Use of outcome measures in children with severe cerebral palsy: A survey of U.K. physiotherapists

OBJECTIVES

To investigate the use of outcome measures for children with cerebral palsy (CP) by paediatric physiotherapists (PTs) who are based in the United Kingdom, as limited research exists regarding their use in this population, and to explore therapists' use of measures within different Gross Motor Function Classification System (GMFCS) levels and for different types of CP.

METHODS

A six-item online survey was advertised through two paediatric therapy special interest groups inviting physiotherapists to participate. Descriptive statistics (range, frequencies, and percentages) were used to analyse survey data.

RESULTS

Two hundred and seven physiotherapists returned completed survey questionnaires. One hundred and seventy-six (85%) therapists reported using a wide variety of outcome measures (57). Eighty-one per cent of therapists' responses for having "most difficulty" in identifying responsive outcome measures were for children with impaired mobility at GMFCS Levels IV-V and children with more significant body involvement (76%), for example, spastic quadriplegia or dyskinesia. Eighty-six per cent of therapists' responses for having "greatest ease" of identifying responsive outcome measures were for children within GMFCS Levels I-III and for children with less significant body involvement (72%), for example, hemiplegia. The variety of outcome measures used by therapists with children within GMFCS IV-V was less (16).

CONCLUSIONS

The majority (85%) of the PTs surveyed used outcome measures with children with CP, but 81% perceived a difficulty in identifying responsive measures for children with more severe impairments who are classified as GMFCS IV-V. The reasons for this perceived difficulty warrant investigation and may suggest a need for training regarding relevant measures and/or a need to develop new measures for this group of children.

Does visual perceptual testing correlate with caregiver and teacher reported functional visual skill difficulties in school-aged children?

Purpose

As occupational therapists embrace evidence-informed and occupation-centred practice, the use of standardised visual perceptual tests remains a strong feature of typical paediatric practice. Yet, the research evidence for the use of such tools is inconclusive at best. This study compared the results of the Test of Visual Perceptual Skills (TVPS) with a checklist of reported functional difficulties in 30 children attending occupational therapy. The purpose of this paper was to determine the usefulness of visual perceptual testing in relation to occupation-centred practice.

Design/methodology/approach

A descriptive correlational study design was used. Participants were 30 primary school-age children who were on a paediatric occupational therapy caseload. An additional 30 typically developing children participated in the development of the checklist.

Findings

Correlations were found between reported functional visual skill difficulties and two subtests of the TVPS (visual memory and visual discrimination). No correlation was found between the reported functional difficulties and any of the other five subtests of the TVPS or the total score.

Originality/value

Results highlight the weak relationship that existed in this study between standardised measures of visual perception, as measured by the TVPS, and functional difficulties. Therapists are cautioned to explore both the evidence base for continued use of standardised visual perceptual measures to inform occupation-centred practice and the need to embrace a more comprehensive person-centred approach to visual perceptual assessment.

The state of play in children's occupational therapy: A comparison between Ireland, Sweden and Switzerland

Introduction

Play is viewed as an important occupation in childhood and consequently in children's occupational therapy. However, few studies have explored the place of play in therapy practice. This study aimed to contribute to this knowledge gap by exploring play in occupational therapy in three European countries.

Method

A cross-sectional survey of occupational therapists in Ireland, Sweden and Switzerland was conducted to examine the use of play with children under 12 years old. A web-based survey was distributed to 935 occupational therapists, resulting in 338 returned surveys (36%). Responses were analysed using descriptive statistics and content analysis.

Results

Results were organised into three themes: (1) demographics and practice context; (2) play education and (3) use of play in practice. Respondents reported that although they valued play as an occupation, their primary focus was on play as a means to achieving other goals. Lack of education on play (research, theory and interventions) and pressures in the workplace were identified as barriers to play-centred practice.

Conclusion

Findings indicate that there is a mismatch between therapists valuing play as an occupation and how play is utilised in therapy practice. There is a need to strengthen education and research on play occupation to strengthen play-centred practice.

Is sensory processing an issue for infants with colic?

OBJECTIVES

To determine the association between sensory functioning, sleep, cry/fuss, and feeding behaviors of infants with colic younger than 4 months of age.

METHODS

Dunn's Infant/Toddler Sensory Profile™ and a modified Barr Baby Day Diary^© were used to assess 44 breastfed infants with colic under four months of age. Colic was defined according to Wessel's criteria.

RESULTS

Thirty-four of the 44 infants with colic (77%) scored as atypical for sensory processing. Of these, 56% scored atypical for sensory processing on quadrant one (Q1) (Low Registration), with 24%, 65%, and 18% scoring as atypical for sensory processing on Q2 (Sensory seeking), Q3 (Sensory sensitivity), and Q4 (Sensation avoiding), respectively. All infants demonstrating sensation avoiding also scored as Low Threshold. A moderate statistically significant correlation was found between sensation seeking and time spent sleeping (r=0.31; p=0.04). No other statistically significant associations between infant behaviors and their sensory functioning were demonstrated. Overall, infants demonstrating atypical sensory responses (in any quadrant) slept significantly more than infants demonstrating typical sensory responses (mean difference=-67.8min/day; 95% CI=-133.6 to -2.1; p=0.04).

CONCLUSION

Very limited associations between infant behaviors and sensory functioning were demonstrated, suggesting that sensory functioning may not be a significant factor in the multifactorial nature of infant colic. Further well-designed studies using validated tools for infants with colic are required to determine whether associations between infant behaviors and sensory functioning exist.

A systematic review of evidence-based assessment practices by allied health practitioners for children with cerebral palsy

AIM

The routine use of psychometrically robust assessment tools is integral to best practice. This systematic review aims to determine the extent to which evidence-based assessment tools were used by allied health practitioners for children with cerebral palsy (CP).

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols 2015 was employed. A search strategy applied the free text terms: 'allied health practitioner', 'assessment', and 'cerebral palsy', and related subject headings to seven databases. Included articles reported assessment practices of occupational therapists, physiotherapists, or speech pathologists working with children with CP aged 0 to 18 years, published from the year 2000.

RESULTS

Fourteen articles met the inclusion criteria. Eighty-eight assessment tools were reported, of which 23 were in high use. Of these, three tools focused on gross motor function and had acceptable validity for use with children with CP: Gross Motor Function Measure, Gross Motor Function Classification System, and goniometry. Validated tools to assess other activity components, participation, quality of life, and pain were used infrequently or not at all.

INTERPRETATION

Allied health practitioners used only a few of the available evidence-based assessment tools. Assessment findings in many areas considered important by children and families were rarely documented using validated assessment tools.

Convergent Validity of Two Visual Motor Integration Tests

Background:

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

Objective:

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

Method:

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

Results:

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

Conclusion:

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

Use of Standardised Assessments and Outcome Measures among a Sample of Irish Occupational Therapists Working with Adults with Physical Disabilities

This study was carried out to explore the current usage of standardised assessments and outcome measures by occupational therapists working with adults with physical disabilities. A survey research design, using a postal questionnaire specifically designed for the study, was employed.

Completed questionnaires were returned by 109 occupational therapists working in a variety of settings, including acute care, community and inpatient rehabilitation. A range of standardised assessments and outcome measures was in use, with an average of four different measures being used by the individual respondents. The most commonly used measures were the Mini Mental State Examination (Folstein et al 1975), Rivermead Behavioural Memory Test (Wilson et al 1985), Functional Independence Measure (Uniform Data System for Medical Rehabilitation 1999), Barthel Index (Mahoney and Barthel 1965) and the Chessington Occupational Therapy Neurological Assessment Battery (Tyerman et al 1986). However, the consistency of use tended to be low. The barriers to a more consistent use of standardised assessments and outcome measures included time restraints, the unsuitability of the available measures and a lack of sensitivity of the available measures to capture the effectiveness of occupational therapy.

The findings support those of previous studies exploring this issue among occupational therapists from different areas of practice. The respondents in this study highlighted the need for a multifaceted approach, encompassing educational, managerial and individual responsibility, to address the issue of the usage of standardised assessments and outcome measures among occupational therapists.

Use of Assessment Methods in Paediatrics: The Practice of Private Occupational Therapists

This study is part of a larger research project investigating the assessment practices of paediatric occupational therapists in independent practice in the United Kingdom. The focus of this paper is the identification of the assessment methods used and the factors influencing respondents' satisfaction with them. The research design was a cross-sectional descriptive survey using a postal questionnaire as the data collection tool.

Out of 89 questionnaires sent, 66 (74%) were returned and 48 (54%) were deemed usable. The findings demonstrated that the respondents used a combination of assessment methods, with interviewing being used by all of them. The majority of the respondents were satisfied with the methods that they used. The most frequently mentioned factors influencing the respondents' satisfaction level were issues concerning standardised tests and the quality and quantity of the information gathered about the client.

The implications for clinical practitioners include the benefits of using a combination of assessment methods and their selection after extensive clinical reasoning. Moreover, the use of interviewing is stressed and its multiple purposes are pointed out.