A profile of canadian pediatric occupational therapy practice

Profile of paediatric occupational therapy practice in Eastern Mediterranean countries

BACKGROUND

Paediatric occupational therapy (OT) is considered the largest practice area in OT in several regions, including the Eastern Mediterranean (EM) countries.

AIMS/OBJECTIVES

This study aimed to establish a profile of paediatric occupational therapists in EM countries to identify theoretical models, assessments and interventions employed. It also investigated the therapists' usage of evidence-based practice in their practice.

MATERIAL AND METHODS

We conducted a cross-sectional survey using a questionnaire which was distributed electronically to occupational therapists working with children.

RESULTS

The participants included 118 therapists. Majority of the participants were working at rehabilitation centres. The primary client groups were pre- and school-age children with autism spectrum disorder and cerebral palsy. The most frequently used assessments were sensory-related tools. Activities of daily living and play were the most often targeted interventional area. Participants highlighted some of the challenges faced in implementing evidence in their practice.

CONCLUSION

Paediatric occupational therapists are usually exposed to specific age groups and conditions. However, a lack of knowledge practice in some areas and challenges in others exist.

SIGNIFICANCE

Within the EM region, knowledge regarding therapists' practices is lacking. Actions should be taken to improve current practice and meet the current needs of clients, and utilise evidence-based practices.

Occupational Therapists in Patient Navigation: A Scoping Review of the Literature

This review seeks to understand the literature on patient navigator programs (PNPs) that employ occupational therapists (OTs), including the role (conceptualization), functions (operationalization) of OTs who work as patient navigators (PNs) and the settings and populations they serve. This review also mapped the role of PNs to the 2021 Competencies for Occupational Therapists in Canada. Scoping review methodology by Arksey and O'Malley (2005) was employed. Data were analyzed thematically and numerically to identify frequent patterns. Ten articles were included. Within PNPs, OTs worked in hospitals and communities, but their role was rarely well-defined. Five competency domains (i.e., communication and collaboration, culture, equity and justice, excellence in practice, professional responsibility, and engagement with the profession) were evident in existing PNPs that included OTs. This review supports the increasing interest in OTs as PNs by demonstrating the alignment between the OT competencies and roles and functions of OTs working within PNPs.

The Effect of a Short-Term Occupational Therapy Intervention on the Participation and Personal Factors of Preschoolers with Developmental Disabilities

BACKGROUND

Preschoolers with developmental disabilities are referred to occupational therapy due to their decreased participation in daily life occupations. The purpose of this study was to evaluate the improvement in preschoolers' participation and sensory-motor abilities following an occupational therapy intervention.

MATERIALS AND METHODS

A prospective cohort study of 38 preschoolers and their parents was conducted using an interrupted time-series design, including assessments at three time points: base line (upon referral to an occupational therapy assessment), pre-intervention, and post-intervention after 9-12 sessions of occupational therapy interventions. Children were evaluated with the Developmental Test of Visual-Motor Integration, as well as the balance and fine motor precision sub tests of the Bruininks-Oseretsky Test of Motor Proficiency. Parents completed the Children's Participation Questionnaire and the Child Performance Skills Questionnaire. Each intervention session was documented by the therapists using the Documentation of Occupational Therapy Session Intervention form.

RESULTS

Significant improvement in children's sensory-motor abilities were found in balance, visual integration, and fine motor precision post-intervention. There were also improvements in the measures of diversity, children's independence, and parental satisfaction.

CONCLUSIONS

A short-term occupational therapy intervention applied to preschoolers with developmental disabilities is effective in improving their sensory-motor abilities, as well as in promoting their participation in daily activities.

Preliminary Adaptation of Motor Tests to Evaluate Fine Motor Skills Associated with Mathematical Skills in Preschoolers

Mathematics is the subject in which many school-age children reveal difficulties. The literature has shown that fine motor skills, namely fine motor coordination and visuomotor integration, have been more robustly associated with mathematical performance. Studies have shown the importance that instruments have to evaluate these skills, however, the characteristics of these instruments do not fit the reality of kindergartens, they are usually time consuming and expensive and are usually administered by specialists. Thus, the main objective of this study was to identify, select, adapt and validate motor tests to evaluate fine motor skills associated with mathematical skills to allow the kindergarten teachers to apply them simultaneously to the class, with few material resources, in a short period of time and without the need for a lot of training to apply, score and classify. For this purpose, firstly, it was necessary to understand the main difficulties highlighted by kindergarten teachers regarding the use of instruments to evaluate fine motor skills and, thus, elaborate criteria to identify and select the tests that best fit the reality of kindergartens. The test identified, selected and adapted to evaluate fine motor coordination was threading beads from the Movement Evaluation Battery for Children, 2nd Edition. The main adaptation of the test was related to time, that is, instead of counting the time it takes the child to string the total number of cubes on the string, we counted the number of cubes the child strung on the string in a pre-defined time. To evaluate visual-motor integration, the test identified, selected and adapted was the Visual-Motor Integration (6th Edition) test. The main adaptation was related to material resources, that is, it will be possible to apply the test using only one sheet per child instead of the seven suggested by the original test. After the preliminary adaptation of the tests, their validation was performed by means of the degree of reliability (test-retest) and predictive validity. The results indicated that the adapted tests presented an excellent degree of reliability (>0.9) and could therefore be used to administer them simultaneously to the class group. The adapted Visual-Motor Integration test seems to be the most suitable one to be used by kindergarten teachers, in a classroom context, to simultaneously evaluate students' fine motor skills and associate their results with mathematical skills.

Sensory integration therapy for children with autism and sensory processing difficulties: the SenITA RCT

BACKGROUND

Carers report unmet need for occupational therapy services addressing sensory difficulties in autism, yet insufficient evidence exists to recommend a therapeutic approach.

OBJECTIVES

Our aim was to determine the clinical effectiveness and cost-effectiveness of sensory integration therapy for children with autism and sensory difficulties across behavioural, functional and quality-of-life outcomes.

DESIGN

We carried out a parallel-group randomised controlled trial, incorporating an internal pilot and a process evaluation. Randomisation utilised random permuted blocks.

SETTING AND PARTICIPANTS

Children were recruited via services and self-referral in Wales and England. Inclusion criteria were having an autism diagnosis, being in mainstream primary education and having definite/probable sensory processing difficulties. Exclusion criteria were having current/previous sensory integration therapy and current applied behaviour analysis therapy.

INTERVENTION

The intervention was manualised sensory integration therapy delivered over 26 weeks and the comparator was usual care.

OUTCOMES

The primary outcome was problem behaviours (determined using the Aberrant Behavior Checklist), including irritability/agitation, at 6 months. Secondary outcomes were adaptive behaviour, functioning and socialisation (using the Vineland Adaptive Behavior Scales); carer stress (measured using the Autism Parenting Stress Index); quality of life (measured using the EuroQol-5 Dimensions and Carer Quality of Life); functional change (according to the Canadian Occupational Performance Measure); sensory processing (determined using the Sensory Processing Measure™ at screening and at 6 months to examine mediation effects); and cost-effectiveness (assessed using the Client Service Receipt Inventory). Every effort was made to ensure that outcome assessors were blind to allocation.

RESULTS

A total of 138 participants were randomised (n = 69 per group). Usual care was significantly different from the intervention, which was delivered with good fidelity and adherence and minimal contamination, and was associated with no adverse effects. Trial procedures and outcome measures were acceptable. Carers and therapists reported improvement in daily functioning. The primary analysis included 106 participants. There were no significant main effects of the intervention at 6 or 12 months. The adjusted mean difference between groups on the Aberrant Behavior Checklist - irritability at 6 months post randomisation was 0.40 (95% confidence interval -2.33 to 3.14; p = 0.77). Subgroup differences in irritability/agitation at 6 months were observed for sex of child (intervention × female = 6.42, 95% confidence interval 0.00 to 12.85; p = 0.050) and attention deficit hyperactivity disorder (intervention × attention deficit hyperactivity disorder = -6.77, 95% confidence interval -13.55 to -0.01; p = 0.050). There was an effect on carer stress at 6 months by region (intervention × South England = 7.01, 95% confidence interval 0.45 to 13.56; p = 0.04) and other neurodevelopmental/genetic conditions (intervention × neurodevelopmental/genetic condition = -9.53, 95% confidence interval -18.08 to -0.98; p = 0.030). Carer-rated goal performance and satisfaction increased across sessions (p < 0.001), with a mean change of 2.75 (95% confidence interval 2.14 to 3.37) for performance and a mean change of 3.34 (95% confidence interval 2.63 to 4.40) for satisfaction. Health economic evaluation suggests that sensory integration therapy is not cost-effective compared with usual care alone.

LIMITATIONS

Limitations included variability of the intervention setting (i.e. NHS vs. private), delay for some receiving therapy, an error in administration of Vineland Adaptive Behavior Scales and no measurement of comparator arm goal performance.

CONCLUSIONS

The intervention did not demonstrate clinical benefit above standard care. Subgroup effects are hypothesis-generating only. The intervention is likely to be effective for individualised performance goals, although it is unclear whether effects were in addition to standard care or were maintained.

FUTURE WORK

Further investigation of subgroup effects is needed.

TRIAL REGISTRATION

This trial is registered as ISRCTN14716440.

FUNDING

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 29. See the NIHR Journals Library website for further project information.

Adapting the Wheelchair Skills Program for pediatric rehabilitation: recommendations from key stakeholders

Background

Backed by over 20 years of research development, the Wheelchair Skills Program (WSP) has proven to be a safe and effective program to improving wheelchair skills for adult wheelchair users. However, evidence is lacking for the pediatric population, which may help to explain the limited use of the WSP in pediatric settings. While additional evidence specific to the pediatric population is needed, concurrent implementation of the WSP into pediatric clinical practice is equally prudent to allow those users to benefit from the years of accumulated WSP evidence. To facilitate implementation of evidence-based programs into practice, adaptation is also often required to improve the fit between the program and the local context. Therefore, the objective of this study was to understand what adaptations, if any, are required for the WSP to be implementable in a pediatric setting.

Methods

A deductive qualitative descriptive study design was used, guided by the Knowledge to Action Framework and Consolidated Framework for Implementation Research (CFIR). Occupational Therapists (OTs) from a pediatric rehabilitation center and two specialized schools in Montreal, Canada were invited to participate in a 90-min focus group. The Framework Method was followed for the data analysis.

Results

One focus group in each site (n = 3) was conducted with a total of 19 participants. From the OTs’ perspectives, our analysis revealed benefits of WSP use and various issues (e.g. some skills seem unrealistic) affecting its uptake in relation to the constructs of the CFIR Intervention Characteristics domain. The results provided guidance for the recommendations of adaptations (e.g. addition of a caregiver assistance score) to enhance implementation of the WSP in pediatric rehabilitation settings and helped to identify the need for the production of new knowledge and knowledge translation (KT) tools.

Conclusions

Implementation of the WSP with the adaptations and KT tools proposed could allow pediatric manual wheelchair users to improve their wheelchair skills.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02564-9.

Are the American normative standard scores applicable to the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G)?

BACKGROUND

The Pediatric Evaluation of Disability Inventory (PEDI) is an assessment to evaluate children's performance in activities of daily living.

AIMS

The study investigated if the normative standard scores of the PEDI are applicable to the German version of the PEDI (PEDI-G) in Germany, Austria and Switzerland, and whether there are differences in the applicability of the PEDI-G between the three countries.

MATERIALS AND METHODS

75 children with normal development (35 girls, 40 boys) from Germany (n = 17), Austria (n = 16), and Switzerland (n = 42) aged between 0.9 month and 7.3 years (SD = 2.03) participated in the study. Descriptive statistics, independent samples t-tests, univariate analyses of variance (ANOVA) and post hoc Tukey tests were applied.

RESULTS

No significant differences were identified. However, the German-speaking sample showed higher scores for the domain social function in both scales and in the Caregiver Assistance Scale self-care. Lower scores were identified in the Functional Skills Scale mobility.

CONCLUSIONS AND SIGNIFICANCE

The results support that the normative standard scores of the PEDI are applicable to the PEDI-G and for Austria, Germany and Switzerland, as no significant differences between the countries were identified. However, the generalizability of the results is limited due to sample size and recruitment procedures.

[Overview of the assessment practices of occupational therapists working in Quebec]

BACKGROUND.

In occupational therapy practice, client assessments are essential for establishing treatment priorities and determining the effectiveness of interventions. However, occupational therapists' assessment practices are not well documented.

PURPOSE.

This work aimed to provide an overview of the assessment practices of Quebec occupational therapists based on the person-environment-occupation components and clienteles.

METHOD.

A cross-sectional survey was conducted using an online survey that was sent to occupational therapists in Quebec.

FINDINGS.

In paediatrics, occupational therapists tend to use standardized tools to assess physical and neurological abilities. Adult assessment focuses mainly on physical abilities and productivity. For seniors, assessment focuses mainly on functional aspects (physical abilities, personal care, and home safety) and screening for cognitive difficulties.

IMPLICATIONS.

Occupational therapy assessment mostly focuses on physicial abilities. To ensure a holistic approach, more occupational and environmental components should be included in the assessment practices.

Convergent validity of two motor skill tests used to assess school-age children

BACKGROUND

Motor skills allow children to interact with their surrounding environment, making the progression of competent motor skills crucial to development. The most common form of motor skill assessment is through the use of performance-based tests. Performance measures need to be both reliable and valid to ensure they are of high quality. Two examples of performance-based motor skill tests often used to assess children are the Bruininks-Oseretsky Test of Motor Proficiency--2nd edition (BOT-2) and the Movement Assessment Battery for Children--2nd edition (MABC-2).

AIM

This study investigated the convergent validity between the BOT-2 and MABC-2 when completed by typically developing school-aged children aged 7-16 years.

METHOD

A convenience sample of 50 children aged 7-16 years with no history of motor or intellectual impairments was recruited. Scores from the BOT-2 and MABC-2 were analysed using Spearman's rho correlation.

RESULTS

The study found that the MABC-2 11- to 16-year-old group (age band 3) was significantly associated with the BOT-2; however, there were no significant relationships between the MABC-2 7- to 10-year-old group (age band 2) and the BOT-2.

CONCLUSION

The MABC-2 and BOT-2 appear to assess associated motor skill abilities in children aged 11-16 years but not in children aged 7-10. This study adds to the body of convergent validity evidence regarding the MABC-2 and BOT-2.

Are performance-based and self-report measures of children's motor skill abilities linked?

Traditionally, children's motor skills were assessed using standardized performance-based tests; however, practitioners are now being encouraged to utilize client-centered and child-centered assessment approaches (such as self-report scales). The purpose of the study was to investigate the association between standardized performance-based and child-report measures of children's motor skill abilities using a convenience sample of 93 typically developing school-age children (52 boys and 41 girls with a mean age of 10.3 years [standard deviation = 1.4]). Data obtained from the Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-2) and the Physical Self-Description Questionnaire (PSDQ) were analyzed using Spearman's rho correlations. Of the eight BOT-2 subscales, the three that significantly correlated with 8 or more of the 11 PSDQ subscales were the BOT-2 Balance, Running Speed and Agility, and Strength subscales. The PSDQ Body Fat and Flexibility subscales did not correlate with any of the BOT-2 subscale scores. This suggests that children offer a unique perspective of their motor skill performance relative to other sources of assessment information. The PSDQ is recommended for inclusion as part of the motor skill assessment repertoire that practitioners use with children.

Top-down and bottom-up approaches to motor skill assessment of children: are child-report and parent-report perceptions predictive of children's performance-based assessment results?

BACKGROUND/ AIM: Therapists use different types of tests, scales, and instruments to assess children's motor skills, including those classified as being top-down and bottom-up. The aim of the study was to investigate the ability of measures of children's motor skill performance from the perspectives of children and parents (a type of top-down assessment) to predict children's performance-based motor ability test results (a type of bottom-up assessment).

METHODS

A convenience sample of 38 children and parents was recruited from Victoria, Australia. Motor skill performance was evaluated from a top-down perspective using the Physical Self-Description Questionnaire (PSDQ) and the Movement Assessment Battery for Children--Second Edition (MABC-2) Checklist to measure children's and parents' perspectives respectively. Motor skill performance was also evaluated from a bottom-up approach using the Bruininks-Oseretsky Test of Motor Proficiency--Second Edition (BOT-2). Data were analyzed using multiple linear regression analysis to determine whether the PSDQ or MABC-2 Checklist was predictive of the children's BOT-2 performance results.

RESULTS

Two predictive relationships were identified based on parents' perspectives, where the total score of the MABC-2 Checklist was found to be a significant predictor of the BOT-2 Manual Coordination motor composite score, accounting for 8.35% of its variance, and the BOT-2 Strength and Agility motor composite score, accounting for 11.6% of its variance. No predictive relationships were identified between the children's self-report PSDQ perspectives and the BOT-2 performance scores.

CONCLUSIONS

Therapists are encouraged to utilize a combination of top-down and bottom-up approaches and purposefully to seek parents' and children's perspectives when evaluating children's motor skill performance.

Motor skill assessment of children: is there an association between performance-based, child-report, and parent-report measures of children's motor skills?

Client-centered practice requires therapists to actively seek the perspectives of children and families. Several assessment tools are available to facilitate this process. However, when evaluating motor skill performance, therapists typically concentrate on performance-based assessment. To improve understanding of the information provided by the different approaches, the study investigated correlations between performance-based, child-report, and parent-report measures of children's motor skill performance. A sample of convenience of 38 children 8-12 years of age with no history of motor or intellectual impairments and their parents was recruited from Victoria, Australia. Scores for the Bruininks-Oseretsky Test of Motor Proficiency (performance-based, administered by a therapist), Physical Self-Description Questionnaire (child report), and Movement Assessment Battery for Children Checklist (parent report) were analyzed using Spearman's rho correlation. Several significant moderate-to-large correlations were found between scores for parent-report and scores for performance-based assessments, while few significant correlations were found between scores for child report and scores for the other two measures. The results suggest that children offer a unique perspective which should be integrated with other sources of information to gain a more holistic perspective of their motor skill performance.

Convergent Validity of Two Visual Motor Integration Tests

Background:

Occupational therapists often assess visual motor integration (VMI) skills. It is, therefore, imperative that therapists use VMI tests with robust measurement properties.

Objective:

This study examined the convergent validity of two VMI tests used to assess children, adolescents and adults.

Method:

Three groups of healthy participants (n = 153) completed the Beery-Buktenica Developmental Test of Visual-Motor Integration (DTVMI) and the Full Range Test of Visual Motor Integration (FRTVMI). Seventy-three children aged 5–10 years (37 males and 36 females; mean age 7.5 years, SD = 2.20), 19 adolescents aged 11–17 years (8 males and 11 females; 13.1 years, SD = 2.16), and 61 adults (18 males and 43 females; mean age 31.82 years, SD = 11.20) completed the DTVMI and the FRTVMI. Spearman rho correlation coefficients were used to investigate whether each pair of the VMI test scores for each of the three participant age groups were associated.

Results:

The Spearman rho correlation coefficients between all three versions of the DTVMI and FRTVMI were statistically significant. For the child group, the correlation coefficient was rho = 0.70 (p<0.000), while the correlation between the VMI scores obtained by the adolescent group on the two tests was rho = 0.77 (p<0.000). For the adult participant group, the correlation coefficient between the DTVMI and the FRTVMI was rho = 0.70 (p<0.000).

Conclusion:

The VMI scores obtained by the three participant age groups on the DTVMI and the FRTVMI were all significantly correlated with each other. Overall, the DTVMI and the FRTVMI exhibited large levels of convergent validity with each other, indicating that the two tests appear to measure similar visual-motor integration constructs.

Congenital diaphragmatic hernia and occupational therapy: a case report

This case report describes occupational therapy (OT) intervention in an outpatient setting and outcomes for a child diagnosed with congenital diaphragmatic hernia (CDH) from 4 to 28 months of age. There is little information on therapy intervention and outcomes of children who have survived. The patient is a white male, born at 35 weeks gestation with a diagnosis of left CDH that required a patch repair. He also had a Nissen fundoplication, gastrostomy tube and spent the first 100 days of his life in the hospital. He received outpatient OT for 2 years. The process of service provision is described using the "Occupational therapy practice framework: Domain and process, 2nd edition" (American Occupational Therapy Association, 2008 , American Journal of Occupational Therapy, 62(6), 625-683). The focus of intervention, description of the intervention process, and timeline for achievement of skills is provided. Outcomes and assessment tools used included the Canadian Occupational Performance Measure and Peabody Developmental Motor Scales-Second Edition.

An evaluation of the construct validity of the Developmental Test of Visual-Motor Integration using the Rasch Measurement Model

BACKGROUND

One method of evaluating the construct validity of instruments is the Rasch Measurement Model (RMM), an increasingly popular method used for test construction and validation.

AIM

The aim was to examine the construct validity of the Developmental Test of Visual-Motor Integration 5th Edition (VMI) by applying the RMM to evaluate its scalability, dimensionality, differential item functioning and hierarchical ordering.

METHOD

The participants were 400 children aged 5 to 12 years, recruited from six schools in Melbourne, Victoria, who completed the VMI under the supervision of an occupational therapist. VMI items 1, 2 and 3 were excluded from the Rasch analysis since all of the children achieved a perfect score on these items.

RESULTS

None of the items exhibited RMM misfit due to goodness-of-fit mean square (MnSq) infit statistics and standardised z (ZStd) scores being outside the specified acceptable range. VMI item 9 (copied circle) exhibited differential item functioning based on gender. In relation to hierarchical ordering of items, several were found to have similar logit difficulty values. For example, VMI items 26, 27 and 29; items 18, 22 and 24; and items 4, 5 and 11 were found to have the same level of challenge. As well, the VMI scale item logit measure order did not match that presented in the VMI test manual.

CONCLUSION

Theoretically, the VMI items are developmentally ordered; however, this ordering was not mirrored by the item logit difficulty scores obtained. This has scoring implications, where scoring a respondent's VMI test booklet is terminated after three consecutive items are not passed. Clinicians should also be aware that item 9 may exhibit bias related to gender.

Is There a Role for Occupational Therapy within a Specialist Child and Adolescent Mental Health Eating Disorder Service?

In Northern Ireland, only two occupational therapists work within the specialist field of child and adolescent mental health (CAMH). This is despite recommendations made by the Bamford Review of Mental Health and Learning Disability (Northern Ireland) that occupational therapy should be a core element of CAMH provision. The College of Occupational Therapists has urged practitioners to challenge inequalities in health and social care provision and to use occupational language to reinforce the relationship between occupation, recovery and wellbeing. This opinion piece highlights occupational therapy core skills and occupational therapy frames of reference or modalities, underlining the application of both to eating disorders. The treatment models discussed are the Model of Human Occupation, the Canadian Model of Occupational Performance and sensory integration. Evidence reinforces that the models discussed are applicable, appropriate and valuable when treating children and adolescents with an eating disorder.

It is argued that the valuable and unique role of occupational therapy must be recognised by health and social care commissioners and CAMH providers and be vocalised by occupational therapists. CAMH teams are advised to embrace the unique skills that occupational therapists have to offer children and adolescents with eating disorders in order to ensure that clients receive truly multidisciplinary and client-centred evidence-based services.

Construct validity of the Test of Visual-Motor Skills-Revised (TVMS-R): an evaluation using the Rasch Measurement Model

Construct validity of instruments, tests, and scales can be examined using the Rasch Measurement Model (RMM) during their initial construction and validation, or after they have been published. The aim of this study was to examine the construct validity of the Test of Visual-Motor Skills-Revised (TVMS-R) by applying the RMM to evaluate its scalability, dimensionality, differential item functioning, and hierarchical ordering. The participants included 400 children aged 5 to 12 years, recruited from six schools in the Melbourne metropolitan area, Victoria, Australia. Children completed the TVMS-R under the supervision of an occupational therapist. Overall, 39 out of 142 of the TVMS-R scale scoring accuracy classification criteria items exhibited poor measurement properties. As nearly one-third of the scoring classification criteria items were found to be problematic, the TVMS-R in its current form is not recommended for clinical use, as it is not consistent with the clinical demands expected of an instrument used to evaluate the visual motor integration skills of children.