Psychometric properties of the German Version of the Pediatric Evaluation of Disability Inventory (PEDI-G): A factor analysis

BACKGROUND

Activities of daily living (ADL) are crucial for children because they enable them to participate in everyday life. For the evaluation of children`s ADL performance, health professionals such as occupational therapists use standardized ADL assessments. To implement assessments into practice it is important that the score generated from an assessment can be viewed as a unidimensional measure.

AIM

To investigate the factor structure of the German Pediatric Evaluation of Disability Inventory (PEDI-G) in a sample of typically developing children and children with an impairment.

MATERIAL AND METHODS

An exploratory factor analysis (EFA) with factor rotation was performed to assess the factor structure for the PEDI-G domains (self-care, mobility and social function) of the Functional Skills Scale and the Caregiver Assistance Scale.

RESULTS

262 children (118 (45%) girls and 144 (55%) boys) participated in this study. Their mean age (SD) was 4 years (SD 1.91). Results suggest that the PEDI domains of the Functional Skills Scale and the Caregivers Assistance Scale can be used as unidimensional measures to evaluate child`s ability to perform activities of daily living.

CONCLUSION

The results of this study support the use of the PEDI-G for research and practice in Austria, Germany and Switzerland.

Assistive technology based on client-centered for occupational performance in neuromuscular conditions

Knowledge of the patient's own perception of functioning and dependence, and of environmental factors, is of significant value. The main goals of this study are (1) to obtain a general profile of the occupational performance of persons with neuromuscular disorders (NMD) and their needs related to that performance and (2) to determine the support resources (assistive technologies [AT], adjustment, and/or caregiver) required to improve or maintain their level of independence.This cross-sectional study involved 24 persons with NMD. The functional independence measure (FIM), the checklist of a home's accessibility level, and a specific questionnaire were administered.The sample included 14 women (58.3%) and 10 men (41.7%). A mean of 61.7 (standard deviation = 17.2) was obtained for FIM motor, over 91, indicating a moderate level of dependence. The AT most frequently used was a wheelchair (70.8%). Architectural barriers were detected in the majority of users' homes (87.5%).Concise assessment of the independence needs of people with NMD, according to their occupational performance, and prescription of resources to meet those needs are required. This procedure should be implemented in healthcare programs, including care to a caregiver.

Determining Occupational Performance Issues in Women with Breast Cancer Referred to Treatment Centers of Hamadan, Iran

Objective: Women with breast cancer experience functional limitations at the time of diagnosis and after the initial treatment of cancer. Such limitations interfere with participation in self-care, work affairs, and leisure activities. The present study aimed to determine occupational performance priorities in women with breast cancer who had referred to treatment centers in Hamadan, Iran. Methods: In this cross-sectional, descriptive-analytical study, 102 women with breast cancer who had referred to treatment centers in Hamadan were selected through convenience sampling. The participants’ information was gathered using their medical records and a demographic information questionnaire. Then, they were interviewed using the Canadian Occupational Performance Measure (COPM) to determine their occupational performance issues. The gathered data were coded and analyzed using the SPSS statistical software, version 16. Results: The results indicated that out of the 22 defined codes for the patients’ selected activities, 45.8%, 30.8%, and 23.4% belonged to self-care, productivity, and leisure domains, respectively. Conclusion: Women with breast cancer experience various occupational performance issues due to disease complications and received treatments. In the present study, self-care comprised the occupational performance priority. Determining the clients’ intervention priorities, which is among the bases of occupational therapy interventions, can help women with breast cancer reach the desired quality of life.

Occupational engagement of people living with a life-limiting illness: Occupational therapists' perceptions

BACKGROUND/AIM

Occupational therapists working in palliative care aim to enable clients living with a life-limiting illness to continue participating in meaningful activities for as long as possible. However, little is published about the occupations people living with a life-limiting illness wish to engage in, and how occupational therapists can best enable occupational engagement. Therefore, this study aimed to gain an in-depth understanding of occupational therapists' perceptions on clients' occupational engagement post-diagnosis of a life-limiting condition.

METHODS

Occupational therapists working in Australia with people with a life-limiting illness were recruited to participate in a national online survey over the period of a month. Recruitment used a purposive, snowball sampling technique, resulting in 144 survey responses. Data were analysed using modified grounded theory methods.

RESULTS

Findings revealed two interrelated categories and four subcategories. The first category, focusing on life is concerned with therapists' perceptions of how clients continue to focus on living post diagnosis and encompasses two subcategories: (i) prioritised engagement and (ii) altered engagement. The second category, preparing for death, centres on therapists' perceptions of what clients do to practically prepare for death and find closure as their illness progresses, and is comprised of the two subcategories: (i) practical preparation for death and (ii) "facilitating closure".

CONCLUSION

Therapists perceived that meaningful occupational engagement changes over time as occupational performance levels decrease and clients prepare for death.

Competence and Satisfaction in Occupational Performance Among a Sample of University Students: An Exploratory Study

Success at university may be influenced by concerns with occupation and occupational performance. To understand occupations of concern and occupational performance among a sample (N = 144) of university students in the Midwest United States, the Canadian Occupational Performance Measure was administered. Socially related (n = 103), academic-related (n = 75), and work-related (n = 64) occupations were the three most frequently reported occupational concerns. Time management (n = 79) was the most frequent person-level concern. Mean self-perceived competence in occupations was 29.83 (SD = 7.18) out of 50 and mean performance satisfaction was 26.80 (SD = 8.01) out of 50. There were no differences in occupational performance across gender, race/ethnicity, class standing, living environment, or work status. However, within participants, there was a significant and clinically relevant difference between performance satisfaction and self-perceived competence in occupation, t(143) = 7.052, p < .0005, d = 0.58. Students have varied occupations that they find important, and future research should explore how occupational performance and performance satisfaction influence university success.

Initial Studies of Validity of the Children's Occupational Performance Questionnaire

Studies of validity of a new caregiver report measure, the Children's Occupational Performance Questionnaire (COPQ) designed to address children's performance in the domains of personal and instrumental activities of daily living (IADLs), social participation, play/leisure, and education/work are presented. I examined criterion-related and discriminant validity of the COPQ. Criterion-related validity was addressed by correlating children's COPQ scores with those from the Vineland Adaptive Behavior Scale (VABS-II). Quasi-experimental methods were used to compare COPQ scores from a heterogeneous group of children with disabilities with those from neurotypical children matched by age. COPQ scores correlated highly with scores from the VABS-II including social interaction, communication, daily living skills, and motor skills. Capacity of the COPQ to discriminate between children with and without disabilities varied dependent on age, and the occupational domain being considered. Preliminary support for the validity of COPQ as a measure of occupational performance for children was provided. Further study of the tool's psychometrics and with larger samples is needed.

Results from a Danish randomized controlled trial

BACKGROUND

There is growing interest in enabling older adults' occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults.

METHODS

An assessor-masked randomized controlled trial among adults 60 + with chronic health issues, who received or applied for homecare services. Recruitment took place September 2012 to April 2014. All participants received practical and personal assistance and meal delivery as needed. In addition, they were randomized to receive either a maximum 22 sessions of occupation-based ICC-OT (N = 59) or to receive usual practice with a maximum three sessions of occupational therapy (N = 60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM).

RESULTS

No important adverse events occurred. ICC-OT was accepted by 46 participants (88%), usual practice by 60 (100%). After 3 months, the ICC-OT-group had improved 1.86 points on COPM performance; the Usual-Practice group had improved 0.61 points. The between-group difference was statistically significant (95% confidence interval 0.50 to 2.02), t-test: p = 0.001.

CONCLUSIONS

ICC-OT improved older adults' occupational performance more effectively than usual practice. This result may benefit older adults and support programmatic changes.

The Effect of Sensory Integration Therapy on Occupational Performance in Children With Autism

Sensory processing problems and related dysfunctions are among the most common conditions in children with autism spectrum disorder (ASD). This study examined the effect of sensory integration therapy (SIT) on different aspects of occupational performance in children with ASD. The study was conducted on an intervention group ( n = 16) receiving SIT and a control group ( n = 15) with 3- to 8-year-old children with ASD. The Short Child Occupational Profile (SCOPE) was used to compare the two groups in terms of the changes in their occupational performance and the Sensory Profile (SP) was used to assess sensory problems. The intervention group showed significantly greater improvement in all the SCOPE domains, as well as in all the SP domains, except for the "emotional reactions" and "emotional/social responses" domains, ( p < .05). The effectiveness of SIT in improving occupational performance in children with ASD as a health-related factor is supported by our findings.

Fidelity of Occupational Performance Coaching: Importance of Accuracy in Intervention Identification

Establishing fidelity processes and measures is an important step in the development of interventions. Accurate referencing, naming of interventions and robust discussion of deviations from the theories, methods or terminology underpinning interventions support the fidelity of future applications of interventions in research and clinical settings. This commentary clarifies the establishment of fidelity for Occupational Performance Coaching (OPC) in relation to a recent article on this topic by Dunn and colleagues. Fundamental flaws in the referencing, labelling, theoretical underpinnings and methods inaccurately described as OPC are outlined. Guidance in establishing fidelity for future applications of OPC is provided.

Establishing Fidelity of Occupational Performance Coaching

As the call for evidence-based practices has risen, discussions about the fidelity of those practices have received increased attention. Although research suggests that Occupational Performance Coaching (OPC) is effective, a systematic evaluation of the fidelity of OPC is needed. The purpose of this study was to test fidelity of OPC intervention through study design, training, monitoring, and intervention receipt, and to offer the structure from this study as a guide for other programs of research and practice. As part of a trial of OPC with n = 17 families of children with autism spectrum disorder, we measured specific elements of fidelity during the study intervention design, training, delivery, and receipt as outlined by Gearing et al. We established fidelity of OPC design and training from the study data. Transcription and analysis of 40% of intervention sessions showed that we maintained fidelity during intervention delivery and receipt. This study reports on the evidence of the fidelity of OPC and provides fidelity standards for OPC for occupational therapy practice and research applications.

Health Literacy and Written Communication in Skilled Nursing/Subacute Facilities

Health literacy is a concern for older adults. Low health literacy can lead to adverse health outcomes; therefore, practitioners should address health literacy with clients. There is limited research addressing occupational therapy (OT) practitioners' knowledge of health literacy and its implementation in written communication in skilled nursing facility (SNF)/subacute settings. Researchers explored practitioners' knowledge and current practices when using written communication with older adult clients in skilled nursing and subacute settings. This was a nonexperimental, descriptive study of OT practitioners using an online survey. OT practitioners reported having knowledge of health literacy and addressing health literacy with clients. Although knowledge and practice scores were higher for occupational therapy assistants than for occupational therapists, no reliable differences were noted between practitioners. Survey measures yielded good internal consistencies (Cronbach's α= 0.8). While the participants reported having knowledge and practice of health literacy, participants reported limited resources and training in this area.

Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review

Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.

The effects of mental practice combined with modified constraint-induced therapy on corticospinal excitability, movement quality, function, and activities of daily living in persons with stroke

PURPOSE

Studies on to what extent the combined therapy of modified constraint-induced movement therapy and mental practice is more effective than modified constraint-induced movement therapy alone are lacking. This study aims to compare the effects of the combined therapy with modified constraint-induced movement therapy alone on corticospinal excitability, quality of the movement of the affected upper extremity, upper motor functions, and performance of the affected arm in daily life of hemiplegic stroke patients.

METHODS

The participants comprised 14 people who had suffered stroke and were randomly divided into two groups. All participants participated in modified constraint-induced movement therapy, while only the experimental group partook in additional mental practice. Both groups were tested for corticospinal excitability, quality of movement, hand function, and activities of daily living.

RESULTS

Both groups showed significant improvement in the movement quality of reaching and performance of activities of daily living. In the experimental group, functional improvement of the upper limb was also observed. The improvements in corticospinal excitability, upper extremity function, and performance in daily activities were significantly greater in the experimental group compared to the control group.

CONCLUSIONS

This study confirmed that the combined therapy produces more effective improvement in corticospinal excitability, upper limb function, and performance in daily activities. The combined therapy of mental practice and modified constraint-induced movement therapy could be used as a clinically useful intervention. Implications for rehabilitation Modified constraint-induced movement therapy could be used as an intervention method for people with stroke to make improvements in the quality of movement and performance in activities of daily livings with the affected side. With additional mental practice, upper extremity functions improve, and changes in neurological, functional and performance in daily lives are greater compared to modified constraint-induced movement therapy without mental practice. Impact of mental practice has on rehabilitation should not be underestimated.

Occupational problems and barriers reported by individuals with obesity

BACKGROUND

Even if occupational therapists meet many people with obesity in the course of their work, a majority of them do not seem to view weight management as within their area of professional practice.

AIM

To explore the occupational problems and barriers among persons with severe obesity from an occupational therapy perspective.

MATERIALS AND METHODS

The study used the Canadian Model of Occupation and Engagement (CMOP-E) and Canadian Occupational Performance Measure (COPM) to identify and analyze prioritized occupational performance problems and barriers perceived by 63 individuals with obesity.

RESULTS

The occupational problems individuals with obesity most frequently prioritized comprised playing with (grand)children, purchasing clothes, implementing regular meals and going to the swimming pool, while the barriers they most frequently described were dyspnea, musculoskeletal disorders, narrow chairs and seats, fear of glances and comments from others, and social anxiety.

CONCLUSION

Persons with obesity struggle with a large variety of occupational performance problems, which occur in the dynamic relationship between these individuals, their environment and their occupation. Occupational therapists have the skills to take more active role in helping persons with obesity to perform valued occupations and establish healthier everyday routines.

The Perceive, Recall, Plan and Perform (PRPP) system for persons with Parkinson's disease: a psychometric study

BACKGROUND

The Perceive, Recall, Plan & Perform (PRPP) system of task analysis might be feasible to evaluate occupational performance and information processing strategies for persons with Parkinson's disease (PD).

AIM

To evaluate: (1) the random error between raters (inter-rater study), (2) the random error within raters (intra-rater study), and (3) the internal consistency of the PRPP.

MATERIALS AND METHODS

(1) video-recorded performance of meaningful activities of 13 Dutch persons with PD, scored independently by 38 Dutch PRPP trained occupational therapists were included in the analysis. The random error between raters was analyzed with two-way random Intraclass Correlation Coefficients (ICC). (2) Four videos were scored twice by 30 raters (6 week time interval). The random error within raters was analyzed using one-way random ICC's. (3) Internal consistency study: data of 190 persons with PD were analyzed using Cronbach's alpha (α).

RESULTS

Inter-rater reliability ranged from slight to moderate (ICC= 0.06-0.43). The mean intra-rater reliability ranged from moderate to almost perfect (ICC= 0.60-0.83). Internal consistency is good (α = 0.60-0.86).

CONCLUSION

The limited inter-rater reliability but adequate intra-rater reliability and internal consistency show the feasibility of the PRPP when used for persons with PD. Implications for reliable clinical use are discussed.

A tool to enhance occupational therapy reasoning from ICF perspective: The Hasselt Occupational Performance Profile (H-OPP)

BACKGROUND

In order to enhance occupational therapy reasoning in clinical practice, different elements such as client-centred approach, evidence-based care and interdisciplinary work should be taken into account, but is a challenge.

AIM

To describe the development of the digital Hasselt Occupational Performance Profile (H-OPP^©) that enhances occupational therapy reasoning from ICF perspective.

METHOD

A participative qualitative design was used to create the H-OPP^© in an iterative way in which occupational therapy lectures, ICF experts, students and occupational therapists in the field were involved.

RESULTS

After linking occupational therapy terminology to the ICF, different stages of the H-OPP were identified and elaborated with main features: generating an occupational performance profile based on inventarization of problems and possibilities, formulating an occupational performance diagnosis and enabling to create an intervention plan. In all stages, both the perspectives of the client and the occupational therapist were taken into account. To increase practical use, the tool was further elaborated and digitalized.

CONCLUSION

The H-OPP^© is a digital coach that guides and facilitates professional reasoning in (novice) occupational therapists. It augments involvement of the client system. Furthermore, it enhances interdisciplinary communication and evidence-based care.

Soccer practice and functional and social performance of men with lower limb amputations

Practicing sports together with rehabilitative treatment improves the development of motor, social and emotional abilities of lower limb amputees. The aim of this study was to compare the functional and social performance of individuals with lower limb amputations between those who played soccer and those who did not engage in any sports activities. A total of 138 individuals participated in the study and were divided into two groups: soccer players (n = 69, 34 ± 8.1 years) and non-athletes (n = 69, 38 ± 8.9 years). A checklist, based on the International Classification of Functioning, Disability and Health, was used. Data were analyzed using the Chi-square and Mann-Whitney tests. The soccer players group showed significantly better performance than the non-athletes group in most items of body function, body structure, occupational performance components and daily activities (p < 0.001 for all), and also in some important items of social and environment factors (p < 0.001 for all). The results strongly suggest that amputee soccer significantly improves the functional and social performance in individuals with lower limb amputations.

Mastery motivation: a way of understanding therapy outcomes for children with unilateral cerebral palsy

PURPOSE

To investigate the impact of mastery motivation on occupational performance outcomes immediately following upper limb (UL) training and 6 months post-intervention for school-aged children with unilateral cerebral palsy.

METHOD

This prediction study was a post-hoc analysis of a matched pairs randomized comparison trial (COMBiT Trial Registration: ACTRN12613000181707). The Canadian Occupational Performance Measure (COPM) was administered at baseline, 13 and 26 weeks post-intervention. Parents completed the Dimensions of Mastery Questionnaire (DMQ), Parenting Scale and a demographic questionnaire. Children's UL capacity and performance was assessed using the Melbourne Assessment of Unilateral UL Function and assisting hand assessment (AHA). Regression models were fitted using generalized estimating equations to baseline, 13 and 26 week measurements.

RESULTS

Forty-six children (7.78 years SD 2.27 years, 31 males, Manual Ability Classification System I = 23, II = 23) participated. Higher levels of bimanual performance (AHA: β = 0.03, p < 0.001), greater object-oriented persistence (DMQ: β = 0.31, p = 0.05), and treatment group allocation (Standard Care: β = 0.24, p = 0.01) were positively associated with COPM performance scores post-intervention.

CONCLUSIONS

Children's bimanual performance and persistence with object-oriented tasks significantly impact occupational performance outcomes following UL training. Predetermining children's mastery motivation along with bimanual ability may assist in tailoring of intervention strategies and models of service delivery to improve effectiveness. Implications for Rehabilitation Children's object persistence and bimanual performance both impact upper limb training outcomes Working with children's motivational predispositions may optimize engagement and therapy outcomes. Supporting positive parenting styles may enhance a child's mastery motivation and persistence with difficult tasks.

Becoming occupation-based: a case study

This descriptive case study illustrates the experiences of a 55-year-old male with a chronic disability resulting from a stroke, living in the community and a clinician's trial using occupation-based interventions predominately in a rehabilitation setting. The participant engaged in occupation-based interventions three times a week for 5 weeks guided by the Canadian Occupational Performance Measure (COPM). Data were collected through semi-structured interviews during the intervention sessions and journal entries made by the therapist. Results suggested occupation-based interventions facilitated a transformation for both the client and the therapist by enhancing the participant's occupational performance and the ability to resume previous roles. The therapist's belief in the power and value of occupation-based practice was reinforced and validated, particularly in the rehabilitation of an individual with chronic stroke.

Hand function in the play behavior of children with cerebral palsy

OBJECTIVE

The aim of this study was to evaluate the influence of hand function on the occupational performance of playing for children with cerebral palsy.

METHODS

Twenty children with cerebral palsy took part in the study, of both genders, aged 3-10 years, with motor abilities ranging from I to V and manual abilities from II to IV. Data were collected using the Assessment of Ludic Behaviour before and after botulinum toxin was applied in the upper limbs to reduce spasticity.

RESULTS

Significant differences were found between the scores before and after the application of botulinum toxin in relation to the total Assessment of Ludic Behaviour score (p < 0.001), as well as in basic ludic interest (p = 0.003), basic ludic ability (p < 0.001), ludic attitude (p = 0.008), and communication of needs and feelings (p = 0.025), except for general level of interest (p = 0.957).

CONCLUSIONS

The reduction of spasticity permits better handling of the play materials, which promotes the children's involvement in play situations.

Repetitive box lifting performance is impaired in a hot environment: implications for altered work-rest cycles

This study investigated the effects of environmental temperature on repetitive box lifting (RBL) performance, associated stress hormone and creatine kinase (CK) responses. Ten healthy males performed two experimental trials in a random crossover design. The trials consisted of three 40 min (10 min sitting, 20 min standing, and 10 min RBL) circuits performed in either 23 °C or 38 °C followed by a 180 min seated recovery period in 23 °C. RBL performance (i.e., number of boxes lifted) was reduced (p ≤ 0.05) in 38 °C compared to the 23 °C trial. Physiological Strain Index was significantly different between trials (38 °C: 8.5 ± 1.1 versus 23 °C: 7.2 ± 0.7; p ≤ 0.01). Plasma testosterone was elevated (p ≤ 0.05) across both trials and then decreased at 60 min recovery, compared to pre-exercise (PRE) measures, but was higher (p ≤ 0.05) during the 38 °C trial. Plasma cortisol increased (p ≤ 0.05) at 60 min during both trials and remained elevated until 120 min in 23 °C, and until 60 min recovery in 38 °C. Serum CK was greater through 48 hr post compared to PRE values in both trials. Thus, 10 min RBL performance was reduced in 38 °C despite the 30-min rest periods between RBL intervals. Plasma testosterone and cortisol were generally higher during the 38 °C trial, suggesting a greater stress response. Additional research is needed to determine optimal work:rest cycles for maximizing work performance in thermally oppressive environments.

Changes in everyday life after discharge from day care rehabilitation

Community-based day care that provides rehabilitation (DCR) targets elderly people with physical disabilities. The goal of these programmes is mainly to improve physical ability in order to enable participants to remain in their ordinary homes. Knowledge of the outcomes of DCR is limited as well as knowledge of what it is that makes a difference for the individual. The aim of this study was to describe what changes in everyday life elderly persons experienced after discharge from a community-based day care rehabilitation centre and to give possible explanations for these changes. Fifteen elderly people were interviewed after that they had been discharged from DCR. A narrative approach was used for analysing the interview data. Four case stories constitute the findings, each of them with unique descriptions of changes in everyday life as well as possible explanations for these changes. The first case story described resumption of daily activities that made the days more eventful and meaningful. The second described how everyday life became an arena for exercising, which create confidence for the future. The third described how an increased sense of certainty and security in the movements led to an increased appetite for life. Finally, the fourth case story described both the stay at the DCR centre and the promise of a new period there as uplifting that made the days easier. Concerning possible explanations for these changes, the findings indicate that it was a combination of several events that together contributed to the changes. Examples were physical training, counselling about how to live in an active and healthy lifestyle, and socialisation with other patients in formal as well as in informal sessions.