Parental Adherence to Home Activities in Early Intervention for Young Children With Delayed Motor Development

Facilitators of and Barriers to Caregiver Adherence to Home Therapy Recommendations for Infants and Children With Neuromotor and Neuromuscular Diagnoses: A Scoping Review

IMPORTANCE

Caregiver-performed home therapy programs are essential to occupational therapy intervention for infants and children with neuromotor and neuromuscular diagnoses. Factors that facilitate or are barriers to caregiver adherence when making home therapy recommendations should be considered.

OBJECTIVE

To identify facilitators of and barriers to caregiver adherence to home therapy recommendations for children with neuromotor and neuromuscular disorders.

METHOD

The review followed the five-step methodological framework developed by Arksey and O'Malley (2005) and was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

DATA SOURCES

Searches with no language or date range limits were performed in MEDLINE, CINAHL Plus with Full Text, PsycINFO, and SocINDEX on the EBSCO platform, and Scopus on the Elsevier platform from database inception through January 24, 2023.

STUDY SELECTION AND DATA COLLECTION

Study inclusion criteria included caregiver adherence to home therapy recommendations for children with neuromotor and neuromuscular diagnoses. Eight hundred seventy-five articles underwent title and abstract screening; 64 articles met the criteria for full review.

FINDINGS

Twelve articles met the inclusion criteria. Four used qualitative measures, 7 used quantitative measures, and 1 used mixed methods. Qualitative thematic analysis revealed four facilitators: routine, efficacy of caregiver education, positive relationship with therapist, and perceived benefit of treatment. The analysis revealed three barriers: lack of time, lack of confidence, and caregiver stress.

CONCLUSIONS AND RELEVANCE

The facilitators and barriers identified are central to best-practice occupational therapy. Therapists can use expertise in analyzing routines and context to maximize the fit between family needs and home therapy recommendations. Plain-Language Summary: Home therapy for children with a neuromotor and neuromuscular diagnosis is common and uses some form of caregiver-performed movement activities or techniques. To support caregivers, occupational therapists need to understand what factors facilitate or serve as barriers to following home therapy recommendations. The review found three barriers: lack of time, lack of confidence, and caregiver stress. The review provides strategies to support home therapy based on core principles of occupational therapy practice. It also identifies the need for more research to support home therapy recommendations that fit within the child's and family's routine, that can be taught in a way that meets the child's and family's learning needs, that facilitate self-efficacy and confidence, and that reflect the values and motivators of all participants.

The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: A systematic review

INTRODUCTION

Involving parents of children with cerebral palsy (C-CP) in home exercise programmes (HEP) is globally practiced strategy closely linked to improved physical performance and functional outcomes for the child. Nevertheless, non-adherence to HEP is increasing at an alarming rate, and little is known about the factors influencing adherence to HEP (AHEP) especially in parents of C-CP. This systematic review aimed to identify the factors enhancing AHEP among parents of C-CP to reinforce the efficacy of rehabilitation practices proposed by health professionals, researchers, and educators.

MATERIALS AND METHODS

We conducted searches in PubMed, Scopus, CINHAL, PsycINFO, and Embase for articles published up to March 2023, that investigated the factors influencing AHEP among parents of C-CP. A narrative synthesis was conducted using the search results and pertinent material from other sources.

RESULTS

Overall, non-adherence rates to HEP were moderate to high, ranging from 34% to 79.2%. Strong evidence suggests that factors enhancing AHEP fall into three categories: child-related (such as younger age and better gross motor function [GMF]), the caregiver-related (including high self-efficacy and knowledge, strong social support, low levels of depression, anxiety and stress symptoms, and a low perception of barriers), and the physiotherapist-related. For the latter category, the parent's perception of a supportive and collaborative relationship with the therapist is one of the conditions most favourably influences AHEP.

CONCLUSION

Our findings highlight that factors influencing AHEP are multifactorial. Some, such as GMF or the economic and social conditions of the family, are challenging to change. However, the relationship between therapist and parent is an aspect that can be strengthened. These results underscore the importance of substantial training and psychosocial support for therapists to enhance their awareness and competence in building supportive relationship with parents.

Implementation of coaching methods to decrease the parenting stress levels among teenage mothers in Indonesia: A quasi-experimental study

Background

The high rate of early marriage, teenage pregnancy, and teenage mothers increases the prevalence of emotional and mental disorders, depression, parenting stress, and child stunting. Parenting coaching is among the effective ways to overcome parenting stress and improve parents' knowledge, skills, and behaviors, thereby avoiding child stunting. However, studies on parenting coaching are not widely conducted, particularly in Indonesia.

Objective

This study aimed to present the current status of parenting stress among teenage mothers and assess whether parenting coaching effectively reduces parenting stress among teenage mothers.

Methods

A quasi-experimental design was used. The participants were randomly selected into two groups: the intervention group receiving parenting coaching intervention and the control group receiving standard education using a leaflet. Data were collected in June 2021 in Takalar Regency, South Sulawesi, Indonesia. Statistical Program for Social Science version 21 (Armonk, NY, USA) was employed for all statistical analyses.

Results

The parenting coaching intervention had a significant effect on parenting stress (p <0.001), with significant positive changes in knowledge, attitude (p <0.001), behavior (p <0.001), self-efficacy (p <0.001), and maternal function (p <0.001). Additionally, a significant difference in the achievement of z-score values was observed between the intervention and control groups based on Body Weight/Age (BW/A) (p <0.001) and Body Length/Age (BL/A) (p <0.001). However, Body Weight/Body Length (BW/BL) did not show a significant difference in the achievement of z-score (p = 0.34) in the third month.

Conclusion

Parenting coaching can reduce parenting stress among teenage mothers and improve their knowledge, attitudes, behavior, self-efficacy, and maternal function; hence, this intervention can be used as a reference in the nursing process to reduce parenting stress and prevent child stunting.

A remote parent-led early intervention protocol to promote motor development in infants with congenital heart disease: a feasibility pilot study of a randomized clinical trial

This study evaluated the feasibility of a parent-led, home-based early intervention for motor development in infants with Congenital Heart Disease (CHD), part of a larger multicenter, single-blind randomized controlled trial (ClinicalTrials.gov NCT05907109). Parents, supported by remote specialists weekly, engaged in multidomain stimulation activities five days a week, for six months. Feasibility was assessed via parental questionnaires, adherence rates, and infant motor development assessments. Despite high dropout and mortality rates, results showed 80% adherence, 91% parental satisfaction, 75% availability, and 60% self-efficacy. No significant motor skill differences were noted between the intervention (IG; n = 19) and control groups (CG; n = 11) at six months, but the higher baseline risk in IG suggests promotion of motor skills in the intervention group. Future studies in Brazil might extend the study duration to address high dropout and mortality rates.

Parents' Perspectives on the Application of Home Activities in Early Intervention

Aims: This study explored parents' successes, challenges, and recommendations in relation to the application of home activities in early intervention.Methods: An electronic survey was prepared with Qualtrics software and distributed to parents of children with motor delays. Three open-ended questions were included at the end of the survey. Participants were the child's primary caregiver or guardian and their child must be currently receiving early intervention services or have received early intervention services from a physical or an occupational therapist in the United States in the past 5 years. Two coders used content analysis to analyze parents' responses to open-ended questions.Results: A total of 252 participants responded to at least one of the open-ended questions that were included in the survey. Responses were grouped into codes and categories that lead to the emergence of four themes. The themes indicated parent-reported challenges, successes, and recommendations in relation to team collaboration, individualization of activities, developmental gains, and parental support.Conclusions: The results of this study suggest that more focus should be directed toward parent-therapist partnership, multidisciplinary collaboration, and personalization of activities in early intervention. Parents-reported experiences and recommendation could assist early intervention personnel in advancing services provided for children with motor delays.

Leg Movement Rate before and after a Caregiver-Provided Intervention for Infants at Risk of Developmental Disability: A Pilot Study

AIM

Our purpose was to assess daily leg movement rate before and after a caregiver-provided in-home intervention for infants at risk for developmental disability. We also assessed adherence and quality of caregiver-child interaction.

METHODS

Twelve infants, at risk for developmental disabilities, and their caregivers participated in an intervention focused on increasing leg movements. Intervention started between 3- and 6-months corrected age and ended once the infant was able to sit independently or at 9 months corrected age, whichever occurred first. Infants were assessed monthly.

RESULTS

Infants at risk for developmental disabilities who were moving less than 1200 leg movements per hour awake at the start of the intervention increased their daily leg movement rate following the intervention (Median [range]: pre-1047 [506-1056], post- 1104 [655-1359], p = 0.040). Additionally, the caregivers had a high adherence (Median: 89%, Range: 11.43%-329.17%) and good quality of caregiver-child interaction (Median NCAST total: 46, Range: 34-59); and maintained similar amounts of adherence (p = 0.575) and quality of caregiver-child interaction (p = 0.432) throughout the intervention.

CONCLUSION

This study provides preliminary evidence that leg movement rate has the potential to be used as an outcome measure to assess an infant's progress and motor practice during an intervention.