Motivation and paediatric interventions: is it a predisposition, a mechanism for change, or an outcome?

The Nature, Value, and Experience of Engagement in Pediatric Rehabilitation: Perspectives of Youth, Caregivers, and Service Providers

Purpose: To conduct a qualitative investigation of engagement in pediatric rehabilitation therapy.Methods: Interviews were conducted with 10 youth, 10 caregivers, and 10 service providers. Transcripts were analyzed thematically using an inductive approach.Results: Themes illustrated three perspectives: engagement as a connection with components of the therapy process, engagement as working together, and engagement as an affective and motivational process. Engagement created valued connections with therapy components and forward momentum for therapy.Conclusions: The themes supported a view of engagement as complex, transactional, and multidimensional. Participants focused on different, yet not discrepant, aspects of engagement. Youth focused on having fun and personal connection with service providers. Caregivers provided a more complex perspective encompassing both their own and their child's engagement, with an emphasis on relationship, understanding what is taking place, and feeling valued in the process. Service providers highlighted goal attainment and the value of engagement in bringing about outcomes.

A review of goal setting theories relevant to goal setting in paediatric rehabilitation

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.

Development of the Pediatric Disability Inventory-Patient Reported Outcome (PEDI-PRO) measurement conceptual framework and item candidates

BACKGROUND

To address the gap in patient reported outcome measures (PROMs) of functional performance appropriate for youth and young adults with developmental disabilities (DD) we developed the Pediatric Evaluation of Disability Inventory-Patient Reported Outcome (PEDI-PRO).

AIM/OBJECTIVE

We used a participatory process to: (1) Develop the measurement conceptual framework; (2) Identify discrete functional tasks to include in the PEDI-PRO; and (3) Refine item candidates.

METHODS

We collaborated with eight youth with DD over 33 months. These youth and university researchers explored the construct of functional performance, developed and refined items, and collected and analyzed data. We also conducted focus groups with youth with DD (n = 62) and rehabilitation professionals (n = 26), and consulted with PEDI measurement experts (n = 3).

RESULTS

Youth's understanding of their functional performance is embedded in their experiences participating in everyday life situations. We developed 78 Daily Activities, 65 Social/Cognitive, and 52 Mobility item candidates that are linked to 11 everyday life situations to assess discrete functional tasks important to youth with DD and rehabilitation professionals.

CONCLUSION AND IMPLICATIONS

As a result of our participatory development process, the PEDI-PRO's proposed conceptual framework and item candidates are grounded in the lived experience of youth with DD.

Initial evaluation of the effects of an environmental-focused problem-solving intervention for transition-age young people with developmental disabilities: Project TEAM

AIM

Project TEAM (Teens making Environment and Activity Modifications) teaches transition-age young people with developmental disabilities, including those with co-occurring intellectual or cognitive disabilities, to identify and resolve environmental barriers to participation. We examined its effects on young people's attainment of participation goals, knowledge, problem-solving, self-determination, and self-efficacy.

METHOD

We used a quasi-experimental, repeated measures design (initial, outcome, 6-week follow-up) with two groups: (1) Project TEAM (28 males, 19 females; mean age 17y 6mo); and (2) goal-setting comparison (21 males, 14 females; mean age 17y 6mo). A matched convenience sample was recruited in two US states. Attainment of participation goals and goal attainment scaling (GAS) T scores were compared at outcome. Differences between groups for all other outcomes were analyzed using linear mixed effects models.

RESULTS

At outcome, Project TEAM participants demonstrated greater knowledge (estimated mean difference: 1.82; confidence interval [CI]: 0.90, 2.74) and ability to apply knowledge during participation (GAS: t[75]=4.21; CI: 5.21, 14.57) compared to goal-setting. While both groups achieved significant improvements in knowledge, problem-solving, and self-determination, increases in parent reported self-determination remained at 6-week follow-up only for Project TEAM (estimated mean difference: 4.65; CI: 1.32, 7.98). Significantly more Project TEAM participants attained their participation goals by follow-up (Project TEAM=97.6%, goal-setting=77.1%, p=0.009).

INTERPRETATION

Both approaches support attainment of participation goals. Although inconclusive, Project TEAM may uniquely support young people with developmental disabilities to act in a self-determined manner and apply an environmental problem-solving approach over time.

WHAT THIS PAPER ADDS

Individualized goal-setting, alone or during Project TEAM (Teens making Environment and Activity Modifications) appears to support attainment of participation goals. Project TEAM appears to support young people with developmental disabilities to apply an environmental problem-solving approach to participation barriers. Parents of young people with developmental disabilities report sustained changes in self-determination 6 weeks after Project TEAM.

Developing authentic clinical simulations for effective listening and communication in pediatric rehabilitation service delivery

PURPOSE

To describe the creation and validation of six simulations concerned with effective listening and interpersonal communication in pediatric rehabilitation.

METHODS AND FINDINGS

The simulations involved clinicians from various disciplines, were based on clinical scenarios related to client issues, and reflected core aspects of listening/communication. Each simulation had a key learning objective, thus focusing clinicians on specific listening skills. The article outlines the process used to turn written scenarios into digital video simulations, including steps taken to establish content validity and authenticity, and to establish a series of videos based on the complexity of their learning objectives, given contextual factors and associated macrocognitive processes that influence the ability to listen. A complexity rating scale was developed and used to establish a gradient of easy/simple, intermediate, and hard/complex simulations.

CONCLUSIONS

The development process exemplifies an evidence-based, integrated knowledge translation approach to the teaching and learning of listening and communication skills.

The development of the Pediatric Motivation Scale for rehabilitation

Background.

Clinicians recognize that client motivation is key to optimizing rehabilitation; however, they are limited in its assessment by a paucity of motivation measures.

Purpose.

This paper presents the preliminary psychometrics of the Pediatric Motivation Scale (PMOT) designed to measure motivation from a child’s perspective.

Method.

Content validity of the PMOT was measured through expert feedback ( n = 12), and field testing ocurred with 41 children, 21 in rehabilitation and 20 healthy. Pearson product-moment correlations were used to analyze subscale correlations, test-retest reliability, and convergent validity with the Pediatric Volitional Questionnaire (PVQ). Internal consistency was measured using Cronbach’s alpha.

Findings.

Preliminary psychometric evaluation indicates strong internal consistency for PMOT total (α = .96) and subscales (α = .79–.91). The PMOT and PVQ moderately correlated in the rehabilitation subsample ( r = .71, p < .01); no correlation was found in the healthy subsample ( p > .05). Test-retest reliability was excellent ( r = .97).

Implications.

This study provides preliminary psychometric evidence of the PMOT for children undergoing rehabilitation. These pilot findings warrant ongoing scale development.

Family-centered care for children with cerebral palsy: conceptual and practical considerations to advance care and practice

This article focuses on conceptual and practical considerations in family-centered care for children with cerebral palsy and their families. In the last 5 years, there have been important advances in our understanding of the components of family-centered care, and initial attempts to understand the client change processes at play. Recent research elaborates on family-centered care by delving into aspects of family-provider partnership, and applying family-centered principles to organizational service delivery to bring about organizational cultures of family-centered care. Recent research has also begun to consider mediators of client change, and new practice models have been proposed that embrace family-centered principles and illustrate the "art" of practice. Future research directions are discussed, including explorations of causal relationships between family-centered care principles, elements of caregiving practice, client change processes, and child and family outcomes. The meaning of the recent literature for pediatric neurology practice is considered.

The effects of motivating interventions on rehabilitation outcomes in children and youth with acquired brain injuries: a systematic review

PRIMARY OBJECTIVE

To systematically review the evidence of the effects of motivating rehabilitation interventions on outcomes in children with acquired brain injury (ABI).

METHODS

A literature search of six databases was conducted to identify intervention studies published until July 2013. The American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) systematic review methodology was used as a framework. Two reviewers independently extracted data and assessed level of evidence and quality of studies.

RESULTS

Of 891 records initially retrieved, 166 were screened by abstract and 31 by full text; 10 studies comprised of five randomized controlled trials, two case series and three single subject research design studies met the inclusion criteria. Studies fell into three intervention categories: (1) token economy based interventions; (2) virtual reality (VR); and (3) memory and attention interventions.

CONCLUSIONS

A paucity of evidence has examined the effects of rehabilitation interventions with a motivational component. Token economies can significantly enhance memory and response inhibition performance in children with ABI. VR systems are motivating, yet findings are limited by the lack of use and availability of psychometrically evaluated measures of motivation. Findings point to the need for further research to evaluate the effects of motivation-based interventions.