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Maleki Z, Heidarabadi S, Mohammadi A, Azami-Aghdash S, Rosenbaum P, Cross A, Soper AK. Disseminating the F-Words for Child Development to Parents of Children With Developmental Disabilities in Iran: A Qualitative Pilot Feasibility Study. Child Care Health Dev 2024; 50:e13321. [PMID: 39169646 DOI: 10.1111/cch.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/09/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Attitudes toward childhood disability have historically focused on biomedical efforts on 'fixing'. The introduction of WHO's ICF framework for health and Canadian researchers' 'F-words' (functioning, fitness, fun, friends, family and future) have significantly changed the field. To explore whether the F-words ideas influenced parents' perspectives on their child's abilities and rehabilitation goals, this qualitative pilot study introduced the F-words to Iranian parents with a child with a developmental disability. METHODS This study was conducted in Tabriz, Iran, in 2023, using Iranian educational F-words materials built on ideas available on the CanChild F-words Knowledge Hub. Data were collected through semistructured interviews with five mothers of children <5 years old with a developmental disability before and after attending an 'F-words Awareness Session' and analysed using thematic analysis. RESULTS In the preinterviews, six themes (and 20 subthemes) were identified: (i) routines (5); (ii) challenges (4); (iii) parental concerns (3); (iv) child's needs and priorities (3); (v) the role of parents in satisfying needs and challenges (2); and (vi) expectations of rehabilitation (3). In the postinterview, the same six themes and four additional subthemes emerged. CONCLUSION Findings from the pilot study showed that the intervention had an impact on the attitudes and behaviours of participants. Specifically, teaching about the F-words reduced parents' emphasis on the concept of 'normality'. Families' positive response to the 'F-words Awareness Session' indicates their openness to incorporating this approach into their daily lives. These findings highlight the potential benefits of utilizing the F-words in rehabilitation in Iran. Studies like these can serve as a foundation for developing effective strategies for integrating the F-words into existing rehabilitation practices in Iran.
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Affiliation(s)
- Zahra Maleki
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seifollah Heidarabadi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Mohammadi
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Cross
- Department of Pediatrics, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Alice Kelen Soper
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Al-Otaibi SL, Algabbani MF, Alboraih AM, AlAbdulwahab SS. Effectiveness of Family-Professional Collaboration on Functional Goals Achievement of Children with Cerebral Palsy and Caregivers' Quality of Life and Burden: A Randomized Comparative Study. J Clin Med 2024; 13:4057. [PMID: 39064097 PMCID: PMC11277485 DOI: 10.3390/jcm13144057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Family-professional collaboration is important to enhance the outcomes for children with cerebral palsy and their caregivers. Aims: This study examined the effect of implementing a family-professional collaboration practice model on children with cerebral palsy and their caregivers. Materials and methods: A randomized, single-blind comparative study included 28 physical therapists, 44 children with cerebral palsy between the ages of 2 and 12 years old, and their caregivers. Physical therapists in the experimental group received training in how to implement collaboration in their therapy sessions over the course of two sessions (3 h each). The children's achievement goal-range rate was measured using the Goal Attainment Scaling, the caregivers' quality of life was assessed using the World Health Organization Quality of Life-Brief, and the caregiver burden was evaluated using the Zarit Burden Interview. Results: All children showed improvement on the Goal Attainment Scaling change rate (p = 0.002), with no significant differences between groups (p < 0.44). However, a group × time interaction was observed. The Children Goal Attainment Scaling rate decreased between the two assessment sessions for children in the control group, while the Goal Attainment Scaling change rate was steady for the experimental group. There were no main effects of time and group or interaction of time × group reported on World Health Organization Quality of Life-Brief domains and no main effect of time on the Zarit Burden Interview, but there was a main effect between groups (p = 0.03), with partial eta square = 0.11 in favor of the experimental group. Conclusions: The family-professional collaboration practice model could be a potential practice to positively improve the outcomes in children with cerebral palsy and their caregivers.
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Affiliation(s)
- Sarah L. Al-Otaibi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia (S.S.A.)
| | - Maha F. Algabbani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia (S.S.A.)
| | - Azza M. Alboraih
- Research and Scientific Center, Sultan Bin Abdulaziz Humanitarian City, Riyadh 13571, Saudi Arabia
| | - Sami S. AlAbdulwahab
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia (S.S.A.)
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Mota LAT, Silva MZ, Dos Santos M, Pfeifer LI. The processes and outcomes related to 'family-centred care' in neuromotor and functional rehabilitation contexts for children with cerebral palsy: A scoping review. Child Care Health Dev 2024; 50:e13271. [PMID: 38738842 DOI: 10.1111/cch.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/14/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE The aim of this study is to identify the main processes and outcomes related to family-centred care (FCC) in neuromotor and functional rehabilitation of preschool children with cerebral palsy (CP). BACKGROUND FCC is considered a reference for best practices in child rehabilitation. CP is the most common cause of physical disability in childhood with repercussions on functionality. There is a gap in knowledge of the practical principles of FCC, and it is necessary to develop a reference model for the practice of child rehabilitation professionals. METHODS In this scoping review, the main databases selected were as follows: LILACS; Pubmed; Embase; The Cochrane Library; CINAHL (EBSCO); Scopus; Web of Science; PEDro (Physiotherapy Evidence Database); Open Gray and other banks of thesis. The terms combined in the search strategy were as follows: 'Family-centered', 'Family-centred' and 'CP'. Inclusion criteria are as follows: studies on preschool-aged children with CP, undergoing family-centred functional therapeutic interventions (FCFTI) with outcomes on bodily structures and functions and/or activities and/or participation. RESULTS The main participatory care methods identified were home intervention, environmental enrichment, collaborative realistic goal setting, planning of home-based activities and routine, child assessment feedback, family education/training, family coaching, encouraging discussion, observation of therapist and supervised practice. The main relational care qualities identified were as follows: respect, active listening, treat parents as equals, clear language, respect parents' ability to collaborate, demonstrate genuine care for the family, appreciate parents' knowledge and skills, demonstrate competence, experience and commitment. The main outcomes identified in children were improvement in motor and cognitive function and the child's functional ability. The main parentaloutcomes identified were empowerment, feeling of competence, self-confidence, motivation and engagement. CONCLUSION The main differences in FCFTI programs refer to the parental education/guidance component and the amount of intervention carried out by parents. It is possible that the elements chosen by the therapist in a FCFTI depend on characteristics of the child and caregivers.
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Affiliation(s)
- Larissa Audi Teixeira Mota
- Department of Neurosciences and Behavioral Sciences of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (USP), São Paulo, Brazil
- Department of Physiotherapy, University of Ribeirão Preto (UNAERP), Ribeirão Preto, Brazil
| | - Michelle Zampar Silva
- Department of Childcare and Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo (USP), São Paulo, Brazil
| | | | - Luzia Iara Pfeifer
- Department of Neurosciences and Behavioral Sciences of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (USP), São Paulo, Brazil
- Department of Occupational Therapy, Federal University of São Carlos, São Carlos, Brazil
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Nordbye-Nielsen K, Maribo T, Rahbek O, Narayanan U, Møller-Madsen B. The Danish child and parent Gait Outcomes Assessment List questionnaires were reliable and valid for cerebral palsy. Acta Paediatr 2024; 113:353-361. [PMID: 38009533 DOI: 10.1111/apa.17046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 10/12/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
AIM We investigated the reliability and validity of the Danish child and parent versions of the Gait Outcomes Assessment List (GOAL) questionnaires for ambulatory children with cerebral palsy (CP). METHODS Translation and cultural adaptations were performed and content validity evaluated. Participants were enrolled between 2016 and 2018 from Aarhus University Hospital, Denmark. Children and parents completed the GOAL questionnaires twice for test-retest reliability. Discriminative validity was evaluated by comparing the child and parent GOAL scores between children with Gross Motor Function Classification System (GMFCS) levels I and II. The concurrent validity of the GOAL questionnaires were investigated by comparing them with Challenge-20, which assesses motor skills in children with CP. RESULTS We studied 59 children (57% boys) with CP and GMFCS I-II at a mean age of 10.6 years. Test-retest intra-class correlations were excellent for the children (0.91, 95% confidence interval (CI) 0.83-0.96) and good for the parents (0.83, 95% CI 0.67-0.91). GOAL scores decreased with increasing GMFCS (p < 0.05). Both versions correlated well. The mean children's scores were significantly (6.2/100) higher than the parents' (p < 0.001). The GOAL scores correlated positively with Challenge-20. CONCLUSION The Danish GOAL child and parent questionnaires demonstrated good reliability and content and discriminative and concurrent validity.
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Affiliation(s)
- Kirsten Nordbye-Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Children's Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Maribo
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ole Rahbek
- Aalborg University Hospital, Aarhus, Denmark
| | - Unni Narayanan
- Division of Orthopaedic Surgery & Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Bjarne Møller-Madsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Children's Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Ullenhag A, Jahnsen R, Klove N, Smedvig S, Hoberg A. How did youth with cerebral palsy perceive participation in everyday life after participating in a periodical intensive rehabilitation program based on adapted physical activity in groups? A qualitative interview study. Disabil Rehabil 2024; 46:58-66. [PMID: 36803505 DOI: 10.1080/09638288.2023.2180096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Explore how youths with CP experience participation in everyday life, their experience of having participated in a periodical intensive rehabilitation programme and their expectations for the future. MATERIALS & METHODS A qualitative design that included semi-structured interviews with 14 youths with CP (mean age 17 years). RESULTS The qualitative content analysis exposed six themes, (1) Everyday life - to get the pieces of your life to fit together, (2) Participation means inclusion and belonging - the meaning of life, (3) Individual and environmental factors influencing participation, (4) Experience of physical and social activities away from home together with like-minded people, (5) To be continued locally, and (6) You do not know the future, anything can happen - visions for the future. CONCLUSIONS Participation in everyday life increases the meaning of life but takes energy. Periodical intensive rehabilitation programme enabled youths to try new activities, make friends and increase self-insight in their own strengths and limitations.IMPLICATIONS FOR REHABILITATIONYoung people with cerebral palsy (CP) describe participation as the meaning of life and state that it is essential for inclusion and being able to contribute to societyAdaptation of environmental factors including collaboration across service sectors and capacity building in young people within their preferred life situations appear to be essentialA periodical intensive rehabilitation, including adapted physical activities in groups, is recommended to provide peer learning and mastery experiences in young people with CP.Young people with CP seem to have the same hopes for the future as their typically developing peers.
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Affiliation(s)
- Anna Ullenhag
- Department of Research, Beitostolens Healthsports Center, Beitostølen, Norway
- School of Health, Care and Social Welfare, Mälardalens University, Västerås, Sweden
| | - Reidun Jahnsen
- Department of Research, Beitostolens Healthsports Center, Beitostølen, Norway
- Department of Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, CHARM, University of Oslo, Oslo, Norway
| | - Nina Klove
- Department of Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Solveig Smedvig
- Department of Research, Beitostolens Healthsports Center, Beitostølen, Norway
| | - Anita Hoberg
- Department of Research, Beitostolens Healthsports Center, Beitostølen, Norway
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Klatte IS, Ketelaar M, de Groot A, Bloemen M, Gerrits E. Collaboration: How does it work according to therapists and parents of young children? A systematic review. Child Care Health Dev 2024; 50:e13167. [PMID: 37724049 DOI: 10.1111/cch.13167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 05/18/2023] [Accepted: 08/06/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Collaboration between therapists and parents of children with developmental disabilities is a key element of family-centred care. In practice, collaboration appears to be challenging for both parents and therapists. This systematic review aims to make explicit how therapists can optimise their collaboration with parents of young children with developmental disabilities, according to the perspectives of parents and therapists. METHODS A systematic review was conducted using the following databases: Medline (PubMed), CINAHL (OVID) and PsychINFO (OVID). Those papers were selected, which focused on collaboration using a two-way interaction between therapists and parents, exploring the perspectives of therapists and/or parents of children between 2 and 6 years. Papers needed to be published in English or Dutch between 1998 and July 2021. Included papers were synthesised using a qualitative analysis approach by two researchers independently. Results sections were analysed line-by-line, and codes were formulated and discussed by all authors. Codes were aggregated, resulting in a synthesis of specific collaboration strategies in combined strategy clusters. RESULTS The search generated 3439 records. In total, 24 papers were selected. Data synthesis resulted in an overview of specific strategies organised into five clusters: (1) continuously invest time in your collaboration with parents, (2) be aware of your important role in the collaboration with parents, (3) tailor your approach, (4) get to know the family and (5) empower parents to become a collaborative partner. CONCLUSIONS This systematic review resulted in an overview of concrete strategies for therapists to use in their collaboration with parents of children with developmental disabilities. The strategies formulated enable therapists to consciously decide how to optimise their collaboration with each individual parent. Making these strategies explicit facilitates change of practice from therapist-led and child-centred towards family-centred care.
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Affiliation(s)
- Inge S Klatte
- HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Utrecht Institute of Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Marjolijn Ketelaar
- The Center of Excellence for Rehabilitation Medicine Utrecht, UMCU, Utrecht, The Netherlands
- De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | | | - Manon Bloemen
- HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Ellen Gerrits
- HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Utrecht Institute of Linguistics OTS, Utrecht University, Utrecht, The Netherlands
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Akyurek G, Gurlek S, Ozturk LK, Bumin G. The effect of parent-based occupational therapy on parents of children with cerebral palsy: a randomised controlled trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2023. [DOI: 10.12968/ijtr.2022.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background/Aims Parents of children with cerebral palsy face higher levels of stress, anxiety and depression, sadness, exhaustion and burnout. Parent-based therapies have been found to increase parents' satisfaction with therapy, parent–child interactions and reduced parental stress. This study examined the effects of parent-based occupational therapy on stress levels, coping skills, and emotional skills and competencies of parents of children with cerebral palsy. Methods A total of 15 children and their parents who were admitted to the paediatric rehabilitation unit for occupational therapy were divided into two groups (control group: n=7, study group: n=8) using the coin toss randomisation method. The control group received standard occupational therapy, while the study group received parent-based occupational therapy for 45 minutes a session, twice a week, until 10 sessions had been completed. Participants were evaluated before and after the intervention. Results The study group showed a decrease in stress levels (P=0.034) and increases in coping skills (P=0.016), and emotional skills and competencies (P=0.036). In addition, only an improvement in parents' stress levels (P=0.046) was observed in the control group. Conclusions The parent-based occupational therapy programme was more effective regarding stress levels, coping skills, emotional skills and competencies of the families of children with cerebral palsy compared to classical occupational therapy. This study is important in terms of demonstrating the benefits of parent-based occupational therapy for parents of children with cerebral palsy.
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Affiliation(s)
- Gokcen Akyurek
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Sedanur Gurlek
- Department of Occupational Therapy, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Leyla Kaya Ozturk
- Department of Occupational Therapy, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Gonca Bumin
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Collins A, D'Cruz K, Jackman A, Anderson V, Jenkin T, Scheinberg A, Muscara F, Knight S. Engaging children and adolescents with acquired brain injury and their families in goal setting: The family perspective. Neuropsychol Rehabil 2023; 33:1-23. [PMID: 34538207 DOI: 10.1080/09602011.2021.1977154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study explored the experiences of goal setting in paediatric rehabilitation from the perspectives of children and adolescents with acquired brain injury (ABI) and their parents in paediatric rehabilitation. Using a qualitative research design, 15 semi-structured interviews were conducted with 13 parents and 8 young people with ABI aged between 9 and 18 years who were engaged in outpatient rehabilitation. Interview transcripts were analysed using constructivist grounded theory methods. Two main themes and several sub-themes emerged: Experiences of goal setting: The role of professionals; The role of the young person; and The role of the parents. Working as a team: Understanding each other and building trust; Communicating, sharing knowledge and different perspectives; and Being flexible. These themes reflect parent's and young people's experience of goal setting during paediatric rehabilitation for ABI and suggest clinicians play an important role in educating young people and their families about goal setting in the outpatient rehabilitation context. Young people and their parents also perceive the focus of outpatient rehabilitation as working collaboratively with clinicians to gain knowledge to manage the consequences of ABI. Our findings emphasize the importance of the therapeutic consumer-clinician relationship and the need to actively engage young people in goal setting.
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Affiliation(s)
- Alana Collins
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Angie Jackman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Taylor Jenkin
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Adam Scheinberg
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Frank Muscara
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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King G. Central yet overlooked: engaged and person-centred listening in rehabilitation and healthcare conversations. Disabil Rehabil 2022; 44:7664-7676. [PMID: 34647516 DOI: 10.1080/09638288.2021.1982026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Listening in healthcare practice is often overlooked. This article addresses the misconception that listening in rehabilitation and healthcare is a simple skill, and proposes a conceptual framework of effective listening in healthcare conversations, based on conceptualizations, attributes, and outcomes associated with listening. METHOD A critical review was conducted, encompassing literature on listening in everyday and healthcare conversations. Articles were retrieved through database and hand searching. RESULTS Although various types of listening have been proposed, they share common attributes, including being attentive, emotionally involved, and non-judgmental. A conceptual framework is proposed in which listening in healthcare is seen as a relational process fostered by the 'engaged and person-centred listener', leading to relational outcomes (e.g., mutual engagement, collaboration) and client-specific outcomes. Listening in healthcare conversations can be difficult due to situational conditions and the level of self-regulation required. CONCLUSIONS Effective listening in healthcare differs from everyday listening with respect to its attributes, intentionality, and challenges. In healthcare, listening is essential to mutual engagement and other relational outcomes that mobilize the client towards pursuing goals. There is a need for greater understanding of the centrality and challenges to effective listening in healthcare conversations. Implications for rehabilitation practice are discussed.Implications for RehabilitationListening in rehabilitation conversations is a core skill or advanced competency-not a 'soft' skill with little effect on client outcomes.Effective listening is essential to mutual understanding, engagement, relationship building, and collaboration, which mobilize the client towards pursing goals in rehabilitation.Listening effectively in rehabilitation conversations involves deliberately adopting a person-centred perspective.Effective rehabilitation professionals have several listening intentions in mind in addition to understanding, including engaging the other person in the therapy session, building relationship, and collaborating.Rehabilitation professionals can deliberately adopt the intention to be an "engaged and person-centred listener" who is with and for the client.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Singer I, Klatte IS, de Vries R, van der Lugt R, Gerrits E. Using co-design to develop a tool for shared goal-setting with parents in speech and language therapy. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1281-1303. [PMID: 35859264 PMCID: PMC9796747 DOI: 10.1111/1460-6984.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the compelling case for engaging parents in speech and language therapy, research indicates that speech and language therapists (SLTs) currently have a leading role in the goal-setting process of therapy for children with developmental language disorder (DLD). Therefore, we set out to develop a tool that aims to support the dialogue between SLTs and parents and enhance shared decision-making about children's communicative participation goals. We used co-design techniques with SLT-practitioners to include their perspectives throughout the design process. Although co-design has been used for some years in healthcare research, it is still a relatively new research methodology in the field of speech and language therapy. AIMS To provide a detailed description of the co-design process that led to the development of a physical artefact that can support SLTs to engage parents of children with DLD in collaborative goal-setting. METHODS & PROCEDURES The Design Council's Double Diamond model was used to develop a tool in co-design, together with eight SLTs, who participated in all stages of the development process. Usability was tested in actual goal-setting conversations between four SLTs and 11 parents of a child with DLD resulting in stepwise improvements. In addition, usability of the first and final prototypes was tested with five usability criteria that were rated on a 10-point scale by 64 SLTs. OUTCOMES & RESULTS The co-design process resulted in the development of a physical prototype of the tool called 'ENGAGE', consisting of a metal 'tree trunk' on which parents can stick magnetic 'leaves' containing potential participation goals for their child. The 'tree' shape represents a child's development and opportunities for growth. This first prototype received marks between 7.0 and 8.0 out of 10 on attractiveness, user-friendliness, safety, functionality and affordability. After several iterations, there were significantly higher marks for attractiveness, user-friendliness and safety in favour for the final prototype. Marks for functionality and affordability did not change significantly. CONCLUSIONS & IMPLICATIONS As researchers we usually develop pen-and-paper tools, interview protocols, apps or questionnaires to support clinical practice. Including the SLTs' perspectives in the design process resulted in a tree-shaped physical artefact that, according to the SLTs, helps to order information and encourages and guides their dialogue with parents. We strongly advocate the inclusion of end-users in developing innovative user-centred tools for speech and language therapy and we hope that this will become widespread practice. WHAT THIS PAPER ADDS What is already known on the subject Collaborative goal-setting is at the heart of family-centred speech and language therapy. However, research indicates that goal-setting processes for children with DLD are currently predominantly therapist-led, instead of family-centred. Reasons for the lack of parental engagement are that effective communication with parents throughout the goal-setting process appears to be complex, and parents are not always invited and supported to engage in this. We used co-design to develop a tool that aims to support SLTs in their dialogue about therapy goals with parents. What this paper adds to existing knowledge This paper provides an example of applying a co-design approach for the development of a shared goal-setting tool for SLTs and parents of young children with DLD. The co-design approach enabled us to incorporate needs, experiences and ideas of SLTs in the design process. We report the four stages in the co-design process from (1) discovering the needs, wants and desires of the people involved, (2) defining the problem that SLTs experience, (3) developing several solutions and selecting the best solution, and (4) developing and testing the prototype. The detailed description of this process can add to an understanding of the advantages and disadvantages of a design process that includes the perspective of end-users. The result is a physical artefact representing a tree, which aims to support the conversation between SLTs and parents about a child's communicative participation. Items describing facets of communicative participation are printed on 'leaves' that can be hung on a tree trunk by parents. The tree shape is a positive metaphor for the growth and development of a child. What are the potential or actual clinical implications of this work? This study describes how SLTs can be meaningfully involved as partners in a co-design research approach. Incorporating experience from clinical practice was highly relevant since our study aimed to create a solution that would support goal-setting and service delivery by SLTs. We want to show that it is inspiring and beneficial for SLTs to partner with researchers in innovation of their own clinical practice and provide examples of co-design activities that illustrate the involvement and influence of end-users in a design process. Including the perspective of SLTs in the development of a new tool to facilitate the dialogue between SLTs and parents of children with DLD regarding therapy goal-setting is expected to add value and enhance its implementation in clinical practice.
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Affiliation(s)
- Ingrid Singer
- HU University of Applied SciencesUtrechtthe Netherlands
- Utrecht Institute of Linguistics OTSUtrecht UniversityUtrechtthe Netherlands
| | - Inge S. Klatte
- HU University of Applied SciencesUtrechtthe Netherlands
- Utrecht Institute of Linguistics OTSUtrecht UniversityUtrechtthe Netherlands
| | - Rosa de Vries
- HU University of Applied SciencesUtrechtthe Netherlands
| | | | - Ellen Gerrits
- HU University of Applied SciencesUtrechtthe Netherlands
- Utrecht Institute of Linguistics OTSUtrecht UniversityUtrechtthe Netherlands
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Ekwan F, Satink T, Kamwesiga J, Schulze C. Health professionals' experiences with the PEDI-UG: What do Ugandan occupational therapists say about the utility and value of the Pediatric Evaluation of Disability Inventory (PEDI-UG) for children with disabilities? Child Care Health Dev 2022; 49:555-562. [PMID: 36251008 DOI: 10.1111/cch.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Uganda version of Pediatric Evaluation of Disability Inventory (PEDI-UG) was culturally adapted and validated from the PEDI-US, a tool used to evaluate the functional capability of children with or without disability aged 6 months to 7.5 years in the areas of self-care, mobility and social domains. A group of Ugandan occupational therapists with experience of using PEDI-UG participated in this study to explore the question: What do Ugandan occupational therapists say about the utility and value of the PEDI-UG for children with disabilities? METHODS A qualitative research design was chosen to explore the participants' viewpoints concerning the utility and value of the PEDI-UG for children with disabilities. Purposive sampling was used to recruit health professionals for the focus group discussions. Focus group discussions were carried out with 18 occupational therapists and nurses. Thematic analysis was performed to establish patterns and themes. RESULTS Several challenges concerning the contextual use of PEDI-UG were reported. For example, PEDI-UG being culturally adapted in two languages (English and Luganda) makes it difficult for health professionals to use it for children whose caregivers are non-English or non-Luganda speakers. In addition, participants reported adapting the way they asked the assessment questions, struggling with how they interpreted the scores and observing the child's skills if required during PEDI-UG interviews with caregivers. CONCLUSIONS The findings of this study suggest that health professionals are challenged with the use of the PEDI-UG assessment in diverse cultural contexts and/or languages. These challenges are important considerations for the PEDI-UG translation in different Uganda cultural languages and training health professionals on the use and value of PEDI-UG for children with disabilities.
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Affiliation(s)
- Francis Ekwan
- Department of Health and Rehabilitation Sciences/Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Department of Occupational Therapy, Mulago National Referral Hospital, Kampala, Uganda
| | - Ton Satink
- HAN University of Applied Sciences, Nijmegen, The Netherlands.,European Masters of Science in Occupational Therapy, Hogeschool van Amsterdam, Amsterdam, The Netherlands
| | | | - Christina Schulze
- European Masters of Science in Occupational Therapy, Hogeschool van Amsterdam, Amsterdam, The Netherlands.,ZHAW University of Applied Sciences, Zurich, Switzerland
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12
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Killeen H, Anaby DR. The impact of parent involvement on improving participation of children born preterm: The story in the baseline. Contemp Clin Trials Commun 2022; 28:100942. [PMID: 35754976 PMCID: PMC9218735 DOI: 10.1016/j.conctc.2022.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/14/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Preterm birth continues to be a major public health challenge that has long term consequences on participation into adulthood. However, little is known about effective interventions to improve the participation of children born preterm. Methods This study gathered initial evidence on the usefulness of a goal-focused, environmental-based approach (Pathways and Resources for Engagement and Participation (PREP)) in improving the participation of children born preterm, and living in Ireland. Three school-age boys (6–7 years old) with a history of preterm birth participated in the 12-week PREP intervention. A 36-week single-subject AB design was employed and replicated across 3 different participation goals within each child and across 3 children. Activity performance was measured repeatedly, through parental involvement, using the Canadian Occupational Performance Measure (COPM), providing 9 individual outcome trajectories. Visual inspection and mixed-effects segmented regression were used. Results Goals were selected from various participation domains and settings. Throughout the baseline phase, once goals were set, significant improvements in activity performance were observed for all participants (t = 14.06, p < 0.001). Further clinically significant improvements (2.58 on the COPM) for all 9 participation goals were seen in overall performance during the intervention phase. These changes remained at follow-up. Conclusions Findings support family-centered practice and draw attention to the power of goal setting in improving participation within this context. Challenges with single-subject design with this population were also highlighted. Results demonstrate the potential impact of parent involvement when using an environmental-based approach to improve the participation of this underserved population. Improvement in participation in children born preterm, without physical disabilities. Challenges of single-subject design with this population. Environmental-based strategies show effectiveness in addressing participation goals. Environmental-based strategies may promote capacity building in parents. Studies focusing on the impact of goal setting and parental involvement are needed.
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Affiliation(s)
- Hazel Killeen
- College of Medicine, Nursing and Health Sciences, Áras Moyola, National University of Ireland, Galway, Galway, H91 TK33, Ireland
| | - Dana R Anaby
- McGill University, School of Physical and Occupation Therapy, 3630 Promenade Sir-William-Osler, Hosmer House Rm. 302, Montreal, Quebec, H3G 1Y5, Canada
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13
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Ogbeiwi O. Theoretical frameworks for project goal‐setting: A qualitative case study of an organisational practice in Nigeria. Int J Health Plann Manage 2022; 37:2328-2344. [DOI: 10.1002/hpm.3471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Osahon Ogbeiwi
- Faculty of Health Studies University of Bradford Bradford UK
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14
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Bonfert MV, Jelesch E, Hartmann J, Koenig H, Warken B, Meuche A, Jung NH, Bernius P, Weinberger R, Sorg AL, von Kries R, Narayanan UG, Hoesl M, Berweck S, Schroeder AS. Test-Retest Reliability and Construct Validity of the German Translation of the Gait Outcome Assessment List (GOAL) Questionnaire for Children with Ambulatory Cerebral Palsy. Neuropediatrics 2022; 53:96-101. [PMID: 34933378 DOI: 10.1055/s-0040-1722688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Gait Outcome Assessment List (GOAL) is a patient or caregiver-reported assessment of gait-related function across different domains of the International Classification of Functioning, Disability, and Health (ICF) developed for ambulant children with cerebral palsy (CP). So far, the questionnaire is only available in English. The aim of this study was to translate the GOAL into German and to evaluate its reliability and validity by studying the association between GOAL scores and gross motor function as categorized by the gross motor function classification system (GMFCS) in children with cerebral palsy (CP). The GOAL was administered to primary caregivers of n = 91 children and adolescents with CP (n = 32, GMFCS levels I; n = 27, GMFCS level II; and n = 32, GMFCS level III) and n = 15 patients were capable of independently completing the whole questionnaire (GMFCS level I). For assessing test-retest reliability, the questionnaire was completed for a second time 2 weeks after the first by the caregivers of n = 36 patients. Mean total GOAL scores decreased significantly with increasing GMFCS levels with scores of 71 (95% confidence interval [CI]: 66.90-74.77) for GMFCS level I, 56 (95% CI: 50.98-61.86) for GMFCS level II, and 45 (95% CI: 40.58-48.48) for GMFCS level III, respectively. In three out of seven domains, caregivers rated their children significantly lower than children rated themselves. The test-retest reliability was excellent as was internal consistency given the GOAL total score. The German GOAL may serve as a much needed patient-reported outcome measure of gait-related function in ambulant children and adolescents with CP.
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Affiliation(s)
- Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children with Medical Complexity, Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Evelyn Jelesch
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Julia Hartmann
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Helene Koenig
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children with Medical Complexity, Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Birgit Warken
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children with Medical Complexity, Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Anne Meuche
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children with Medical Complexity, Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Nicolai H Jung
- kbo-Kinderzentrum München, Social Pediatrics, Technical University of Munich, Munich, Germany
| | - Peter Bernius
- Specialist Center for Paediatric and Neuro-Orthopaedics, Schoen Clinic Muenchen Harlaching, Munich, Germany
| | - Raphael Weinberger
- Institute of Social Paediatrics and Adolescents Medicine, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Anna Lisa Sorg
- Institute of Social Paediatrics and Adolescents Medicine, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Rüdiger von Kries
- Institute of Social Paediatrics and Adolescents Medicine, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Unni G Narayanan
- Division of Orthopaedics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthias Hoesl
- Gait and Motion Analyis Laboratory, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Steffen Berweck
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children with Medical Complexity, Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.,Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - A Sebastian Schroeder
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children with Medical Complexity, Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
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15
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Toovey RAM, Harvey AR, McGinley JL, Lee KJ, Shih STF, Spittle AJ. Task-specific training for bicycle-riding goals in ambulant children with cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 2022; 64:243-252. [PMID: 34420205 DOI: 10.1111/dmcn.15029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/21/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
AIM To determine whether a task-specific physiotherapist-led training approach is more effective than a non-specific parent-led home programme for attaining bicycle-riding goals in ambulant children with cerebral palsy (CP). METHOD Sixty-two ambulant children with CP aged 6 to 15 years (33 males, 29 females, mean age 9y 6mo) with bicycle-riding goals participated in this multi-centre, assessor-blind, parallel-group, superiority randomized controlled trial. Children in the task-specific group participated in a physiotherapist-led, group-based, intensive training programme. Children in the parent-led home group were provided with a practice schedule, generic written information, and telephone support. Both programmes involved a 1-week training period. The primary outcome was goal attainment at 1 week after training measured using the Goal Attainment Scale. Secondary outcomes included bicycle skills, participation in bicycle riding, functional skills, self-perception, physical activity, and health-related quality of life at 1 week and 3 months after training. RESULTS Children in the task-specific training group had greater odds of goal attainment than those in the parent-led home programme at 1 week after intervention (odds ratio [OR] 10.4, 95% confidence interval [CI] 2.8-38.6), with evidence for superiority retained at 3 months (OR 4.0, 95% CI 1.3-12.5). INTERPRETATION The task-specific physiotherapist-led training approach was more effective for attaining bicycle-riding goals than a non-specific parent-led home programme in ambulant children with CP.
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Affiliation(s)
- Rachel A M Toovey
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.,Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Adrienne R Harvey
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine J Lee
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Melbourne Children's Trials Centre, Melbourne Children's Campus, Melbourne, Victoria, Australia
| | - Sophy T F Shih
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.,Surveillance Evaluation and Research Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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16
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Garnett R, Davidson B, Eadie P. Parent perceptions of a group telepractice communication intervention for autism. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415211070127. [PMID: 36382075 PMCID: PMC9620687 DOI: 10.1177/23969415211070127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND & AIMS Estimates suggest that one in 59 children receive a diagnosis of autism and that early intervention can be effective if applied consistently and intensively. Parent implemented intervention can increase intervention consistency and intensity however, availability of providers, geographical factors, time constraints, and parental stress levels can all act as barriers to service access. Limitations in understanding elements that support family engagement can also impact participation in intervention. Telepractice can increase availability of intervention services and decrease the time and costs associated with face-to-face delivery. Research focused on children with autism has shown that telepractice is acceptable to parents. Despite positive findings for telepractice services with individual clients, limited research has been conducted on telepractice services for parent groups; parent perceptions and preferences regarding intervention; and service delivery methods. This research aimed to investigate parent perceptions of a group intervention programme for autism; the telepractice approach; parent and child outcomes; and parental stress. The purpose of the investigation was to build an understanding of parent's intervention preferences to inform future service offerings, increase choice, and support participation. METHODS Eleven parents of preschool children with autism participated in a telepractice delivered group training programme called Hanen More Than Words (HMTW). The intervention is traditionally delivered face to face and teaches strategies to facilitate social-communication development in young children.Quantitative and qualitative measures were used to evaluate parent perceptions of the telepractice HMTW intervention. Data were collected via the Parenting Stress Index, HMTW programme evaluation forms, and online parent survey.Quantitative data was analysed using descriptive statistics. Pre- and post-intervention comparisons of parenting stress were conducted using paired T-Tests. Open comment field responses were analysed qualitatively using a directed content analysis. RESULTS Parents reported high levels of satisfaction with telepractice delivered HMTW across intervention and post programme evaluations. Interactive learning opportunities, group participation, video coaching, individualisation of service, and programme facilitation were identified as key supports to learning.Parents perceived increased insight into the interaction, learning, and behaviour of themselves and their children. They reported positive changes in strategy implementation and confidence. Parents also perceived improvements in their children's communication, responsiveness, interaction, and play following intervention. Parental stress measurements from pre- to post intervention, were not significantly different. CONCLUSIONS Telepractice may reduce service barriers and improve access, particularly with the efficiency of a group delivery approach. Utilising technology to deliver group intervention was acceptable to parents and perceived to have positive outcomes for both parent and child. Further investigation into parent perceptions of intervention types and delivery approaches, could facilitate a broader understanding of family needs with respect to service access and engagement. IMPLICATIONS Expansion of telepractice offerings can increase efficiencies and service choice for families and providers. Limitations in service availability and barriers to service access and engagement, confirm the importance of pursuing ongoing service improvements and evaluating the preferences of service users. Development of standardised tools to measure and compare parent perceptions across intervention types and service delivery approaches would be beneficial.
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Affiliation(s)
- Robyn Garnett
- Robyn Garnett, Department of Audiology and
Speech Pathology, University of Melbourne, 550 Swanston Street Carlton, VIC
3053, Australia.
| | - Bronwyn Davidson
- Department of Audiology and Speech Pathology,
University of Melbourne, 550 Swanston Street Carlton, VIC 3053,
Australia
| | - Patricia Eadie
- Melbourne Graduate School of Education,
University of Melbourne, 234 Queensberry Street, Parkville VIC 3053,
Australia
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17
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AlShubaily R, Chiarello LA. Collaborative Goal-Setting Beliefs and Practices of Out-Patient Pediatric Physical Therapists Working in Saudi Arabia and the United States. Phys Occup Ther Pediatr 2022; 42:172-186. [PMID: 34423723 DOI: 10.1080/01942638.2021.1965691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS (1) identify and compare family-centered care (FCC) and collaborative goal-setting (CGS) beliefs and practices of out-patient pediatric physical therapists (PTs) in Saudi Arabia (SA) and the United States (US); (2) describe CGS approaches; and (3) determine the association between CGS practices and educational level, clinical experience, and FCC beliefs and practices. METHODS 87 PTs completed an online survey. RESULTS Ninety percent of PTs believed in FCC to a great extent. PTs in the US rated their organization's family-centeredness and their own FCC application significantly higher than PTs in SA. PTs believed in CGS with parents (86%) and children (66%) to a great extent while 69% of PTs reported applying CGS with parents to a great extent compared to 39% with children. PTs in SA rated the importance of determining therapy goals by PTs significantly higher than PTs in the US. The most selected CGS strategy was asking about concerns and needs. Low to moderate significant positive associations were found between CGS practices and PTs belief of their organization's family-centeredness and their own FCC application. CONCLUSION Similarities and differences were found between the two countries in FCC and CGS beliefs and practices. Organizational and individual FCC practices influence CGS practices.
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Affiliation(s)
- Reema AlShubaily
- Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, Pennsylvania, USA.,Rehabilitation Health Sciences Department, King Saud University, Riyadh, Saudi Arabia
| | - Lisa A Chiarello
- Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, Pennsylvania, USA
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18
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Lång C, Tell J, Johansen K. Parents want Swedish child health services to focus more on motor development and practical advice. Acta Paediatr 2021; 110:2415-2423. [PMID: 33851425 DOI: 10.1111/apa.15876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
AIM Parents' experiences and expectations are key to developing evidence-based approaches that respond to family needs. However, little is known about how parents regard the motor assessments in well-child surveillance and what they need to support their child's motor development. This study explored their experiences. METHODS We conducted 11 semi-structured interviews with Swedish-speaking parents whose children had been referred to a physiotherapist by child health services (CHS) before 18 months of age. Consecutive sampling was conducted from March to November 2018. The data were analysed using systematic text condensation. RESULTS The three themes that emerged were that that parents liked the CHS setting, but had concerns about the lack of focus on motor development during routine health visits and wanted more dialogue about this area. The parents said that the assessments varied considerably and that their concerns were not always taken seriously. They wanted to know more about the professionals' observations, how their child was expected to develop and what they could do to support their motor development. CONCLUSION Parents wanted a greater focus on motor development during routine health visits. This included advice on how they could support their child's development.
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Affiliation(s)
- Christina Lång
- Rehabilitation clinic Blekinge Hospital Karlskrona Karlskrona Sweden
| | - Johanna Tell
- Department of Health Blekinge Institute of Technology Karlskrona Sweden
| | - Kine Johansen
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
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19
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Mann J, Trucks MR, Wallace DA, DeLuca S. Pilot Study on the Use of a Video-Based Metric Goal Attainment Assessment. Dev Neurorehabil 2021; 24:287-295. [PMID: 33427006 DOI: 10.1080/17518423.2020.1864043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The scientific investigation of developmental neurorehabilitation has been negatively impacted by a lack of outcome measures sensitive to interventional effect, and is currently in need of assessment measures that can be used during social distancing protocols. Here we report on the usability and feasibility from a pilot test of a novel assessment methodology. This preliminary data demonstrate the usability and feasibility of this assessment system, suggests that it is sensitive to change, and supports the further development and testing of this assessment. The assessment methodology, here presented, generates a percent change score based on the metric measurement of individualized goals before and after intervention, thereby facilitating comparisons between groups and across goals. Moreover, it can be conducted remotely and introduces the novel element of goal appropriacy assessment such that goal selection, as well as goal attainment, are assessed via metric measurement.
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Affiliation(s)
- Jessie Mann
- Virginia Tech: School of Medicine School of Neuroscience, Fralin Biomedical Research Institute, Neuromotor Research Clinic, Director
| | - Mary-Rebekah Trucks
- Fralin Biomedical Research Institute Neuromotor Research Clinic, Postdoc fellow
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20
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Tanner LR, Grinde K, McCormick C. The Canadian Occupational Performance Measure: a Feasible Multidisciplinary Outcome Measure for Pediatric Telerehabilitation. Int J Telerehabil 2021; 13:e6372. [PMID: 34345346 PMCID: PMC8287748 DOI: 10.5195/ijt.2021.6372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study describes the feasibility of using the Canadian Occupational Performance Measure (COPM) as a multidisciplinary outcome measure for pediatric telerehabilitation (TR). The COPM was administered at monthly time points over four months. A follow-up survey was conducted with the therapists to assess clinical utility of the COPM. Seventy-three percent of the children seen in TR > one month had at least two administrations of the COPM. Eighty percent of therapists agreed or strongly agreed that the COPM was easy to use in a reasonable amount of time, helped identify functional goals, could be used with various children with varied diagnoses, and measured functional change. In 37 children, the median clinical change in performance and satisfaction was two points or greater on the COPM over the episode of TR. The COPM is a feasible measure perceived positively by pediatric therapists for TR use.
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Affiliation(s)
- Lynn R Tanner
- Physical Medicine & Rehabilitation, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Kathy Grinde
- Physical Medicine & Rehabilitation, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Cristin McCormick
- Physical Medicine & Rehabilitation, Children's Minnesota, Minneapolis, Minnesota, USA
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21
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Vänskä N, Sipari S, Jeglinsky I, Lehtonen K, Kinnunen A. Co-development of the CMAP Book: a tool to enhance children's participation in pediatric rehabilitation. Disabil Rehabil 2021; 44:1709-1719. [PMID: 34033734 DOI: 10.1080/09638288.2021.1921061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of the co-development project was to create a tool that enhances children's active participation and agency in rehabilitation and in everyday life. MATERIALS AND METHODS Action research was the methodological approach. Participants in the different phases of the process (2015-2017) were children with disabilities, parents and rehabilitation professionals. The co-development process included: (1) designing the tool's first version, (2) piloting the tool, (3) evaluating the tool by collecting feedback and reflection, (4) generating the tool's final version. RESULTS Through the co-development process, an accommodating and digital tool called the CMAP Book-a description of the child's meaningful activities and participation-was developed. The CMAP Book is used with an electronic app enabling the identification and description of what is meaningful in daily life from the child's perspective with videos, photos, pictures, recording and writing. The tool enables the child, family and professionals to prepare and build collaboration in rehabilitation with flexibility according to child and family needs. CONCLUSIONS Use of the CMAP Book promotes the active involvement of the child and parents in designing the rehabilitation process in daily life in partnership with professionals. The stakeholder involvement in the co-development facilitated meaningful results and a concrete tool for rehabilitation.IMPLICATIONS FOR REHABILITATIONThe CMAP book is a new tool that enhances the child's active participation and agency in the rehabilitation process based on meaningful activities in everyday life expressed by the child.Identifying and utilising meaningful issues in the child's daily life through collaboration increases the child's commitment and motivation, and thus may enhance the benefits and effects of rehabilitation. Through co-development, the child and his/her family can be active and equal partners not only in development projects but also in the rehabilitation process.In the future, child-specific practices and policies should be developed to promote participatory co-research between families and clinicians linked to the daily lives of families with children.
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Affiliation(s)
- N Vänskä
- Department of Rehabilitation and Examination, Metropolia University of Applied Sciences, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - S Sipari
- Department of Wellbeing, Metropolia University of Applied Sciences, Helsinki, Finland
| | - I Jeglinsky
- Department of Health and Wellbeing, Arcada University of Applied Sciences, Helsinki, Finland
| | - K Lehtonen
- Department of Rehabilitation and Examination, Metropolia University of Applied Sciences, Helsinki, Finland
| | - A Kinnunen
- Department of Health and Wellbeing, Savonia University of Applied Sciences, Kuopio, Finland
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22
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Schoen SA, Miller LJ, Mulligan S. Validity of the Occupational Performance Scale of the Sensory Processing Three Dimensions Measure. Am J Occup Ther 2021; 75:7502205090p1-7502205090p10. [PMID: 33657351 DOI: 10.5014/ajot.2021.044248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The Sensory Processing Three Dimensions (SP3D) Occupational Performance Scale (OPS) is a new parent-report measure developed for use as part of a comprehensive occupational therapy evaluation for children with sensory processing and integration challenges. OBJECTIVE To examine the internal consistency and discriminant validity of the SP3D OPS, examine relations between sensory processing subtypes and areas of occupational performance (OP), and determine the extent to which specific sensory processing challenges predict problems with OP. DESIGN Nonexperimental, descriptive design using correlations, group comparisons, and stepwise regression. SETTING Three outpatient clinic sites in the United States. PARTICIPANTS Parents of 66 children (33 typically developing and 33 with clinical problems) ranging in age from 4 to 12 yr. OUTCOMES AND MEASURES The SP3D OPS and SP3D Inventory were completed by parents to address psychometrics of the SP3D OPS and determine the association between sensory processing and integration challenges with OP. RESULTS Internal consistency reliability and discriminant validity of the SP3D OPS were supported. Scores on the Dyspraxia and Sensory Overresponsivity subscales best predicted deficits in OP. Significant relations were found between sensory processing and integration and competency in multiple OP areas. CONCLUSIONS AND RELEVANCE The SP3D OPS shows promise as a measure of OP. The OP deficits among children with sensory processing and integration challenges are in part due to subtype presentation. Further studies of the SP3D OPS's reliability and validity are needed. WHAT THIS ARTICLE ADDS This new occupational performance measure shows associations between sensory processing and OP areas. It can provide information to support therapists in identifying family concerns relevant to goal setting and intervention.
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Affiliation(s)
- Sarah A Schoen
- Sarah A. Schoen, PhD, OTR/L, is Director of Research, STAR Institute, Centennial, CO, and Associate Professor, Rocky Mountain University of Health Professions, Provo, UT;
| | - Lucy Jane Miller
- Lucy Jane Miller, PhD, OTR, is Director Emeritus, STAR Institute, Centennial, CO, and Professor, Rocky Mountain University of Health Professions, Provo, UT
| | - Shelley Mulligan
- Shelley Mulligan, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of New Hampshire, Durham
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Mathews SB, Mozolic-Staunton B, Jefford E, Salehi N. Canadian Occupational Performance Measure and Early Intervention: A Scoping Review. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2020. [DOI: 10.1080/19411243.2020.1744210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Skye B. Mathews
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Queensland, Australia
| | - Beth Mozolic-Staunton
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Queensland, Australia
| | - Elaine Jefford
- School of Health and Human Sciences, Southern Cross University (Midwifery) New South Wales, Lismore, Australia
| | - Nasim Salehi
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Queensland, Australia
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24
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Jenkin T, Anderson V, D'Cruz K, Collins A, Muscara F, Scheinberg A, Knight S. Engaging children and adolescents with acquired brain injury and their families in goal setting: The clinician perspective. Neuropsychol Rehabil 2020; 32:104-130. [PMID: 32811301 DOI: 10.1080/09602011.2020.1801470] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper explored clinicians' experiences of the goal setting process with children and adolescents with acquired brain injuries (ABI) and their families in paediatric neurorehabilitation. Semi-structured interviews were conducted with 13 clinicians, all members of an interdisciplinary paediatric rehabilitation service, who work with children and adolescents with ABI and their families. Interview transcripts and additional data were analysed using constructivist grounded theory methods. Three main themes and sub-themes were developed: (1) Seeing the bigger picture: Goals change over time; Families set bigger picture goals; Need-to-dos: Goals that the child/adolescent needs to achieve; and Want-to-dos: Goals that the child/adolescent wants to achieve; (2) Collaborating as a team: Everyone needs to be on the same page; Hearing the child's/adolescent's voice; and Parents as advocates; and (3) Recognizing and navigating challenges: Child-/adolescent- and family-related challenges and Time as a service-related challenge. Participants perceived the clinician's role during goal setting as that of an active collaborator, enabling children and adolescents with ABI and their families to generate meaningful goals. These findings demonstrate insights into goal setting in paediatric ABI neurorehabilitation from clinicians' perspectives, and highlight the importance of collaboration, flexibility and anticipation of challenges in facilitating children's, adolescents' and families' involvement in this process.
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Affiliation(s)
- Taylor Jenkin
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | | | - Alana Collins
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Frank Muscara
- Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Adam Scheinberg
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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25
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Pritchard L, Phelan S, McKillop A, Andersen J. Child, parent, and clinician experiences with a child-driven goal setting approach in paediatric rehabilitation. Disabil Rehabil 2020; 44:1042-1049. [PMID: 32650674 DOI: 10.1080/09638288.2020.1788178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore child, parent, and clinician experiences with a child-driven approach to rehabilitation goal setting. METHODS Nine children receiving inpatient and outpatient rehabilitation aged 5.0-12.3 years (x¯ = 8.3, SD = 2.3; 5 females) and their parents (n = 9) participated in a goal setting process intended to maximize child engagement with their physical or occupational therapist. Qualitative interviews were conducted with children (n = 7), their parents (n = 9), occupational therapists (n = 2), a nurse practitioner and a physician to explore their experience with the child-driven approach to goal setting. RESULTS Three themes that reflect child, parent, and clinician experience with a child-driven approach to goal setting were identified: (1) children have voice and insight, (2) child identified goals are rewarding and motivating for children, and (3) we are a team: goal setting as a co-constructed process. CONCLUSIONS Engagement in goal setting resulted in the identification of functional goals that were perceived as motivating for children. Children described feeling valued and heard. Parents and clinicians recognized they had previously underestimated the capacity of children to identify their own goals. Parents wanted input from therapists, particularly related to shaping their goals to focus on shorter-term outcomes. Relational autonomy, which emphasizes the social and relational aspects of decision-making, may be more useful than traditional, individualistic views of autonomy for conceptualizing clinician roles in collaborative goal setting.IMPLICATIONS FOR REHABILITATIONChildren are often not optimally involved in setting their own rehabilitation goals.In this qualitative study, we report that children, parents, and clinicians recognized the value of optimizing child engagement in goal setting including children feeling heard, valued and more motivated to participate in therapy.Parents expressed a need for a collaborative approach to goal setting that respects child, parent, and clinician input.Relational autonomy may be a useful framework for reframing the role of clinicians in collaborative goal setting processes.
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Affiliation(s)
- Lesley Pritchard
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Shanon Phelan
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | - Ashley McKillop
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Canada.,Glenrose Rehabilitation Hospital, Edmonton, Canada
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26
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Flannery H, Jacob J. Measuring psychological outcomes in paediatric settings: Making outcomes meaningful using client-defined perspectives. Clin Child Psychol Psychiatry 2020; 25:594-603. [PMID: 32046508 DOI: 10.1177/1359104520904120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a growing drive to develop and implement patient-reported outcome measures within paediatric health services, particularly for young people living with chronic health conditions; however, there is little consensus on how best to do this in meaningful ways within psychological services working alongside medical teams. This reflective commentary considers some of the challenges of collecting psychological outcome measures in paediatric services and considers alternative approaches to making outcome measurement meaningful. All measures have their limitations; however, they become meaningless if they are not used in meaningful and considered ways with young people. Client-defined outcome measurement, such as goal-based outcome measures, alongside other types of measurement, can capture outcomes of meaning to young people living with chronic health conditions, and can enable them to feed into a shared decision-making process.
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Affiliation(s)
- Halina Flannery
- Child and Adolescent Psychology Team, Paediatric and Adolescent Division, University College London Hospitals NHS Foundation Trust, UK
| | - Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, University College London, UK
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27
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Singer I, Klatte IS, Welbie M, Cnossen IC, Gerrits E. A Multidisciplinary Delphi Consensus Study of Communicative Participation in Young Children With Language Disorders. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1793-1806. [PMID: 32543956 DOI: 10.1044/2020_jslhr-19-00326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Our aim was to develop consensus on the definition and operationalization of communicative participation (CP) in 2- to 8-year-old children with language disorders (LDs). A clear definition and operationalization can facilitate the discussion about children's communication problems in daily life between parents and professionals. Method In an online Delphi study, anonymized thoughts and opinions were collected on the definition and operationalization of CP in young children with LD. The 47 Delphi panel members were Dutch parents, young adults with LDs, teachers and assistants, speech-language pathologists, clinical linguists, and clinical researchers. Thematic content analysis was used to develop a concept definition and items operationalizing CP. The Delphi panel rated the suitability of concept definitions using a 7-point Likert scale. Concept definitions were revised with feedback from the Delphi panel until consensus was achieved. The Delphi panel rated items on how well they operationalize CP, using the same Likert scale. Results The majority (79%) of the Delphi panel indicated that the essence of CP was captured by the definition: "CP is understanding and being understood in a social context, by applying verbal and non-verbal communication skills." In addition, 33 behavioral items were developed. Conclusion This study resulted in strong consensus on the definition of CP between Dutch parents and professionals. Items were developed that can inform speech-language pathologists on the type of questions to ask a child's parents or teacher when discussing CP. Further research is needed on how the items can best be used in clinical practice.
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Affiliation(s)
- Ingrid Singer
- Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
| | - Inge S Klatte
- Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
| | - Marlies Welbie
- Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
| | - Ingrid C Cnossen
- Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
| | - Ellen Gerrits
- Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
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Milton YM, Roe SA, Newby KV. Home programmes based on evidence of best practice for children with unilateral cerebral palsy: Occupational therapists’ perceptions. Br J Occup Ther 2020. [DOI: 10.1177/0308022619898073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Evidence-based occupational therapy home programmes for children with unilateral cerebral palsy have demonstrated efficacy; however, uptake into routine practice is varied. The aim of this study was to gain a deeper understanding of the therapist-perceived supports and barriers to using occupational therapy home programmes for children with unilateral cerebral palsy, based on evidence of best practice in the United Kingdom. Method Fourteen occupational therapists completed semi-structured telephone interviews. Using a qualitative framework analysis approach, support and barrier factors were indexed against the Theoretical Domains Framework, before being categorised more broadly using the Capability, Opportunity, Motivation and Behaviour Model. Findings Common supports included: (a) strong leadership within the team to facilitate the translation of occupational therapy home programmes and evidence-based interventions into service-specific protocols; (b) knowledge exchange within professional networks and (c) mentorship. Common barriers included: (a) lack of resources; (b) restricted opportunities to review occupational therapy home programmes and (c) difficulties keeping up-to-date with the evidence in this area. Conclusion To be effective, occupational therapy home programmes need to be based on evidence of best practice; analysis indicated an urgent need to capture outcomes, record parental practice, further integrate ‘occupation’ within goal-setting, and develop use of conceptual models of practice to both enhance family-centred care and articulate the profession’s unique contribution.
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Affiliation(s)
- Yvonne M Milton
- School of Nursing, Midwifery and Health, Coventry University, UK
- Adoptionplus, Buckinghamshire, UK
| | - Sarah A Roe
- School of Nursing, Midwifery and Health, Coventry University, UK
| | - Katie V Newby
- Centre for Advances in Behavioural Science, Coventry University, UK
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Angeli JM, Schwab SM, Huijs L, Sheehan A, Harpster K. ICF-inspired goal-setting in developmental rehabilitation: an innovative framework for pediatric therapists. Physiother Theory Pract 2019; 37:1167-1176. [DOI: 10.1080/09593985.2019.1692392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jennifer M. Angeli
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Sarah M. Schwab
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Center for Cognition, Action, and Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Lobke Huijs
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Amber Sheehan
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
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30
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Vinblad E, Larsson I, Lönn M, Olsson E, Nygren JM, Svedberg P. Development of a Digital Decision Support Tool to Aid Participation of Children With Disabilities in Pediatric Rehabilitation Services: Explorative Qualitative Study. JMIR Form Res 2019; 3:e14493. [PMID: 31579015 PMCID: PMC6777283 DOI: 10.2196/14493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/10/2019] [Accepted: 07/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Building a health care system in accordance with the rule of law requires child-centered care, where children and young people, regardless of ability, are allowed to participate in visits with their health care professionals. As part of an overall project focusing on developing and implementing a digital decision support tool to increase the participation of children with disabilities in pediatric rehabilitation, this study brings new knowledge as to how this specific patient group views participation. OBJECTIVE The aim of this formative study was to explore the experiences of children and young people with disabilities concerning increasing their participation in the pediatric rehabilitation services. METHODS The formative study had an explorative design, based on a latent qualitative content analysis with an inductive approach. Interviews were conducted with 20 children (6-17 years) and 8 young people (19-30 years) with disabilities about their experiences of participation in pediatric rehabilitation services. RESULTS A total of 3 categories emerged reflecting the participants' possibilities of participation in the pediatric rehabilitation services: to feel involved, to feel independent, and to work in partnership. To feel involved meant being listened to and being connected, to feel independent meant being admitted and being enabled, and to work in partnership meant being supported and being able to entrust others with the decision making. With the overall theme moving toward empowerment of children in pediatric rehabilitation, a true feeling of participation can be experienced. CONCLUSIONS The views of children and young people with disabilities are that children should be given the prerequisites for empowerment by being allowed to feel involved and independent as well as to work in partnership to experience true participation in the pediatric rehabilitation services. This finding is essential in the design of a digital decision support tool based on the children's needs and perspectives.
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Affiliation(s)
- Elin Vinblad
- Child and Youth Rehabilitation Services, Region Skåne, Kristianstad, Sweden
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | | - Emma Olsson
- Falkenbergs Municipality, Falkenberg, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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31
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Angeli JM, Harpster K, Huijs L, Seid M, Sheehan A, Schwab SM. Patient-Centered Goal Setting in Developmental Therapy: Discordance between Documented Goals and Caregiver-Perceived Goals. Pediatr Qual Saf 2019; 4:e199. [PMID: 31572900 PMCID: PMC6708649 DOI: 10.1097/pq9.0000000000000199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/27/2019] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Productive interactions between engaged patients and clinical teams are key to effective clinical practice. Accordingly, the identification of needs and priorities through the process of collaborative goal setting is fundamental to patient-centered care. Executing a goal-setting process that is truly collaborative is challenging; many caregivers do not feel that they are adequately involved in the goal-setting process. This study presents the results of an initiative intended to understand goal concordance between therapists and caregivers. METHODS We conducted an observational, cross-sectional design study. Twenty-nine pediatric physical and occupational therapists developed and documented collaborative goals for their patients. Over 6 months, 120 randomly selected caregivers from a weekly list of patients scheduled for a follow-up physical or occupational therapy visit participated. Caregivers completed structured interviews related to their children's therapy goals. We calculated agreement coefficients between caregiver-perceived goals and therapist-documented goals. RESULTS Overall strength of agreement was poor (M = -0.03, SD = 0.71). There were no significant differences within variables of a goal setter, goal importance, or goal utility. Median agreement coefficients were greatest for goals perceived to be identified solely by the caregiver, perceived as important, and perceived as functionally useful. CONCLUSIONS The results of this study underscore the state of discordance in the collaborative goal-setting process in pediatric physical and occupational therapy. Healthcare encounters continue to be framed by provider perspectives and priorities. Developing therapy goals that enhance family involvement, relate to function, and are important to the healthcare consumer may improve the agreement.
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Affiliation(s)
- Jennifer M. Angeli
- From the Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Karen Harpster
- From the Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Lobke Huijs
- From the Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Michael Seid
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Amber Sheehan
- From the Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Sarah M. Schwab
- From the Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Psychology, Center for Cognition, Action, & Perception, University of Cincinnati, Cincinnati, Ohio
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32
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O'Connor B, Kerr C, Shields N, Adair B, Imms C. Steering towards collaborative assessment: a qualitative study of parents' experiences of evidence-based assessment practices for their child with cerebral palsy. Disabil Rehabil 2019; 43:458-467. [PMID: 31230482 DOI: 10.1080/09638288.2019.1629652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To understand parents' experiences of evidence-based assessment by health professionals for their child with cerebral palsy. METHODS A qualitative interpretive description study was undertaken. Primary carers of children with cerebral palsy (aged 3-18 years) from south-eastern Australia were invited to participate. Face-to-face interviews were held using a semi-structured topic guide and data analyzed inductively. Credibility was ensured through: journal reflections; co-author review; audit trail; and, participant member-checking. RESULTS Fourteen parents of children with cerebral palsy, representing Gross Motor Functional Classification System levels I-V, participated. Six themes emerged: (1) Protection; (2) Positively Framed; (3) Bridging the Gap; (4) Involvement; (5) Finding Worth; and (6) Trust. Central to parents' experience was protection of their child's identity and personal self. Assessment can be emotionally confronting, at any stage. Representing the child positively and highlighting possibilities was deemed essential. Parents' involvement ranged from being overlooked spectators to being instigators of assessment. Evidence-based assessment was worthwhile when relevant to parents' direction and family context. The researchers' interpretive description generated a schema and metaphor-the Steering Wheel for Collaborative Assessment. CONCLUSIONS A strengths-based approach to diagnosis and assessment is essential. The resulting interpretive description may assist health professionals align evidence-based assessment practices with family-centred care.Implications for rehabilitationParents of children who have cerebral palsy describe having to protect their child's identity and representation, and their own personal well-being, through evidence-based assessment and diagnostic processes.Involving parents in the process of evidence-based assessment and adopting a strengths-based approach is essential.The interpretive description developed-the Steering Wheel for Collaborative Assessment-may assist health professionals to implement evidence-based assessment tools in ways consistent with family-centred care principles.
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Affiliation(s)
- Bridget O'Connor
- School of Allied Health, Australian Catholic University, Melbourne, Australia
| | - Claire Kerr
- School of Allied Health, Australian Catholic University, Melbourne, Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Nora Shields
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Brooke Adair
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia
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33
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Sang RC, Vawda Y, Greenspoon D, Reed N, Hunt AW. An innovative approach to measuring youth concussion recovery: Occupational performance. Br J Occup Ther 2019. [DOI: 10.1177/0308022619851415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Concussion is a common injury in youth. Studies report that active rehabilitation interventions reduce symptoms in these youth. There is no literature that addresses its impact on occupational performance. The purpose of this study was to identify: (a) occupational performance issues experienced by these youth; (b) changes in occupational performance and satisfaction following participation in a 6-week active rehabilitation intervention; and (c) the relationship between changes in occupational performance and symptoms. Method As part of a larger prospective repeated measures study, measures of occupational performance (Canadian Occupational Performance Measure) and self-reported symptoms (Post-Concussion Symptom Inventory) were collected pre and post intervention. Paired t-test, Spearman correlation, and descriptive analyses were conducted. Results Youth (9–18 years; n = 52) reported a range of occupational performance issues in self-care, productivity, and leisure domains. The most frequently reported occupational performance issues were sport (32.70%) and school (31.75%) activities. Positive changes were found in both performance and satisfaction of occupational performance issues post intervention ( p<.001). Correlation analysis revealed that as symptoms decreased, occupational performance improved ( rs = –.359, p = .020). Conclusion Using a measure of occupational performance may provide meaningful insight into the functional recovery of concussion, and can help identify targeted functional approaches to paediatric concussion management.
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Affiliation(s)
- Robyn Chen Sang
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Yasira Vawda
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Dayna Greenspoon
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Nick Reed
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Anne W Hunt
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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Pritchard-Wiart L, Thompson-Hodgetts S, McKillop AB. A review of goal setting theories relevant to goal setting in paediatric rehabilitation. Clin Rehabil 2019; 33:1515-1526. [DOI: 10.1177/0269215519846220] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Goal setting in paediatric rehabilitation is influenced by shifting parent, sibling, caregiver, and child roles over time and evolving child developmental capacity for participation in the process. A theoretical and evidence-informed approach to goal setting, specific to paediatrics, would provide a framework for goal setting in practice and facilitate systematic evaluation of the effects of goal-setting processes on child and family outcomes. Objective: To provide an overview of relevant goal-setting theories and their implications for paediatric rehabilitation. Methods: Prevalent theories were identified from relevant rehabilitation, motivation, behaviour change, and goal-setting literature. Implications for goal setting in paediatrics are summarized according to goal-setting and action-planning phases: (1) preparation, (2) formulation of goals, (3) formulation of action plan, (4) coping planning, and (5) follow up. Results: Social cognitive theory, self-determination theory, Health Action Process Approach, Mastery Motivation, and goal-setting theory are reviewed. Examples of implications for goal setting include, sharing information with families about the purpose of goal setting; identifying goals that are specific, proximal, challenging, and important to the child; and addressing self-efficacy. Conclusion: The theories reviewed have clear implications for paediatric rehabilitation research and practice. They address considerations not typically discussed in adult rehabilitation such as observing children to obtain information about meaningful goals when they are unable to communicate them directly and the importance of establishing flexible processes that will accommodate changing family roles over time. Research is needed to evaluate the effects of goal-setting processes and strategies on outcomes in paediatric rehabilitation.
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Affiliation(s)
- Lesley Pritchard-Wiart
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sandra Thompson-Hodgetts
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ashley B McKillop
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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35
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Milton YM, Dunford C, Newby KV. Occupational therapy home programmes for children with cerebral palsy: A national survey of United Kingdom paediatric occupational therapy practice. Br J Occup Ther 2019. [DOI: 10.1177/0308022619830263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yvonne M Milton
- Faculty of Health and Life Sciences, Coventry University, UK
- Adoptionplus, Buckinghamshire, UK
| | - Carolyn Dunford
- Department of Clinical Sciences, Brunel University London, UK
| | - Katie V Newby
- Centre for Advances in Behavioural Science, Coventry University, UK
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36
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Phoenix M, Jack SM, Rosenbaum PL, Missiuna C. A grounded theory of parents’ attendance, participation and engagement in children’s developmental rehabilitation services: Part 2. The journey to child health and happiness. Disabil Rehabil 2019; 42:2151-2160. [DOI: 10.1080/09638288.2018.1555618] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michelle Phoenix
- CanChild, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Susan M. Jack
- School of Nursing, McMaster University, Hamilton, Canada
| | - Peter L. Rosenbaum
- CanChild, McMaster University, Hamilton, Canada
- Department of Paediatrics, McMaster University, Hamilton, Canada
| | - Cheryl Missiuna
- CanChild, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- John & Margaret Lillie Chair in Childhood Disability Research, McMaster University, Hamilton, Canada
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37
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An M, Palisano RJ, Yi CH, Chiarello LA, Dunst CJ, Gracely EJ. Effects of a Collaborative Intervention Process on Parent-Therapist Interaction: A Randomized Controlled Trial. Phys Occup Ther Pediatr 2019; 39:259-275. [PMID: 30124367 DOI: 10.1080/01942638.2018.1496965] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: To determine whether a collaborative intervention process facilitates parent-therapist interactions. Methods: Participants were 18 children with physical disabilities, their mothers, and 16 physical therapists. Therapists randomized to the experimental group were instructed in strategies for collaboration (working together) with parents in goal setting, planning, and implementing interventions. Family-therapist dyads participated in 6 weekly sessions. Four sessions were videotaped and combined (1st and 2nd for goal-setting/planning, 3rd and 5th for implementation) to code behaviors using Response Class Matrix. Multivariate analysis of variance was used to compare therapist and parent behaviors between groups. Results: Therapists in the experimental group demonstrated a higher frequency of "seeking information" (p < 0.01), "giving information" (p < 0.05), "positive behavior" (p < 0.01) and lower frequency of "child-related behavior" (p < 0.001) than therapists in the comparison group during goal-setting/planning and implementation. Parents in the experimental group demonstrated a higher frequency of "giving information" than parents in the comparison group (p < 0.01) during goal-setting/planning and implementation. Conclusion: Parents and therapists in the experimental group interacted more with each other, whereas those in the comparison group focused more on the child. The collaborative strategies appear to have increased parent participation in the intervention process, which has been a challenge for physical and occupational therapists.
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Affiliation(s)
- Mihee An
- a Department of Physical Therapy and Rehabilitation Sciences , Drexel University , Philadelphia , Pennsylvania , USA
| | - Robert J Palisano
- a Department of Physical Therapy and Rehabilitation Sciences , Drexel University , Philadelphia , Pennsylvania , USA
| | - Chung-Hwi Yi
- b Department of Physical Therapy , Yonsei University , Wonju , Ganwon-do , South Korea
| | - Lisa A Chiarello
- a Department of Physical Therapy and Rehabilitation Sciences , Drexel University , Philadelphia , Pennsylvania , USA
| | - Carl J Dunst
- c Orelena Hawks Puckett Institute , Asheville , North Carolina , USA
| | - Edward J Gracely
- d Department of Epidemiology and Biostatistics , Drexel University , Philadelphia , Pennsylvania , USA
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Bexelius A, Carlberg EB, Löwing K. Quality of goal setting in pediatric rehabilitation-A SMART approach. Child Care Health Dev 2018; 44:850-856. [PMID: 30112766 DOI: 10.1111/cch.12609] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/27/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Setting goals for treatment is often the core of the rehabilitation process. The quality of the set goals has however rarely been evaluated. The aims of this study were therefore to assess the quality of goals set in clinical practice of pediatric rehabilitation using SMART criteria (Specific, Measurable, Achievable, Relevant, and Timed) and to assess if the goals were considered relevant from both a client perspective and expertise perspective. METHODS In a retrospective multicase study, a total of 161 goals from 42 children with disabilities (cerebral palsy, n = 22; Down syndrome, n = 16; and developmental disability, n = 4) were assessed. The children were 1.5-5.5 years and had previously participated in goal-directed, activity-focused therapy at four pediatric rehabilitation centers. Collaborative goal setting had been used to define the desired treatment outcome. The quality of the goals was assessed using defined SMART criteria. RESULTS Specific: All goals could be reliably linked to International Classification of Functioning, Disability and Health-Children and Youth version chapters within the Activity/Participation domain. Measurable: A total of 75% of the goals were rated as having a well-defined scaling; in 20%, the scaling was less clear, and in 5%, a scaling could not be determined. Achievable: A total of 80% of the goals were attained. Relevant: All goals were set in collaboration with the family and could therefore be considered relevant from a client perspective. Relevancy judged from a professional perspective was strengthened by the fact that age, baseline status, and diagnosis had an influence on the choice of goals. Timed: All goals were set within a specific time frame. CONCLUSIONS The goals set in clinical practice showed high quality with respect to the SMART criteria. The most difficult part was the construction of the goal attainment scale. The goals settled in clinical practice were considered relevant from both a client perspective and expertise perspective.
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Affiliation(s)
| | - Eva Brogren Carlberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Löwing
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Bartlett DJ, McCoy SW, Chiarello LA, Avery L, Galuppi B. A Collaborative Approach to Decision Making Through Developmental Monitoring to Provide Individualized Services for Children With Cerebral Palsy. Phys Ther 2018; 98:865-875. [PMID: 29982806 DOI: 10.1093/ptj/pzy081] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 07/02/2018] [Indexed: 02/09/2023]
Affiliation(s)
- Doreen J Bartlett
- Professor Emerita, School of Physical Therapy, Western University, 1588 Elborn College, London, Ontario, Canada N6G 1H1
| | - Sarah W McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Lisa A Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, Pennsylvania
| | - Lisa Avery
- Statistical Consultant, Avery Information Services, Orillia, Ontario, Canada
| | - Barbara Galuppi
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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Thomason P, Tan A, Donnan A, Rodda J, Graham HK, Narayanan U. The Gait Outcomes Assessment List (GOAL): validation of a new assessment of gait function for children with cerebral palsy. Dev Med Child Neurol 2018; 60:618-623. [PMID: 29573409 DOI: 10.1111/dmcn.13722] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 10/17/2022]
Abstract
AIM We investigated the validity of the Gait Outcomes Assessment List (GOAL), as an assessment of gait function in children with cerebral palsy (CP). METHOD We studied a prospective cohort of 105 children with CP (Gross Motor Function Classification System [GMFCS] levels I-III; 65 males, 40 females; mean [SD] age 11y 11mo [3y 5mo], range 6-20y), who attended gait assessment over a 10-month period. Parents completed the GOAL, Functional Mobility Scale (FMS), and Functional Assessment Questionnaire (FAQ) during their child's gait evaluation. Ninety children completed instrumented gait analysis (IGA). Total GOAL and domain scores, Gait Profile Score (GPS), and Gait Variable Scores were calculated. RESULTS The total GOAL discriminated between GMFCS levels (mean [SD] GMFCS level I, 72.5 [12.7]; GMFCS level II, 61.4 [13.0]; GMFCS level III, 38.8 [10.6]; [F2,97 =42.4, p<0.001]). Moderate correlations were found between total GOAL and FMS (5m and 50m r=0.59; 500m r=0.66) and FAQ walking (r=0.77) and activities list (r=0.75, p<0.01). There was a moderate negative correlation between total GOAL and GPS (r=-0.59) and gait appearance domain and GPS (r=-0.52, p<0.01). INTERPRETATION The GOAL is a valid assessment of gait function in ambulant children with CP. It has the potential to improve understanding of the child's and parents' priorities and thus, in conjunction with IGA, provide a more balanced assessment across the domains of the World Health Organization's International Classification of Functioning, Disability and Health. WHAT THIS PAPER ADDS The Gait Outcomes Assessment List (GOAL) can discriminate between Gross Motor Function Classification System levels. The GOAL correlates with standard functional assessments and gait analysis. Used with gait analysis, the GOAL provides comprehensive assessment across all International Classification of Functioning, Disability and Health domains.
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Affiliation(s)
- Pam Thomason
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Annie Tan
- Department of Paediatrics, The University of Melbourne, Carlton, VIC, Australia
| | - Alice Donnan
- Department of Paediatrics, The University of Melbourne, Carlton, VIC, Australia
| | - Jill Rodda
- The Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - H Kerr Graham
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Unni Narayanan
- Division of Orthopaedics, Hospital for Sick Children, Toronto, ON, Canada
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Hind D, Parkin J, Whitworth V, Rex S, Young T, Hampson L, Sheehan J, Maguire C, Cantrill H, Scott E, Epps H, Main M, Geary M, McMurchie H, Pallant L, Woods D, Freeman J, Lee E, Eagle M, Willis T, Muntoni F, Baxter P. Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation. Health Technol Assess 2018. [PMID: 28627356 DOI: 10.3310/hta21270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent. OBJECTIVES To assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work. DESIGN Parallel-group, single-blind, randomised pilot trial with nested qualitative research. SETTING Six paediatric neuromuscular units. PARTICIPANTS Children with DMD aged 7-16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8-34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications. INTERVENTIONS Participants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise. MAIN OUTCOME MEASURES Feasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs. RESULTS Over 6 months, 348 children were screened - most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was -5.5 [standard deviation (SD) 7.8] for LBT and -2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient. LIMITATIONS The focus on delivery in hospitals limits generalisability. CONCLUSIONS Neither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN41002956. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Daniel Hind
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - James Parkin
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Victoria Whitworth
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Saleema Rex
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lisa Hampson
- Department of Mathematics and Statistics, University of Lancaster, Lancaster, UK
| | - Jennie Sheehan
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Chin Maguire
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Elaine Scott
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Marion Main
- Dubowitz Neuromuscular Centre (DNC), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michelle Geary
- Children's Therapy Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Heather McMurchie
- Paediatric Physiotherapy, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Lindsey Pallant
- Regional Paediatric Neuromuscular Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Jennifer Freeman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Tracey Willis
- The Oswestry Inherited Neuromuscular Service, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre (DNC), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Peter Baxter
- Paediatric Neurology, Sheffield Children's Hospital, Sheffield, UK
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Goal setting in paediatric rehabilitation for children with motor disabilities: a scoping review. Clin Rehabil 2018; 32:954-966. [DOI: 10.1177/0269215518758484] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The three objectives of this scoping review were to (1) identify key conceptual/theoretical frameworks and the extent to which they are used to inform goal setting related to rehabilitation goal setting with children with motor disabilities, (2) describe research that has evaluated goal setting processes and outcomes, and (3) summarize the purposes of goal setting described in paediatric rehabilitation literature. Methods: The scoping review process described by Arksey and O’Malley was used to guide article selection and data extraction. Results: A total of 62 articles were included in the final review. While the concept of family-centered care was well represented, theoretical frameworks specific to goal setting (i.e. goal setting theory described by Locke and Latham, mastery motivation, social cognitive, personal construct, and self-determination theories) were rarely addressed. No articles reviewed addressed prominent behavior change theory. With the exception of the description of tools specifically designed for use with children, the role of the child in the goal setting process was generally absent or not well described. Few studies ( n = 6) discussed the linkage between goals and intervention strategies explicitly. Only two studies in the review evaluated outcomes associated with goal setting. The primary purpose for goal setting identified in the literature was to develop goals that are meaningful to families ( n = 49). Conclusion: The results highlight significant gaps in the literature explicating a sound theoretical basis for goal setting in paediatric rehabilitation and research evaluating the effects of goal qualities and goal setting processes on the achievement of meaningful outcomes.
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Nguyen L, Mesterman R, Gorter JW. Development of an inventory of goals using the International Classification of Functioning, Disability and Health in a population of non-ambulatory children and adolescents with cerebral palsy treated with botulinum toxin A. BMC Pediatr 2018; 18:1. [PMID: 29301539 PMCID: PMC5755464 DOI: 10.1186/s12887-017-0974-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the management of hypertonicity in children with cerebral palsy (CP), goals should be clearly identified in order to evaluate the effectiveness of botulinum toxin A (BoNT-A) treatment, specifically in non-ambulatory children and adolescents, Gross Motor Function Classification System (GMFCS), level IV or V. A retrospective chart review (Mesterman et al., 2013) identified the need for the development of a set of specific and meaningful goals linked to the International Classification of Functioning, Disability and Health (ICF) for future goal setting and evaluation in this population. Our objective is to create an inventory of goals based on the ICF framework that captures the needs and values of families with children with CP. METHODS This cross-sectional observational study recruited parents of twenty children and youths with CP in GMFCS levels IV or V (mean age 11.2 years, SD 4.3, 13 males) who were assessed for BoNT-A treatment at the Spasticity Management Clinic at McMaster Children's Hospital (Hamilton, ON). A previous inventory of goals was developed by a group of experts at a national botulinum toxin conference held in January 2014 (Montreal, Canada). The inventory of goals was further refined by asking the parents to select goals from the inventory list that they would like their child to accomplish after receiving BoNT-A treatment, and asking healthcare professionals for clarity and phrasing of goals in the inventory list. RESULTS All parents identified body structure and function goals, with more than 75% of parents selecting reduction in muscle tone and increased range of movements in the upper and lower extremities. More than 50% of parents identified activity goals related to ease of caregiving. Two activity goals and three participation goals were missing from the inventory. Participation goals were identified by less than 5% of parents. CONCLUSION The inventory may be a helpful tool to facilitate a discussion about goal setting between healthcare professionals and families in the context of BoNT-A treatment. A future study is needed to conduct qualitative interviews to better understand the information that families may require about setting goals during BoNT-A treatment and to evaluate the usefulness of the inventory.
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Affiliation(s)
- Linda Nguyen
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, 1400 Main Street West, Room 408, Hamilton, ON, L8S 1C7, Canada
| | - Ronit Mesterman
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, 1400 Main Street West, Room 408, Hamilton, ON, L8S 1C7, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, 1400 Main Street West, Room 408, Hamilton, ON, L8S 1C7, Canada.
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Tatla SK, Holsti L, Andrews GS, Feichtinger L, Steele R, Siden H. Charting the territory: Describing the functional abilities of children with progressive neurological conditions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 71:191-199. [PMID: 29054023 DOI: 10.1016/j.ridd.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/15/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
AIMS Little is known about the functional abilities of children with progressive genetic, metabolic, or neurological conditions (PNCs). In this study, children with PNCs were followed over a 2-year period to assess their functional abilities over time. Specific aims were to: 1) describe the changes in functional skills and the effects of age for children with PNCs, 2) assess changes in these children's need for caregiver assistance over time, and 3) examine relationships between these children's functional skills and need for caregiver assistance. METHODS This study involved a longitudinal, descriptive design with three assessments occurring at Baseline, Year 1, Year 2. Functional skills and caregiver assistance were assessed by the Pediatric Evaluation of Disability Inventory (PEDI). The PEDI questionnaire was completed at baseline and then yearly by parents, along with the assistance of a trained research assistant (RA). RESULTS The study was completed with 83 children (mean age at Baseline=7.1yrs, SD=4.6). Mean Functional skills scores were in the low ranges at Baseline and did not change significantly across time points (F(2, 71)=0.437, p=0.58). Time point had no effect on caregiver assistance ratings (p<0.2); however, children required greater amounts of help with self-care at later time points than for other functional domains. Statistically significant correlations were found between PEDI-Functional skills and caregiver assistance ratings (r=0.80-0.90, p<0.01). CONCLUSIONS Functional skills were low for these children overall, irrespective of age. In children with PNCs: 1) mean functional skills did not change significantly over time; 2) caregiver assistance scores remained stable and 3) functional skills and levels of caregiver assistance were strongly positively correlated. Further research to explore the long-term functional trajectory in children with a PNC is recommended.
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Affiliation(s)
- Sandy K Tatla
- BC Children's and Women's Health Centre, BC Children's Hospital Research Institute, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Liisa Holsti
- Department of Occupational Science and Occupational Therapy, University of British Columbia and BC Children's Hospital Research Institute, Clinical Support Building, V3-327, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Gail Stephanie Andrews
- University of British Columbia, BC Children's Hospital Research Institute, F611-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Leanne Feichtinger
- University of British Columbia, BC Children's Hospital Research Institute, F611-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Rose Steele
- School of Nursing, Faculty of Health, York University, Room 342 HNES Building, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Harold Siden
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, F612a-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
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Enhancing Youth Participation Using the PREP Intervention: Parents' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091005. [PMID: 28869491 PMCID: PMC5615542 DOI: 10.3390/ijerph14091005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 02/08/2023]
Abstract
Pathways and Resources for Engagement and Participation (PREP), an innovative intervention aimed at modifying the environment and coaching youth/parents, was found to be effective in improving youth participation in chosen community activities. In order to complement existing quantitative evidence, this study examined parents' perspectives on the PREP approach. Twelve parents of youth with physical disabilities (12 to 18 years old) who received the PREP approach participated in individual semi-structured interviews following the 12-week intervention delivered by an occupational therapist. Thematic analysis revealed three inter-linked themes, the first of which was informative, describing the "nature of intervention", and led to two reflective themes: "multi-faceted effects of care" and "process of care". Parents highlighted the effect of the PREP intervention in a broad sense, extending beyond the accomplishment of the selected activities. This involved improvements on the physical, emotional, and social levels as well as in autonomy. Parents also discussed how their own needs were acknowledged through the intervention and recognized the unique role of the occupational therapist in supporting this process. The findings provide additional information about the usefulness of the PREP approach and describe the various benefits generated by a single intervention. Such knowledge can expand the therapeutic options for positive, health-promoting participation.
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Vroland-Nordstrand K, Eliasson AC, Krumlinde-Sundholm L, Johansson U. Parents' experiences of conducting a goal-directed intervention based on children's self-identified goals, a qualitative study. Scand J Occup Ther 2017; 25:243-251. [PMID: 28573942 DOI: 10.1080/11038128.2017.1335778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM/OBJECTIVE To explore and describe parents' perceptions and experiences of conducting a goal-directed intervention focused on children's self-identified goals. MATERIAL AND METHODS Individual semi-structured interviews were performed with nine parents (8 mothers, 1 father). All the parents had participated actively in conducting a goal-directed intervention addressing their children's self-identified goals. The interviews were analyzed using qualitative content analysis. RESULTS From a parental perspective, working on children's self-identified goals was a positive experience. The findings revealed three categories: Goals challenged the parents describes the parents' experiences of the complexity of goal setting. The intervention demanded an intensive and flexible parental engagement; here the parents expressed the importance of active parental engagement, which for some parents could be challenging. The child's personal goals gave more than anticipated describes the parents' experiences of how the children's personal goals positively influenced the children's self-esteem, increased the children's motivation for practice, and helped the children develop more than the parents had anticipated. CONCLUSIONS AND SIGNIFICANCE In the parents' experience, goal-directed intervention comprehensively relies on their engagement. Follow up's from the occupational therapist motivated the parents and their own child's personal goals gave them more than they could have expected. This indicates the importance of supporting parents and letting children actively participate in the goal setting process.
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Affiliation(s)
- Kristina Vroland-Nordstrand
- a Department of Women's and Children's Health, Neuropediatric Unit , Karolinska Institutet , Sweden , Stockholm.,b Centre for Research & Development , Uppsala University/Region of Gavleborg , Gävle , Sweden
| | - Ann-Christin Eliasson
- a Department of Women's and Children's Health, Neuropediatric Unit , Karolinska Institutet , Sweden , Stockholm
| | - Lena Krumlinde-Sundholm
- a Department of Women's and Children's Health, Neuropediatric Unit , Karolinska Institutet , Sweden , Stockholm
| | - Ulla Johansson
- b Centre for Research & Development , Uppsala University/Region of Gavleborg , Gävle , Sweden.,c Department of Neurobiology, Care Sciences and Society, Occupational Therapy Unit , Karolinska Institutet , Stockholm , Sweden
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Klevberg GL, Østensjø S, Elkjær S, Kjeken I, Jahnsen RB. Hand Function in Young Children with Cerebral Palsy: Current Practice and Parent-Reported Benefits. Phys Occup Ther Pediatr 2017; 37:222-237. [PMID: 27065199 DOI: 10.3109/01942638.2016.1158221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To (1) describe characteristics of current interventions to improve hand function in young children with Cerebral Palsy (CP), and explore factors associated with (2) increased likelihood of hand and ADL training and (3) child benefits of training. METHODS A cross-sectional design was used with parent-reported data and data from the Norwegian CP Follow-up Program (CPOP). A total of 102 children (53% of the cohort of newly recruited children in the CPOP, mean age: 30.3 months, SD: 12.1) were included. Hand function was classified according to the Mini-Manual Ability Classification System (Mini-MACS). Data were analyzed with descriptive statistics, cross-tables and direct multiple logistic regressions. RESULTS The majority of the children performed training of hand skills and ADL. Parents reported high amounts of training, and training was commonly integrated in everyday activities. Both parents (OR = 5.6, p < .011) and OTs (OR = 6.2, p < .002) reported more hand training for children at Mini-MACS levels II-III compared to level I. Parents reported larger child benefits when training was organized as a combination of training sessions and practice within everyday activities (OR = 7.090, p = .011). CONCLUSIONS Parents reported that the children's everyday activities were utilized as opportunities for training, hence describing the intensity of therapy merely by counting minutes or number of sessions seems insufficient.
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Affiliation(s)
- Gunvor Lilleholt Klevberg
- a Research Center for Habilitation and Rehabilitation Models and Services (CHARM) , Institute for Health and Society, Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Sigrid Østensjø
- b Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| | - Sonja Elkjær
- c Cerebral Palsy Follow-up Programme (CPOP), Department of Neurosciences for Children , Oslo University Hospital , Oslo , Norway
| | - Ingvild Kjeken
- b Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences , Oslo , Norway.,d National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital , Oslo , Norway
| | - Reidun Birgitta Jahnsen
- b Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences , Oslo , Norway.,c Cerebral Palsy Follow-up Programme (CPOP), Department of Neurosciences for Children , Oslo University Hospital , Oslo , Norway.,e Department of Research , Sunnaas Rehabilitation Hospital , Nesodden , Norway
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Hind D, Parkin J, Whitworth V, Rex S, Young T, Hampson L, Sheehan J, Maguire C, Cantrill H, Scott E, Epps H, Main M, Geary M, McMurchie H, Pallant L, Woods D, Freeman J, Lee E, Eagle M, Willis T, Muntoni F, Baxter P. Aquatic therapy for boys with Duchenne muscular dystrophy (DMD): an external pilot randomised controlled trial. Pilot Feasibility Stud 2017; 3:16. [PMID: 28357131 PMCID: PMC5367005 DOI: 10.1186/s40814-017-0132-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/08/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Standard treatment of Duchenne muscular dystrophy (DMD) includes regular physiotherapy. There are no data to show whether adding aquatic therapy (AT) to land-based exercises helps maintain motor function. We assessed the feasibility of recruiting and collecting data from boys with DMD in a parallel-group pilot randomised trial (primary objective), also assessing how intervention and trial procedures work. METHODS Ambulant boys with DMD aged 7-16 years established on steroids, with North Star Ambulatory Assessment (NSAA) score ≥8, who were able to complete a 10-m walk test without aids or assistance, were randomly allocated (1:1) to 6 months of either optimised land-based exercises 4 to 6 days/week, defined by local community physiotherapists, or the same 4 days/week plus AT 2 days/week. Those unable to commit to a programme, with >20% variation between NSAA scores 4 weeks apart, or contraindications to AT were excluded. The main outcome measures included feasibility of recruiting 40 participants in 6 months from six UK centres, clinical outcomes including NSAA, independent assessment of treatment optimisation, participant/therapist views on acceptability of intervention and research protocols, value of information (VoI) analysis and cost-impact analysis. RESULTS Over 6 months, 348 boys were screened: most lived too far from centres or were enrolled in other trials; 12 (30% of the targets) were randomised to AT (n = 8) or control (n = 4). The mean change in NSAA at 6 months was -5.5 (SD 7.8) in the control arm and -2.8 (SD 4.1) in the AT arm. Harms included fatigue in two boys, pain in one. Physiotherapists and parents valued AT but believed it should be delivered in community settings. Randomisation was unattractive to families, who had already decided that AT was useful and who often preferred to enrol in drug studies. The AT prescription was considered to be optimised for three boys, with other boys given programmes that were too extensive and insufficiently focused. Recruitment was insufficient for VoI analysis. CONCLUSIONS Neither a UK-based RCT of AT nor a twice weekly AT therapy delivered at tertiary centres is feasible. Our study will help in the optimisation of AT service provision and the design of future research. TRIAL REGISTRATION ISRCTN41002956.
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Affiliation(s)
- Daniel Hind
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - James Parkin
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Victoria Whitworth
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Saleema Rex
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Tracey Young
- School of Health and Related Research, Sheffield, UK
| | - Lisa Hampson
- Department of Mathematics and Statistics, University of Lancaster, Lancaster, UK
| | - Jennie Sheehan
- Evelina London Childrens Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Chin Maguire
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Elaine Scott
- School of Health and Related Research, Sheffield, UK
| | | | - Marion Main
- Dubowitz Neuromuscular Centre (DNC), The UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michelle Geary
- Children’s Therapy Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Heather McMurchie
- Paediatric Physiotherapy, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Lindsey Pallant
- Regional Paediatric Neuromuscular Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel Woods
- Paediatric Neurology, Sheffield Children’s Hospital, Sheffield, UK
| | - Jennifer Freeman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Michelle Eagle
- Newcastle Muscle Centre, Newcastle University, Newcastle, UK
| | - Tracey Willis
- The Oswestry Inherited Neuromuscular Service, The Robert Jones and Agnes Hunt, Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre (DNC), The UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Peter Baxter
- Paediatric Neurology, Sheffield Children’s Hospital, Sheffield, UK
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McDonald M, Davis K, Mahar N. When Funding Meets Practice: The Fate of Contemporary Therapeutic Approaches and Self-Determination in a Consumer-Centred Disability Funding Scheme. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2016. [DOI: 10.1111/jppi.12195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Myfanwy McDonald
- Murdoch Childrens Research Institute, Centre for Community Child Health; Royal Children's Hospital Melbourne; Parkville VIC Australia
| | - Kate Davis
- Education Program for Infants & Children; Bundoora VIC Australia
| | - Nicole Mahar
- Education Program for Infants & Children; Bundoora VIC Australia
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Milton Y, Roe S. Occupational therapy home programmes for children with unilateral cerebral palsy using bimanual and modified constraint induced movement therapies: A critical review. Br J Occup Ther 2016. [DOI: 10.1177/0308022616664738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The home context is considered a good location for children with cerebral palsy to practise meaningful occupations. The aim of this critical review was to gain a deeper understanding of how bimanual therapy and modified constraint induced movement therapy or constraint induced movement therapy methods are used within occupational therapy home programmes from an occupational perspective. Method A literature search was conducted using electronic databases for health research; five studies met the inclusion criteria. These were critically appraised and were analysed according to the relevant supports and barriers of the person–environment–occupation conceptual model of practice. Findings Family collaboration, strategic use of outcome measures, construction of the programme within the home environment and occupation-focused goals and activities emerged as commonly used methods. Enhanced descriptions of intervention context, the child’s voice in defining goals and challenges in optimising occupational balance surfaced as gaps in the programmes. Conclusion The methods used in implementing these approaches within occupational therapy home programmes requires combining motor and non-motor approaches, core occupational therapy skills, working within individual contexts and valuing family preferences. Using child-specific goal-setting instruments would strengthen the child’s voice and promote participation within a wider range of occupations.
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Affiliation(s)
- Yvonne Milton
- Senior Lecturer in Occupational Therapy, Coventry University, UK; Clinician, Adoptionplus, Milton Keynes, UK
| | - Sarah Roe
- Associate Head of School/Principal Lecturer in Occupational Therapy, Coventry University, UK
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