Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment

Effectiveness of school-based physiotherapy intervention for children

PURPOSE

To evaluate the effectiveness of school-based physiotherapy interventions for improving students' participation in school settings.

METHOD

A systematic review was reported using PRISMA guidelines. Four databases were searched for studies investigating physiotherapy outcomes of school-based physiotherapy interventions in children. Studies were categorised by intervention type and evaluated based on evidence level and conduct.

RESULTS

Fifteen intervention types (23 studies) met criteria. Strong positive evidence supported treadmill training without bodyweight support (n = 1), and upper limb interventions (n = 2). Moderate positive evidence supported robotic-assisted gait training (n = 1), Gross Motor Activity Training with Multimodal Education-Based Therapy (GMAT + MET) (n = 2), neurodevelopmental treatment (n = 2), and rock climbing (n = 1). Weak positive evidence supported environmental modifications (n = 1), Ergonomic Health Literacy (n = 3), GMAT (n = 1), GMAT with progressive resistance exercise (GMAT-PRE) (n = 1), hippotherapy (n = 1), MET alone (n = 7), overground gait training (n = 2), treadmill training with partial body-weight support (n = 1), and non-immersive virtual reality (n = 3).

CONCLUSION

There is preliminary supporting evidence for a variety of school-based physiotherapy interventions which is consistent with evidence for interventions with established efficacy in other contexts. The evidence for interventions in school contexts alone is insufficient to guide current practice. Future research should specifically evaluate the effectiveness of physiotherapy approaches in school settings.

Participation-Based Student Goals in School-Based Physical Therapy Practice: Influence on Service Delivery and Outcomes

Aims: Legislation, perspectives, and guidelines support the use of goals that address student participation in school. The purpose of this study was to determine if students with participation-based goals receive school-based physical therapy services differently and demonstrate better outcomes than students with non-participation-based goals.Methods: Secondary data analysis. School-based physical therapists (n = 109) provided services to students (n = 294) over 20 weeks. The physical therapists determined a primary goal for each student and classified this goal based on if it was (n = 181) or was not (n = 113) performed and measured within a school activity or routine (participation-based versus non-participation-based). The physical therapists documented the proportion of services provided within a school activity, on behalf of the student, and consisting of activity-focused functional activities. They also measured goal attainment and assessed participation via the School Function Assessment at the beginning and end of the study.Results: Students with participation-based goals received a significantly greater proportion of services within a school activity than those with non-participation-based goals (p < 0.001). There was no significant difference for the remaining service variables, nor for the outcome variables.Conclusions: Use of participation-based goals may promote school-based physical therapy service delivery within a school activity, thus supporting best practice.

A Structured Goal-Setting Process to Promote Functional and Measurable Outcomes in School-Based Physical Therapy: A Knowledge Translation Study

INTRODUCTION

Goal setting is an important component of school-based physical therapy; however, evidence suggests that therapists may not consistently write goals that are relevant, context specific, and measurable. The aims of this knowledge translation study were to evaluate implementation of a goal-setting method for school-based therapists.

METHOD

This study was created to align with the Knowledge to Action framework and included 1-day training and follow-up mentorship. Goals were assessed pre- and posttraining, and questionnaires assessed barriers and facilitators.

RESULTS

Twenty-two physical therapists participated. Nineteen participants (90%) strongly agreed/agreed that the training helped change their perspectives about goal setting in the school environment. There was a statistically significant difference in goal quality pre- and posttraining. Therapists identified barriers and facilitators to implementation of effective goal setting in practice.

DISCUSSION

Results indicate that this method may be effective at improving goal writing that is relevant, context specific, and measurable in school settings.

School-based physical therapy services and student functional performance at school

AIM

We explored relationships of school-based physical therapy to standardized outcomes of students receiving physical therapy.

METHOD

Using a practice-based evidence research design, School Function Assessment (SFA) outcomes of 296 students with disabilities (mean age 7y 4mo [standard deviation 2y]; 166 males, 130 females), served by 109 physical therapists, were explored. After training, therapists completed 10 SFA scales on students at the beginning and end of the school year. Therapists collected detailed weekly data on services (activities, interventions, types, student participation) using the School-Physical Therapy Interventions for Pediatrics (S-PTIP) system. Stepwise linear regressions were used to investigate S-PTIP predictors of SFA outcomes.

RESULTS

Predictors of SFA section outcomes varied in strength, with the coefficient of determination (R² ) for each outcome ranging from 0.107 to 0.326. Services that correlated positively with the SFA outcomes included mobility, sensory, motor learning, aerobic/conditioning, functional strengthening, playground access interventions, and higher student participation during therapy (standardized β=0.11-0.26). Services that correlated negatively with the SFA outcomes included providing services within student groups, within school activity, with students not in special education, during recreation activities, and with positioning, hands-on facilitation, sensory integration, orthoses, and equipment interventions (standardized β=-0.14 to -0.22).

INTERPRETATION

Consideration of outcomes is prudent to focus services. Overall results suggest we should emphasize active mobility practice by using motor learning interventions and engaging students within therapy sessions.

WHAT THIS PAPER ADDS

No specific interventions predicted positively on all School Function Assessment (SFA) outcomes. Active movement practice seems related to overall better SFA outcomes. Active mobility practice improved SFA participation, mobility, recreation, and activities of daily living. Engaging students in therapy activities and interventions improved outcomes.

Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?

This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system.

WHAT THIS PAPER ADDS

The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.