Quality of goal setting in pediatric rehabilitation-A SMART approach

The positioning information that should be provided to caregivers of adults with a physical disability on supply of custom-contoured seating, a Delphi study

PURPOSE

This research aims to identify information that is important to provide on supply of custom-contoured seating. The way this information would be best communicated is also of interest. A two-round e-Delphi study was utilised to explore consensus. A panel of stakeholders from Ireland including experts in positioning clients in custom-contoured seating and caregivers were recruited. The first round consisted of open-ended questions and was analysed using thematic analysis. The second round employed a rating technique and 7-point Likert scale. Consensus was set a priori at 70% agreement. The way information should be communicated and by whom was rated in order of preference.

MATERIALS AND METHODS

Fifteen participants were recruited, nine clinicians and four caregivers. Fifty-two statements under six themes (transfers = 10, positioning = 22, pressure care = 4, general use = 4, post-supply follow-up = 8, functional activity = 4) were generated in round 1 by 13/15 participants. Round 2 was completed by 10/15. 49/52 statements reached consensus and were deemed important. The ways information should be communicated and by whom was identified. Caregivers want individualised information whereas clinicians preferred a more generic approach.

RESULTS AND CONCLUSIONS

There was a high degree of consensus on what information is required to support caregivers. The topics demonstrate the extensive information that should be provided. The preferred delivery method for primary caregivers was hands-on training with the opportunity to practice and take videos. Stakeholders differed in how they would prefer information delivered. Further research should evaluate the method of delivering training and its effectiveness.

Quality Objectives in Standardized Quality Management Systems

BACKGROUND AND OBJECTIVES

The effectiveness of a quality management system consistent with the ISO 9001 standard depends on how quality objectives are established and pursued. The aims of this article are to identify quality objectives in selected certified organizations providing medical services, assess their compliance with the requirements of the ISO 9001 standard, and determine factors influencing such objectives.

METHODS

The first theoretical part of the article is based on a systematic literature review. The empirical part contains an analysis of documentation related to quality management systems and conducted audits. The data were collected during 42 quality management system audits conducted in 16 health care organizations in the years 2015-2020. Uncategorized interviews were conducted with quality management system representatives. The data were verified by interviews with 6 management system auditors having at least 15 years' experience in auditing health care organizations. The assessment of the methodological correctness is based on the ISO 9001:2015 standard criteria.

RESULTS

The most frequently formulated quality objectives include improving customer satisfaction, task-based objectives related to planned works, improvements, and development of new medical services. The quality objectives fulfill the requirements of the ISO 9001 standard. However, they are not ambitious. The most significant factors influencing the processes of goal setting are economic (financial incentives, available resources for modernization), social (community needs), and managerial (the scope of performed analyses, the quality of the audit process, and the calculation of necessary effort).

CONCLUSIONS

Health care organizations need to pursue more ambitious objectives, intensify the use of performed medical analyses, and integrate quality objectives into management remuneration systems.

A pilot rating system to evaluate the quality of goal attainment scales used as outcome measures in rehabilitation

Goal Attainment Scaling (GAS) is a method for writing person-centred approach evaluation scales that can be used as an outcome measure in clinical or research settings in rehabilitation. To be used in a research setting, it requires a high methodological quality approach. The aim of this study was to explore the feasibility and reliability of the GAS quality rating system, to ensure that GAS scales used as outcome measures are valid and reliable. Secondary objectives were: (1) to compare goal attainment scores' reliability according to how many GAS levels are described in the scale; and (2) to explore if GAS scorings are influenced by who scores goal attainment. The GAS scales analysed here were set collaboratively by 57 cognitively impaired adults clients and their occupational therapist. Goals had to be achieved within an inpatient one-month stay, during which clients participated in an intervention aimed at improving planning skills in daily life. The GAS quality rating system proved to be feasible and reliable. Regarding GAS scores, interrater reliability was higher when only three of the five GAS levels were described, i.e., "three milestone GAS" (0.74-0.92), than when all five levels were described (0.5-0.88), especially when scored by the clients (0.5 -0.88).

Child-led goal setting and evaluation tools for children with a disability: A scoping review

AIM

To examine child-led goal setting and evaluation tools and approaches for children with a disability or developmental delay.

METHOD

Six databases were searched for studies that included population (children aged less than 18 years with disability or developmental delay); construct (child-led goal setting tool or approach); and context (developmental therapy or rehabilitation). The utility of tools and approaches across the goal setting and evaluation process was investigated using abductive content analysis.

RESULTS

Fifty articles met the inclusion criteria. Three approaches and four tools for child-led goal setting and evaluation were identified. No studies reported the clinimetric properties of tools specifically for child self-respondents. Qualitative analysis revealed six distinct goal phases in which tools and approaches were used, which were synthesized into a new framework for child-led goal setting and evaluation titled DECIDE: Direct children to goal setting; Elicit goal topics and priorities; Construct a goal statement; Indicate baseline goal performance; Develop an action plan to address the goal; and Evaluate goal progress after the intervention.

INTERPRETATION

Children actively participated in goal setting and evaluation across six DECIDE goal phases. Further clinimetric information is required to support use of goal setting and evaluation tools with child self-respondents. Future research should emphasize the development of multi-phase goal setting tools and approaches for diverse populations of children.

Response Shifts in the Canadian Occupational Performance Measure: A Convergent Mixed-Methods Study

IMPORTANCE

A response shift (RS) is a phenomenon in which there is an individual perceptual gap between pre and post assessments. RS effects were not considered in the Canadian Occupational Performance Measure (COPM) development process.

OBJECTIVE

To detect the effects of RS on the COPM.

DESIGN

Convergent mixed-methods research.

SETTING

Subacute rehabilitation hospital in Japan.

PARTICIPANTS

Nineteen adult patients with a range of neurological and musculoskeletal conditions recruited from a subacute rehabilitation hospital.

OUTCOMES AND MEASURES

In the qualitative analysis, patients' perceptions regarding occupation identified by the COPM were compared between the initial assessment (Time 1 [T1]) and a reassessment (Time 2 [T2]). In the quantitative study, patients were asked to re-rate the occupations in which the RS had occurred, giving feedback on their perceptions at T1 (T2'). The difference between T2 and T2' was calculated to clarify the magnitude of the RS.

RESULTS

Of the 19 patients, 18 had an RS in at least one occupation. The RS effects were classified into five categories: Replacing, Adding, Reducing, Unspecified, and Embodiment. Ninety occupations were extracted from all the patients, and 46 (51.1%) were affected by RS. The percentages of occupations for which the change in score due to RS exceeded the minimal clinically important difference (±2 points) was 26.1% (12 of 46) for COPM-Performance scores and 30.4% (14 of 46) for COPM-Satisfaction scores.

CONCLUSIONS AND RELEVANCE

Diverse RS effects have been identified in the COPM, which also affect score interpretation. Plain-Language Summary: The Canadian Occupational Performance Measure has a potential measurement bias that is due to a response shift in which there is an individual perceptual gap between pre and post assessments. The results of this study reveal a need to establish more accurate measurement methods to reduce the impact of response shifts on COPM scores.

A Specific, Measurable, Achievable, Relevant, Timed (SMART) Nursing Project Reduces Anxiety, Depression, and Post-Traumatic Stress Disorder in Parents of Childhood or Adolescent Osteosarcoma Patients

Specific, measurable, achievable, relevant, timed (SMART) principle improves the nursing utility by setting individual goals for participants and helping them to achieve these goals. Our study intended to investigate the impact of a SMART nursing project on reducing mental stress and post-traumatic stress disorder (PTSD) in parents of childhood or adolescent osteosarcoma patients. In this randomized, controlled study, 66 childhood or adolescent osteosarcoma patients and 126 corresponding parents were enrolled and divided into SMART or normal care (NC) groups at a 1:1 ratio. All parents received a 3-month corresponding intervention and a 6-month interview. Our study revealed that the self-rating anxiety scale score at the 3rd month (M3) (P < 0.05) and the 6th month (M6) (P < 0.01), and anxiety rate at M3 (P < 0.05) and M6 (P < 0.05) were lower in parents in SMART group vs. NC group. The self-rating depression scale score at M3 and M6, and depression rate at M3 and M6 were lower in parents in SMART group vs. NC group (all P < 0.05). Impact of events scale-revised score at the 1st month (M1) (P < 0.05), M3 (P < 0.05), and M6 (P < 0.01) were lower in parents in SMART group vs. NC group. By subgroup analyses, the SMART nursing project showed better impacts on decreasing anxiety, depression, and PTSD in parents with an undergraduate education or above than in those with a high school education or less. Conclusively, SMART nursing project reduces anxiety, depression, and PTSD in parents of childhood or adolescent osteosarcoma patients, which is more effective in those with higher education.

Early rehabilitation and mobilisation of neonatal and paediatric extracorporeal membrane oxygenation patients: A UK and Ireland consensus document

Despite increasing early rehabilitation and mobilisation (ERM) in paediatric intensive care, current evidence for ERM of neonatal and paediatric patients receiving extracorporeal membrane oxygenation (ECMO) is limited. The proposed benefits of ERM in neonatal and paediatric ECMO patients are multifaceted, including reduced immobility related issues and maintenance of functional ability. However, ECMO presents additional safety and logistical challenges, and currently there are no published neonatal or paediatric guidelines. A consensus document was developed to provide guidance for ERM with neonatal and paediatric ECMO patients. The document was developed by specialist physiotherapists from nine ECMO centres within the UK and Ireland, together with the UK Paediatric Critical Care Society ECMO group and members of the multidisciplinary team. The document covers key considerations and practicalities for completing ERM in this population including, acuity level measurement, activity level guidance, safety and risk assessment, and goal setting. Risk assessment and safety checklist bedside tools are also included and designed to be adapted as required to meet specific unit policies and protocols.

Rehabilitation Practices Delivered by Physical and Occupational Therapists to Brazilian Children With Congenital Zika Syndrome: A Cross-Sectional Study

INTRODUCTION

Congenital Zika syndrome (CZS) is a health condition that has affected the development of thousands of children in Brazil. Because it is a new condition, its understanding is an ongoing process. Therefore, it is important to know the rehabilitation interventions being delivered to improve the functioning of these children. We aimed to describe the practices of physical therapists (PTs) and occupational therapists (OTs) who provide follow-up care for children with CZS in Brazil.

METHODS

This cross-sectional study included PTs and OTs who assist children with CZS in Brazil. An online questionnaire was used to verify the participants' personal characteristics and professional work environment, as well as the rehabilitation programs they implemented in Brazil for children with CZS. Data were analyzed using descriptive statistics.

RESULTS

A total of 116 professionals (79 PT and 37 OT) who work mainly in public health services (81.9%) participated in the study. Of these, 24.1% plan interventions based on reading scientific articles, 66.4% did not report using the biopsychosocial model, 52.6% do not perform any assessments before starting an intervention, 31.9% use neurodevelopmental treatment, and 22.4% use sensorimotor stimulation interventions. The majority of the interventions are delivered 1 to 2 times a week, lasting up to 1 hour.

CONCLUSIONS

Professional training and knowledge translation strategies are needed to implement evidence-based practices and improve the quality of rehabilitation programs for Brazilian children with CZS.

[Goal-setting in Plastic Surgery using the SMART principle]

INTRODUCTION

The process of continuous acquisition of surgical expertise is a key element in registrar training. The principle of active, self-directed learning, which is regularly applied in medical school, can also be used to gain surgical expertise in registrar training.

METHODS

Surgical training can be compared to acquiring expertise in music or sport, where both intellectual and manual capabilities are required. Specific training principles, including analysis, goal setting, practice and reflection on the process, are commonly encountered in these fields. Smart goal setting is preferred in order to ensure compliance and a successful strategy. This can also be used in plastic surgery training.

APPLICATION

Surgical principles as well as partial or complete surgical procedures can be practiced using the smart principle. The fragmentation of a larger task into smaller units allows rapid acquisition of surgical expertise without impeding patient safety.

DISCUSSION

Surgical training today happens in a setting caught between economic and medicolegal challenges. The reduction of case load requires simulation practice as well as self-directed learning - which has been shown to improve outcomes. The smart principle allows distinct goal setting which can improve compliance of the student and increase success. As this form of learning is not intuitive to all individuals, supervisors and mentor can support trainees in the acquisition of surgical expertise using this principle.

Promoting Participation-Focused Practices in Inclusive Educational Settings: Stakeholders' Perspectives Following a Knowledge Translation Initiative

IMPORTANCE

Available participation-focused interventions (e.g., the Pathways and Resources for Engagement and Participation intervention [PREP]), are not well integrated into practice, indicating a knowledge-to-practice gap.

OBJECTIVE

To explore the perspectives of school-based (SB) occupational therapists and occupational therapy managers following knowledge translation (KT) programs for facilitating participation-based practices in inclusive education.

DESIGN

This was an implementation qualitative study. After taking part in KT programs for implementing PREP, which were tailored to the needs and contexts of each stakeholder group, occupational therapists participated in focus groups, and occupational therapy managers responded to open-ended survey questions. A content analysis was done separately for each group, then integrated and organized according to the Participation-focused KT (P-KT) framework.

SETTING

Inclusive educational setting.

PARTICIPANTS

Seven occupational therapists working in inclusive schools and 39 occupational therapy managers.

RESULTS

We identified 10 themes addressing the micro, meso, and macro levels of the P-KT framework across the two groups. Five themes, common to all participants, addressed micro (e.g., setting participation-focused goals) and meso (e.g., school-PREP fit) levels. Macro-level themes were addressed by managers only (e.g., anchoring PREP to existing policy of the Israeli Ministry of Education).

CONCLUSIONS AND RELEVANCE

Targeting different stakeholders at the micro and meso levels of the educational system can initiate a shift in practice toward a focus on participation. KT intersectoral initiatives at the macro level (e.g., targeting community services and local policies), and engaging other stakeholders (e.g., students, families, and educators), are required to ensure the sustainability of participation-based practices. What This Article Adds: The authors present two knowledge translation programs that target both occupational therapists and managers in the educational system. The programs promote a shift in school-based occupational therapy services toward a focus on participation and environment.

Goal attainment of children with cerebral palsy participating in multi-modal intervention

AIM

We aimed to determine if there was a significant difference in the functional performance of family requested daily tasks by a heterogeneous group of children with cerebral palsy following a programme of neuro-developmental treatment and in comparison to a randomly control group.

BACKGROUND

There are considerable challenges in conducting research into the functional performance of children with cerebral palsy. These include the highly heterogeneous nature of the population group, poor ecological and treatment fidelity, floor and ceiling effects in assessments, and insensitivity to the diverse functional needs and goals of children and families. Therapists and families identified functional goals and specified all aspects of performance details for each goal on five point goal attainment scales. Children with cerebral palsy were assigned randomly to treatment and alternate treatment groups. Children were video recorded attempting to perform targeted functional skills at pre-test, post-pest and follow-up. Videos were recorded and rated by expert clinicians blind to experimental condition.

RESULTS

After the first round of target intervention and alternate treatment had been completed, a significant difference in the goal attainment was noted between the control group and the treatment group at the post test, indicating that intervention was associated with a higher level of goal attainment than that attained by the control group (p = 0.0321) with a large effect size.

CONCLUSIONS

The study provided evidence of an effective way to investigate and to enhance the available motor capacity of children with moderate to severe cerebral palsy during participation in requested daily task performance, as reflected in goal attainment. Goal attainment scales were a reliable measure that was able to be used to detect changes in functional goals among a highly heterogeneous population group with individualized goals that were meaningful to each child and family.

Rehabilitation Evidence-Based Decision-Making: The READ Model

Evidence-based practice is the foundation of rehabilitation for maximizing client outcomes. However, an unacceptably high number of ineffective or outdated interventions are still implemented, leading to sub-optimal outcomes for clients. This paper proposes the Rehabilitation Evidence bAsed Decision-Making (READ) Model, a decision-making algorithm for evidence-based decision-making in rehabilitation settings. The READ Model outlines a step-by-step layered process for healthcare professionals to collaboratively set goals, and to select appropriate interventions. The READ Model acknowledges the important multi-layered contributions of client's preferences and values, family supports available, and external environmental factors such as funding, availability of services and access. Healthcare professionals can apply the READ Model to choose interventions that are evidence-based, with an appropriate mode, dose, and with regular review, in order to achieve client's goals. Two case studies are used to demonstrate application of the READ Model: cerebral palsy and autism spectrum disorder. The READ Model applies the four central principles of evidence-based practice and can be applied across multiple rehabilitation settings.

Goal setting for nutrition and body weight in rehabilitation nutrition: position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication)

The most important nutrition goals in rehabilitation nutrition are improving function and quality of life, and they are useful to set body weight goals to further improve these aspects. In this paper, we clarified our position, as the Japanese Association of Rehabilitation Nutrition, on body weight goal setting. Body weight goals should be SMART (Specific, Measurable, Achievable, Realistic/Relevant, and Timed). The standard amount of energy accumulation/deficit needed to gain/lose 1 kg body weight is 7500 kcal. In other words, if the nutrition goal is set at 1 kg body weight gain per month, daily energy accumulation can be calculated as approximately 250 kcal. It is necessary to reconcile the rehabilitation goal setting, the content, quantity, and quality of physical activity and exercise therapy, and the patient's general condition and intentions to set nutrition goals. Body weight goal setting is more variable than rehabilitation goal setting, and it is important to confirm the degree of achievement through rehabilitation nutrition monitoring.

The utility of goal attainment scaling in evaluating a structured water dance intervention for adults with profound intellectual and multiple disabilities

BACKGROUND

Adults with profound intellectual and multiple disabilities (PIMD) have problems to be actively involved in essential life activities that affect their health. The aim of this study was to explore the utility of goal attainment scaling (GAS) in evaluating an intervention for adults with PIMD, and to describe how the GAS goals were set according to the International Classification of Functioning, Disability and Health (ICF) domains of body function as well as activity and participation.

METHOD

As part of an aquatic intervention (Structured water dance), 28 adults with PIMD received GAS goals which were adapted to their individual needs and which the intervention could affect.

RESULT

Twenty of the goals were formulated within the ICF Activity/Participation domain and eight within the Body Functions domains. On average, participants improved by 1.25 levels on the five-level GAS scales.

CONCLUSION

GAS can be a useful tool for setting and evaluating individualized and meaningful goals, in body functions as well as in activity and participation, related to a healthpromoting activity for adults with PIMD.

Goals of children with unilateral cerebral palsy in a brain stimulation arm rehabilitation trial

AIM

To explore relationships between category classifications for children's rehabilitation goals, outcomes, and participant characteristics.

METHOD

Children with hemiparetic cerebral palsy due to perinatal stroke rated self-selected goals with the Canadian Occupational Performance Measure (COPM) and completed the Assisting Hand Assessment (AHA) and Box and Block Test (BBT), at baseline and 6 months, in a randomized, controlled 10-day neuromodulation rehabilitation trial using repetitive transcranial magnetic stimulation. Goals were classified with the Canadian Model of Occupational Performance and Engagement and the International Classification of Functioning, Disability and Health. Analysis included standard linear regression.

RESULTS

Data for 45 participants (mean age 11y 7mo, SD 3y 10mo, range 6-19y, 29 males, 16 females) on 186 goals were included. Self-care goal percentage corresponded with baseline BBT by age (standardized ß=-0.561, p=0.004). Leisure goal percentage corresponded with baseline BBT (standardized ß=0.419, p=0.010). AHA change corresponded with productivity goals (standardized ß=0.327, p=0.029) and age (standardized ß=0.481, p=0.002). COPM change corresponded with baseline COPM and age by AHA change (p<0.05).

INTERPRETATION

Younger children with lower motor function were more likely to select self-care goals while those with better function tended to select leisure goals. Functional improvement corresponded with older age and productivity goals. COPM change scores reflected functional improvement among older children. Children chose functionally and developmentally appropriate goals. Consequently, children should be free to set goals that matter to them.

WHAT THIS PAPER ADDS

Children in a brain stimulation trial chose divergent upper extremity functional goals. Younger children with lower ability chose more self-care goals. Children with higher ability chose more leisure goals. Older children's goal ratings reflected objective functional motor gains. Children chose goals appropriate to their function and level of development.

Quality objectives in management systems – their attributes, establishment and motivational function

Purpose

The aim of this paper is to show the ways of setting quality objectives, their attributes and the conditions under which they can perform a motivational function.

Design/methodology/approach

Collecting relevant data, the authors used the results of previous research and theoretical assumptions concerning quality objectives. Subsequently, they carried out a survey and exemplification research based on participatory observations, document content analysis and interviews.

Findings

Goals are set mainly by top management, but the communication process itself is insufficient; the needs of system users are not taken into account. In the opinion of the employees, quality objectives are measurable and objective, although not very ambitious. For quality objectives to fulfil a motivational function, they should be objective and measurable. Also, the allocation of tasks among employees needs to be fair. Furthermore, quality objectives have to play a greater role in remuneration systems.

Originality/value

This paper is one of the first publications on the role and function of quality objectives. Its advantage is that it defines the conditions under which such objectives can have a motivational effect and encourage employees to pursue the improvement of their products and services.

Transition to Multidisciplinary Pediatric Telerehabilitation during the COVID-19 Pandemic: Strategy Development and Implementation

Telerehabilitation offers a unique solution for continuity of care in pediatric rehabilitation under physical distancing. The major aims of this study were to: (1) describe the development of telerehabilitation usage guidelines in a large hospital in Israel, and to (2) evaluate the implementation of telerehabilitation from the perspectives of healthcare practitioners and families. An expert focus group developed guidelines which were disseminated to multidisciplinary clinicians. Following sessions, clinicians filled The Clinician Evaluation of Telerehabilitation Service (CETS), a custom-built feedback questionnaire on telerehabilitation, and parents completed the client version of the Therapist Presence Inventory (TPI-C) and were asked to rate the effectiveness of sessions on an ordinal scale. Four goals of telerehabilitation sessions were defined: (1) maintenance of therapeutic alliance, (2) provision of parental coping strategies, (3) assistance in maintaining routine, and (4) preventing functional deterioration. Principal Components Analysis was used for the CETS questionnaire and the relationships of CETS and TPI-C with child’s age and the type of session were evaluated using Spearman’s correlations and the Kruskal–Wallis H test. In total, sixty-seven telerehabilitation sessions, with clients aged 11.31 ± 4.8 years, were documented by clinicians. Three components (child, session, parent) explained 71.3% of the variance in CETS. According to therapists, their ability to maintain the therapeutic alliance was generally higher than their ability to achieve other predefined goals (p < 0.01). With younger children, the ability to provide feedback to the child, grade treatment difficulty and provide coping strategies to the parents were diminished. Families perceived the therapist as being highly present in therapy regardless of treatment type. These results demonstrate a potential framework for the dissemination of telerehabilitation services in pediatric rehabilitation.

Decreasing Patient Dwell Times for Outpatient Cardiac Nuclear Medicine Studies: The Benefits of SMART Goals, Scope Limitations, and Society Guidelines in Quality Improvement

BACKGROUND

We describe a quality improvement project to improve patient dwell times for outpatient cardiac nuclear medicine exams. Preliminary data indicated that the mean patient dwell time was about 270 minutes. Our specific, measurable, achievable, relevant, and time-bound goal was to reduce patient dwell times for outpatient pharmacologically stressed cardiac nuclear medicine exams by 60 minutes over the course of 2 months.

METHODS

An interdisciplinary team was formed which used staff interviews and workflow observation to create a cause and effect diagram as well as a process map. Review of the national guidelines for cardiac nuclear medicine exams identified rest and stress intervals as intervention targets. A new protocol was designed and implemented.

RESULTS

The mean patient dwell time was improved from 270 to 184 minutes.

CONCLUSIONS

Overall, we found that a clear specific, measurable, achievable, relevant, and time-bound goal, limited scope, and national guideline review allowed for a successful quality improvement project.

Establishment of Key Performance Indicators for Green Building Operations Monitoring—An Application to China Case Study

Released green building evaluation standards for operation stage include a huge number of indicators, which are very comprehensive and systematic. However, the indicators of these standards are very complicated and a large amount of time and manpower are consumed for their evaluation. To evaluate the operational performance of green buildings more practically and efficiently, some studies collect the operational data for part of the indicators (mainly focusing on building energy performance, indoor environmental quality or occupant satisfaction), which are too rough to evaluate the performance of green building. This paper proposed a total of 27 key performance indicators (KPIs) for green building operations monitoring. The number of proposed indicators is much fewer than the evaluation standards, as well as suitable for long-term monitoring, which can dramatically reduce evaluation time and cost. On the other hand, the indicators involving Outdoor environmental quality, Indoor environmental quality, HVAC system, P&D system, Renewable energy system, Total resource consumption and User behavior, which are more comprehensive and systematic than the conventional monitoring studies for operational performance of green building. Firstly, an indicators library for operations monitoring of green building was established based on relevant standards and literature review in this field. Secondly, “SMART” principle and Delphi method were adopted to select the key performance indicators for green building operations monitoring. Different background experts regarding green building industry were chosen to screen the most relevant, accessible and measurable indicators. Subsequently, two projects in China were selected for case study of key performance indicators proposed in this paper for green building operations monitoring to validate the feasibility and advancement.

Use of the International Classification of Functioning, Disability and Health to support goal-setting practices in pediatric rehabilitation: a rapid review of the literature

INTRODUCTION

The International Classification of Functioning, Disability and Health (referred to as the ICF) is the World Health Organization's framework for health. It can be used to identify goals that capture all aspects of a person's life and to inform clinical goal-setting processes. This review aims to report how healthcare providers are using the ICF framework to support goal-setting practices in pediatric rehabilitation services.

METHODS

A rapid review was conducted using scoping review principles in the following databases: CINAHL, Medline and PsycINFO. Key terms included: "ICF", "goal-setting" and "pediatrics".

RESULTS

Sixteen studies met the inclusion criteria. Three main themes emerged about the use of the ICF in pediatric rehabilitation: 1) match the content of goals to the ICF domains; 2) implement with existing tools for goal-setting; and 3) inform the development of new tools for goal-setting. Healthcare providers often use a combination of goal-setting tools. The SMART approach is used to frame goals, while the Canadian Occupational Performance Measure and Goal Attainment Scale have been used to document and evaluate goals.

CONCLUSION

The ICF framework can be used with current goal-setting practices and offers a common lens and language with which to facilitate collaborative goal-setting with families and healthcare providers.Implications for RehabilitationThe International Classification of Functioning, Disability and Health (ICF) provides a common framework and language to support collaborative goal-setting between families and healthcare providersDespite the opportunity for the ICF to be used as a framework with goal-setting approaches, to date the ICF has mainly been used to match the content of goals to ICF domains for documentation purposesThe ICF should be incorporated into the established clinical routines in order to promote its use among healthcare providersThe ICF can be used with existing goal-setting tools in clinical practice and to inform the ongoing development of new tools to support the goal-setting process in family-centred services.

Associations of Participation-Focused Strategies and Rehabilitation Service Use With Caregiver Stress After Pediatric Critical Illness

OBJECTIVE(S)

Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over 6 months post-PICU discharge.

DESIGN

Substudy of a data from Wee-Cover, a prospective cohort study.

SETTING

Two PICU sites.

PARTICIPANTS

Caregivers (N=168) of children 1-17 years old admitted into a PICU for ≥48 hours.

MAIN OUTCOME MEASURES

Data were collected from caregivers at enrollment and 3 and 6 months post-PICU discharge. Caregiver stress was assessed using the Pediatric Inventory for Parents. Having strategies to support their child's participation in home-based activities was assessed using the Participation and Environment Measure (PEM). In PEM, caregivers report on strategies used to support their child's participation in home-based activities. Data were dichotomized (yes, no) to denote having participation-focused strategies and if their child received PICU rehabilitation services. Additional covariates were history of a preexisting condition, child age, length of PICU stay, and change in functional capacities at PICU discharge.

RESULTS

History of a preexisting condition, time, and change in functional capacities significantly predicted caregiver stress frequency and difficulty. The interaction of having strategies-by-rehabilitation-by-time significantly predicted caregiver stress frequency and difficulty.

CONCLUSION(S)

Results highlight the role of early rehabilitation and the importance of working with caregivers to develop participation-focused strategies to support their child's functioning post-PICU. Families of children with a preexisting condition or those who experience a decrease in function during a PICU stay are susceptible to higher levels of stress and may be a priority population to target for rehabilitation services.