Case study research: Building the occupational therapy evidence base one case at a time

BACKGROUND

There is growing recognition in healthcare that evidence from randomised controlled trials may not be appropriate to answer the full spectrum of practice-based questions and a more pluralistic approach is needed.

AIM

To consider the use of case study research in contributing to the occupational therapy evidence base.

MATERIAL AND METHODS

A critical discussion of the current state of evidence-based practice in occupational therapy and exploration of a viable approach to case study research is used.

RESULTS

Case study research can capture the context and complexity of occupational therapy practice. Cases can then be pooled to make a substantial contribution to the evidence base.

CONCLUSIONS

Occupational therapists should consider the use of case study research to produce practice related, meaningful research. Journal editorial boards need to be mindful of the value of high-quality case study research when considering publication priorities in occupational therapy literature.

SIGNIFICANCE

Highlights a changing landscape in the literature about how best to conduct research in health and social care, particularly for complex interventions and describes a pragmatic approach to case study research for occupational therapy.

Pilot Study: Occupational Therapy in an Equine Environment for Youth With Autism

Despite growing prevalence, research investigating occupational therapy incorporating horses for youth with autism is limited. This study aimed to (a) pilot a screening, evaluation, and intervention protocol of occupational therapy in an equine environment and (b) assess preliminary effects on occupational performance goals, behavior, and social functioning of youth with autism. A multiple baseline single-case experimental design was used. Six youth with autism participated in a no-treatment baseline phase and 10 weeks of intervention. Therapists implemented the intervention with 95% fidelity. Per parent report, participants improved in occupational performance goals, social motivation, and communication; four demonstrated decreased irritability and hyperactivity. This research operationalizes a screening, evaluation, and intervention protocol for occupational therapy in an equine environment, and demonstrates it may improve occupational, behavioral, and social outcomes for youth with autism. Next steps include manualizing the intervention, refining feasibility measures, and implementing a randomized controlled efficacy study.

Canine-assisted occupational therapy for children on the autism spectrum: Parents' perspectives

INTRODUCTION

Canine-assisted therapy is thought to facilitate the engagement of children on the autism spectrum within therapy sessions. There is limited research, however, about how canine-assisted occupational therapy with children on the autism spectrum enhances their engagement in therapy and therapy outcomes. The aim of this study was to gain the perspectives of parents who observed and participated in occupational therapy sessions, with canine assistance, with their children on the autism spectrum.

METHOD

This study was guided by a qualitative interpretive description design. A total of 10 parents participated in one semi-structured interview to describe their experience of canine-assisted occupational therapy with their child. Inductive thematic analysis was used to analyse the data.

RESULTS

Four themes emerged which described parents' experiences of canine-assisted occupational therapy with their children on the autism spectrum, these were: therapist qualities, goal-directed (canine-assisted) therapy, emotional safety, and therapy engagement. Parents described that the inclusion of the therapy dog appeared to provide emotional safety within the sessions facilitating rapport building between their child and the therapist. However, parents indicated that the inclusion of the therapy dog alone was not sufficient to facilitate therapy engagement for their children. The skills and qualities of the therapist as well as the provision of goal-directed therapy were considered essential for children's engagement.

CONCLUSION

The findings from this study contribute to our understanding of the impact of canine-assisted occupational therapy for children on the autism spectrum. This sparsely researched area requires more evaluation to ensure best practice canine-assisted occupational therapy for children on the autism spectrum.

Symptom severity, caregiver stress and intervention helpfulness assessed using ratings from parents caring for a child with autism

This exploratory study assessed the relationships between autism spectrum disorder symptoms, caregiver stress and intervention helpfulness, using parent ( n = 182) ratings. Advocacy and intervention-related tasks were rated more stressful than support tasks (e.g. toileting, mealtimes), indicating that advocacy is emerging as a major caregiver task for parents. Deficits in prosocial behaviours were perceived to have the highest impact on the child’s function. No difference was found between mean helpfulness ratings across the six representative interventions taken from the New Zealand context. Differences in care-related task stress across intervention choices were better explained by differences in symptom severity, suggesting that impairment drives intervention choice. Limited evidence was uncovered suggesting that intervention helpfulness moderates the relationship between core autism spectrum disorder symptoms and parent stress.