcm9103092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although facility-based cancer rehabilitation and exercise programs exist, patients are often unable to attend due to distance, cost, and other competing obligations. There is a need for scalable remote interventions that can reach and serve a larger population. METHODS We conducted a mixed methods pilot study to assess the feasibility, acceptability and impact of CaRE@Home: an 8-week online multidimensional cancer rehabilitation and exercise program. Feasibility and acceptability data were captured by attendance and adherence metrics and through qualitative interviews. Preliminary estimates of the effects of CaRE@Home on patient-reported and physically measured outcomes were calculated. RESULTS A total of n = 35 participated in the study. Recruitment (64%), retention (83%), and adherence (80%) rates, along with qualitative findings, support the feasibility of the CaRE@Home intervention. Acceptability was also high, and participants provided useful feedback for program improvements. Disability (WHODAS 2.0) scores significantly decreased from baseline (T1) to immediately post-intervention (T2) and three months post-intervention (T3) (p = 0.03 and p = 0.008). Physical activity (GSLTPAQ) levels significantly increased for both Total LSI (p = 0.007 and p = 0.0002) and moderate to strenuous LSI (p = 0.003 and p = 0.002) from baseline to T2 and T3. Work productivity (iPCQ) increased from T1 to T3 (p = 0.026). There was a significant increase in six minute walk distance from baseline to T2 and T3 (p < 0.001 and p = 0.010) and in grip strength from baseline to T2 and T3 (p = 0.003 and p < 0.001). CONCLUSIONS Results indicate that the CaRE@Home program is a feasible and acceptable cancer rehabilitation program that may help cancer survivors regain functional ability and decrease disability. In order to confirm these findings, a controlled trial is required.
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Affiliation(s)
- Anne Marie MacDonald
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- IMS Program, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Aleksandra Chafranskaia
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Physical Therapy, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Christian J. Lopez
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada;
| | - Lori J. Bernstein
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Eugene Chang
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.O.); (S.M.A.)
| | - David Michael Langelier
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.O.); (S.M.A.)
| | - Maya Obadia
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
| | - Beth Edwards
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
| | - Paul Oh
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.O.); (S.M.A.)
| | - Jacqueline L. Bender
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
| | - Shabbir MH Alibhai
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.O.); (S.M.A.)
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Jennifer M. Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence:
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Bosak DL, Jarvis JM, Khetani MA. Caregiver creation of participation-focused care plans using Participation and Environment Measure Plus (PEM+), an electronic health tool for family-centred care. Child Care Health Dev 2019; 45:791-798. [PMID: 31313843 DOI: 10.1111/cch.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Family-centred care (FCC) is a model for rehabilitation practice that focuses on collaborative partnerships between providers and clients (i.e., children and their caregivers). FCC is a best-practice standard and is expected to yield better outcomes for children and greater caregiver satisfaction with rehabilitation services. A commonly cited barrier to implementing FCC is perceptions about caregiver capability to contribute to designing an initial plan of care, due to lack of skill and/or interest. OBJECTIVES The aim of this study is to address FCC barriers through three objectives: (a) report the proportion of caregivers that created multiple care plans using PEM+, an electronic health tool, (b) assess the proportion of caregivers that created complete and participation-focused care plan(s) and that exceeded criteria of a complete plan, and (c) describe characteristics of caregivers that did not create a complete care plan. METHODS Study objectives were addressed via secondary analyses of a subset of data from the PEM + pilot trial. Participants were caregivers (N = 18) of children with developmental disabilities (aged 0-5 years) receiving rehabilitation services in an early childhood programme. A deductive analytic approach was used to code care plan content to criteria and to determine proportion of caregivers with a complete and participation-focused care plan and those that exceeded the criteria. RESULTS Multiple care plans were created by 72% of the caregivers, 83% caregivers created at least one care plan that was complete and participation-focused per criteria, and 83% exceeded the criteria. CONCLUSION The high occurrence of caregivers who developed multiple care plans and who developed high-quality care plans, in their completeness and participation-focused features, suggests that caregivers are interested and capable of participating in a collaborative goal setting process when using PEM+. This indicates that FCC is feasible to implement in clinical workflow with the use of an electronic health tool, which may better facilitate such care. PEM+ warrants further efficacy testing prior to implementation.
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Affiliation(s)
- Dianna L Bosak
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois
| | - Jessica M Jarvis
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Mary A Khetani
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois
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10
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Pol MC, ter Riet G, van Hartingsveldt M, Kröse B, Buurman BM. Effectiveness of sensor monitoring in a rehabilitation programme for older patients after hip fracture: a three-arm stepped wedge randomised trial. Age Ageing 2019; 48:650-657. [PMID: 31204776 DOI: 10.1093/ageing/afz074] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/15/2019] [Accepted: 05/27/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES to test the effects of an intervention involving sensor monitoring-informed occupational therapy on top of a cognitive behavioural treatment (CBT)-based coaching therapy on daily functioning in older patients after hip fracture. DESIGN, SETTING AND PATIENTS three-armed randomised stepped wedge trial in six skilled nursing facilities, with assessments at baseline (during admission) and after 1, 4 and 6 months (at home). Eligible participants were hip fracture patients ≥ 65 years old. INTERVENTIONS patients received care as usual, CBT-based occupational therapy or CBT-based occupational therapy with sensor monitoring. Interventions comprised a weekly session during institutionalisation, followed by four home visits and four telephone consultations over three months. MAIN OUTCOMES AND MEASURES the primary outcome was patient-reported daily functioning at 6 months, assessed with the Canadian Occupational Performance Measure. RESULTS a total of 240 patients (mean[SD] age, 83.8[6.9] years were enrolled. At baseline, the mean Canadian Occupational Performance Measure scores (range 1-10) were 2.92 (SE 0.20) and 3.09 (SE 0.21) for the care as usual and CBT-based occupational therapy with sensor monitoring groups, respectively. At six months, these values were 6.42 (SE 0.47) and 7.59 (SE 0.50). The mean patient-reported daily functioning in the CBT-based occupational therapy with sensor monitoring group was larger than that in the care as usual group (difference 1.17 [95% CI (0.47-1.87) P = 0.001]. We found no significant differences in daily functioning between CBT-based occupational therapy and care as usual. CONCLUSIONS AND RELEVANCE among older patients recovering from hip fracture, a rehabilitation programme of sensor monitoring-informed occupational therapy was more effective in improving patient-reported daily functioning at six months than to care as usual. TRIAL REGISTRATION Dutch National Trial Register, NTR 5716.
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Affiliation(s)
- Margriet C Pol
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Gerben ter Riet
- Department General Practice, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Margo van Hartingsveldt
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ben Kröse
- Research Group Digital Life, Amsterdam University of Applied Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Bianca M Buurman
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Jarvis JM, Gurga A, Greif A, Lim H, Anaby D, Teplicky R, Khetani MA. Usability of the Participation and Environment Measure Plus (PEM+) for Client-Centered and Participation-Focused Care Planning. Am J Occup Ther 2019; 73:7304205130p1-7304205130p8. [PMID: 31318677 PMCID: PMC9563087 DOI: 10.5014/ajot.2019.032235] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The Participation and Environment Measure Plus (PEM+) is a new electronic health application to help caregivers contribute to client-centered and participation-focused care planning for their young child. The PEM+ is designed to help caregivers build on their participation assessment by determining priority activities, setting specific goals, and identifying strategies for goal attainment. OBJECTIVE To examine the usability of the PEM+. DESIGN A single-arm usability trial. SETTING Two early intervention and early childhood educational programs. PARTICIPANTS Six caregivers of children ages 0-3 yr with developmental delay and receiving rehabilitation services. INTERVENTION Caregivers who were eligible and enrolled were given access to the PEM+ for 1 wk and instructed to complete one iteration. OUTCOMES AND MEASURES Usability was assessed according to caregivers' report of PEM+'s technical effectiveness and ease of use, ease of learning, and user satisfaction via the Usefulness, Satisfaction, and Ease of Use questionnaire. RESULTS All caregivers completed the PEM+ online once and in its entirety (mean completion time = 13.6 min). Mean technical effectiveness ratings ranged from 5.7 to 6.3 out of 7.0, and mean ease of use, ease of learning, and user satisfaction ratings were 4.4, 5.4, and 4.2 out of 6.0, respectively. CONCLUSIONS AND RELEVANCE Caregivers of young children can navigate the PEM+. Trends in survey feedback informed optimizations for the PEM+ before further feasibility testing. WHAT THIS ARTICLE ADDS This study provides preliminary evidence for a promising tool that can help to customize the way practitioners partner with families to create a plan for occupational therapy services.
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Affiliation(s)
- Jessica M Jarvis
- Jessica M. Jarvis, PhD, is Postdoctoral Associate, Department of Occupational Therapy, University of Illinois at Chicago
| | - Andrea Gurga
- Andrea Gurga, MS, is Graduate Research Assistant, Department of Occupational Therapy, University of Illinois at Chicago
| | - Alexa Greif
- Alexa Greif, MS, is Graduate Research Assistant, Department of Occupational Therapy, University of Illinois at Chicago
| | - Heather Lim
- Heather Lim, BS, is Graduate Research Assistant, Department of Occupational Therapy, University of Illinois at Chicago
| | - Dana Anaby
- Dana Anaby, PhD, is Associate Professor, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Rachel Teplicky
- Rachel Teplicky, MS, is Business and Engagement Officer, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Mary A Khetani
- Mary A. Khetani, ScD, is Associate Professor, Department of Occupational Therapy, University of Illinois at Chicago;
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Abstract
Telerehabilitation refers to the virtual delivery of rehabilitation services into the patient's home. This methodology has shown to be advantageous when used to enhance or replace conventional therapy to overcome geographic, physical, and cognitive barriers. The exponential growth of technology has led to the development of new applications that enable health care providers to monitor, educate, treat, and support patients in their own environment. Best practices and well-designed Telerehabilitation studies are needed to build and sustain a strong Telerehabilitation system that is integrated in the current health care structure and is cost-effective.
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Community engagement to pilot electronic patient-reported outcomes (e-PROs) in early intervention: Lessons learned. J Clin Transl Sci 2018; 2:20-26. [PMID: 30333929 PMCID: PMC6188646 DOI: 10.1017/cts.2018.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Electronic data capture is essential to advancing family-centered coordinated care in early intervention (EI). The purpose of this paper is to report on EI service coordinator response to piloting an electronic parent-reported outcome (e-PRO) assessment as part of their routine workflow, including lessons learned that may inform future phases of e-PRO implementation. Methods This second pilot study involved families enrolled in a large EI program (n=1040 families) in concert with their implementation of a statewide quality improvement initiative for care plan development and outcomes reporting. A total of 22 EI service coordinators and supervisors were engaged in three phases: initial e-PRO intervention, peer mentor enhancement, and standard recruitment protocol. Results Implementation of the e-PRO intervention and peer mentoring enhancement yielded low enrollment rates over the first six months (n=17). A standard recruitment protocol has resulted in enrollment growth (n=83) towards the targeted enrollment rate (n=832). Conclusions This study reports on early insights for building and sustaining a productive academic-community partnership for e-PRO implementation to support family-centered coordinated care. Lessons learned from this academic-community partnership with respect to strategies for enhancing community significance, collaboration, return, and control are discussed as they inform further development of this intervention prior to scale-up.
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Cornelis N, Buys R, Fourneau I, Dewit T, Cornelissen V. Exploring physical activity behaviour – needs for and interest in a technology-delivered, home-based exercise programme among patients with intermittent claudication. VASA 2018; 47:109-117. [DOI: 10.1024/0301-1526/a000654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: Supervised walking is a first line therapy in peripheral arterial disease (PAD) with complaints of intermittent claudication. However, uptake of supervised programmes is low. Home-based exercise seems an appealing alternative; especially since technological advances, such as tele-coaching and tele-monitoring, may facilitate the process and support patients when adopting a physically active lifestyle. To guide the development of such an intervention, it is important to identify barriers of physical activity and the needs and interests for technology-enabled exercise in this patient group. Patients and methods: PAD patients were recruited at the vascular centre of UZ Leuven (Belgium). A questionnaire assessing PA (SF-International Physical Activity Questionnaire), barriers to PA, and interest in technology-supported exercise (Technology Usage Questionnaire) was completed. Descriptive and correlation analyses were performed. Results: Ninety-nine patients (76 men; mean age 69 years) completed the survey. Physical activity levels were low in 48 %, moderate in 29 %, and high in 23 %. Intermittent claudication itself is the most important barrier for enhanced PA, with most patients reporting pain (93 %), need for rest (92 %), and obstacles worsening their pain (74 %) as barriers. A total of 93 % participants owned a mobile phone; 76 % had Internet access. Eighty-seven reported the need for an exercise programme, with 67 % showing interest in tele-coaching to support exercise. If technology was available, three-quarter stated they would be interested in home-based tele-coaching using the Internet (preferably e-mails, 86 %); 50 % via mobile phone, 87 % preferred text messages. Both were inversely related to age (rpb = 0.363 and rpb = 0.255, p < 0.05). Acquaintance with elastic bands or gaming platforms was moderate (55 and 49 %, respectively), but patients were interested in using them as alternatives (84 and 42 %). Interest in platforms was age-dependent (rs = –0.508, p < 0.01). Conclusions: PAD patients show significant interest in technology-delivered exercise, offering opportunities to develop a guided home-based exercise programme.
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Affiliation(s)
- Nils Cornelis
- Department Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Roselien Buys
- Department Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Tijl Dewit
- Department Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Khetani MA, Lim HK, Corden ME. Caregiver Input to Optimize the Design of a Pediatric Care Planning Guide for Rehabilitation: Descriptive Study. JMIR Rehabil Assist Technol 2017; 4:e10. [PMID: 29066421 PMCID: PMC5676028 DOI: 10.2196/rehab.7566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/21/2017] [Accepted: 08/25/2017] [Indexed: 11/25/2022] Open
Abstract
Background Caregiver input has informed the design of a valid electronic patient-reported outcome (PRO) measure for use in pediatric rehabilitation. This proxy assessment may be further developed to expedite and enhance patient-centered care planning processes, but user input is first needed to finalize the core requirements that will guide its design. Objective The objective of this study was to examine the feasibility of a stepwise process for building on a baseline assessment of young children's participation in activities to develop a care plan relevant to pediatric rehabilitation. Methods A cross-sectional descriptive study design was employed using qualitative methods. Data were collected via Web-based technology and by telephone. Twenty-five caregivers of young children (9 with developmental delays, 16 without delays) and between 1 and 7 years were recruited from a subsample of parents who had previously enrolled in a Web-based validation of a PRO on children’s participation and provided consent for future contact. Each caregiver completed a demographic questionnaire and Young Children’s Participation and Environment Measure (YC-PEM) online, followed by a 20- to 60-min semistructured and audiotaped phone interview to review and build upon PRO results as summarized in an electronic report. Interview data were content coded to the interview guide and reviewed by multiple research staff to estimate feasibility according to stepwise completion rates, perceptions of difficulty in step completion, and perceptions of overall utility. Results Half of the participants in the final study sample (N=25) fully completed a stepwise process of building on their baseline PRO assessment to develop an initial care plan for their child. In most cases, similar stepwise completion rates and trends in the approaches taken for step completion were found regardless of the child’s disability status. However, more parents of children with disabilities reported difficulties in rank ordering their priorities for change and identified child-focused strategies for goal attainment. Nearly 77% (19/25) of users were willing to use the process to develop and communicate intervention priorities and strategies with professionals, family, and friends. Conclusions Results informed revisions to the care planning guide before usability and feasibility testing of an initial Web-based prototype that is now underway.
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Affiliation(s)
- Mary A Khetani
- Children's Participation in Environment Research Lab, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Heather K Lim
- Children's Participation in Environment Research Lab, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Marya E Corden
- Children's Participation in Environment Research Lab, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, United States
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