Operationalizing quality of life for people with profound multiple disabilities: a Delphi study

From assistive to inclusive? A systematic review of the uses and effects of technology to support people with pervasive support needs

BACKGROUND

Although particular technologies can enhance the quality of life (QoL) of people with profound intellectual and multiple disabilities (we use the term pervasive support needs), their objectives and outcomes are understudied. A systematic literature review was therefore conducted to explore this topic.

METHOD

A search of four databases yielded 64 studies. Data were extracted on their general characteristics, methods and sample characteristics as well as the technology types, QoL domains and application within ecological systems. A narrative synthesis was subsequently developed.

RESULTS

Most of the studies applied assistive technology (AT) and focused on personal development and self-determination on an individual level.

CONCLUSIONS

Technology can enhance the QoL of people with pervasive support needs. There are indications that although MT and UD-based technology are used in practice, few studies have examined these technologies. Therefore, there is a knowledge gap regarding the kinds of technology that are used in practice.

The role of people with intellectual disability in intellectual disability research: A systematic review of Delphi studies

BACKGROUND

The way intellectual disability research is designed warrants critical examination, as the knowledge produced through these approaches informs evidence-based practices. People with lived experience should be considered experts in relation to understanding their bodies, conditions, and treatment.

METHOD

This systematic review analyses the design of Delphi studies, to determine the extent to which people with intellectual disability are involved as experts. The design of Delphi studies (involving structured feedback from experts) provides an insight into the extent that 'lived experience' is valued as a source of expert knowledge.

RESULTS

Fifty-five publications reporting on forty-nine separate Delphi studies met our inclusion criteria. Nine publications report the involvement of people with intellectual disability. However, family/informal caregivers are represented as experts in higher numbers and their voices carry greater weight.

CONCLUSION

The findings of this review include guidance for practitioners and researchers to facilitate greater participatory roles of people with intellectual disability.

Framework for Adoption of Next-Generation Sequencing (NGS) Globally in the Oncology Area

Radical new possibilities of improved treatment of cancer are on offer from an advanced medical technology already demonstrating its significance: next-generation sequencing (NGS). This refined testing provides unprecedentedly precise diagnoses and permits the use of focused and highly personalized treatments. However, across regions globally, many cancer patients will continue to be denied the benefits of NGS as long as some of the yawning gaps in its implementation remain unattended. The challenges at the regional and national levels are linked because putting the solutions into effect is highly dependent on cooperation between regional- and national-level cooperation, which could be hindered by shortfalls in interpretation or understanding. The aim of the paper was to define and explore the necessary conditions for NGS and make recommendations for effective implementation based on extensive exchanges with policy makers and stakeholders. As a result, the European Alliance for Personalised Medicine (EAPM) developed a maturity framework structured around demand-side and supply-side issues to enable interested stakeholders in different countries to self-evaluate according to a common matrix. A questionnaire was designed to identify the current status of NGS implementation, and it was submitted to different experts in different institutions globally. This revealed significant variability in the different aspects of NGS uptake. Within different regions globally, to ensure those conditions are right, this can be improved by linking efforts made at the national level, where patients have needs and where care is delivered, and at the global level, where major policy initiatives in the health field are underway or in preparation, many of which offer direct or indirect pathways for building those conditions. In addition, in a period when consensus is still incomplete and catching up is needed at a political level to ensure rational allocation of resources-even within individual countries-to enable the best ways to make the necessary provisions for NGS, a key recommendation is to examine where closer links between national and regional actions could complement, support, and mutually reinforce efforts to improve the situation for patients.

Development of a Cranial Suture Traction Therapy Program for Facial Asymmetry Correction Using the New Delphi Technique

Background and Objectives: We aimed to develop a cranial suture traction therapy program, a non-surgical therapeutic method for facial asymmetry correction. Materials and Methods: Six experts, including rehabilitation medicine specialists, oriental medical doctors, dentistry specialists, five experts, including Master’s or doctoral degree holders in skin care and cosmetology with more than 10 years of experience in the field, 4 experts including educators in the field of skin care, a total of 15 people participated in the validation of the development of the cranial suture traction therapy program in stages 1 to 3. Open questions were used in the primary survey. In the second survey, the results of the first survey were summarized and the degree of agreement regarding the questions in each category was presented. In the third survey, the degree of agreement for each item in the questionnaire was analyzed statistically. Results: Most of the questions attained a certain level of consensus by the experts (average of ≥ 4.0). The difference between the mean values was the highest for the third survey at 0.33 and was the lowest between the second and third surveys at 0.47. The results regarding the perceived degree of importance for each point of the evaluation in both the second and third stages of the cranial suture traction therapy program were verified using the content validity ratio. The ratio for the 13 evaluation points was within the range of 0.40−1.00; thus, the Delphi program for cranial suture traction therapy verified that the content was valid. Conclusions: As most questions attained a certain level of consensus by the experts, it can be concluded that these questions are suitable, relevant, and important. The commercialization of the cranial suture traction treatment program will contribute to the correction and prevention of facial dislocations or asymmetry, and the developed treatment will be referred to as cranial suture traction therapy (CSTT).

Reconciling communication repertoires: navigating interactions involving persons with severe/profound intellectual disability, a classic grounded theory study

BACKGROUND

A rights-based agenda, informed by the UNCRPD, that advocates person-centredness, inclusion, empowerment and self-determination is shaping service provision to people with intellectual disability (ID). Listening to their perspectives is fundamental to meeting these goals. However, communication with people with severe/profound ID is challenging and difficult. Therefore, this study aims to generate a theory that explains how people communicate with and understand each other in these interactions.

METHODS

Classic grounded theory (CGT) methodology was used as it recognises that knowledge can be captured rather than interpreted. According to CGT, capturing rather than interpreting experiences strengthens findings, particularly in relation to participants with severe/profound ID. Concurrent theoretical sampling, data collection and analysis were undertaken. Twenty-two individuals participated in the study: 3 people with severe/profound ID and 19 people with whom they interact. Data were collected over a 9-month period and involved video recordings, field notes, individual and group interviews. Data were analysed using CGT methods of coding, constant comparison and memoing.

RESULTS

The Theory of Reconciling Communication Repertoires was generated. Nurturing a sense of belonging emerged as the main concern and core category that is resolved by reconciling communication repertoires. A communication repertoire refers to the cache of communication skills a person has available to them. To reconcile repertoires is to harmonise or make them compatible with each other in order to communicate. Interactions are navigated through five stages: motivation to interact, connection establishment, reciprocally engaging, navigating understanding and confusion resolution.

CONCLUSIONS

The Theory of Reconciling Communication Repertoires explains how interactions involving people with severe/profound ID are navigated. While this is a substantive rather than formal theory, it has the potential to inform practice, policy, management, education and research as it outlines how communication with people with severe/profound ID can take place to design, inform and plan person-centred care.

Evaluating quality of life in families with Williams Syndrome patients

Background

Williams Syndrome is a developmental disorder characterized by a variable intellectual disability. People with Williams Syndrome need the intervention of several clinical and educational specialists throughout their life. However, little is known about the impact produced by this disability in their immediate environment, especially in families. The purpose was to know the level of quality of life described by families with Williams Syndrome.

Methods

The sample was made up of 33 families belong to Spanish Williams Syndrome Association who were evaluated using the Kidslife Scale. Their children and adolescents were between 4 and 20 years old. Eight main quality of life domains were evaluated: emotional well-being, physical well-being, material well-being, personal development, interpersonal relations, social inclusion, self-determination and rights

Results

The obtained data indicated that the degree and presence of intellectual disability did not homogeneously influence people’s quality of life, but many variables could alter their quality of life to a greater or lesser extent. There are no significant differences between quality of life areas but significant differences appeared for level of dependence in the self-determination subarea (p < .05).

Conclusions

These results led us to analyse the social and emotional implications for families and their environment.

Developing an instrument to measure satisfaction with continuity of midwifery care drawing on the Delphi technique

BACKGROUND

Maternal satisfaction with maternity care is an important indicator of quality maternity services. Continuity of midwifery models of care are increasing in Australia and while several instruments have been developed to measure satisfaction with maternity care most of these have not been validated and there are none that are appropriate to continuity of midwifery maternity care models.

AIM

To develop a questionnaire to measure women's satisfaction with maternity services provided in a continuity of midwifery care service model.

METHODS

A modified Delphi technique was used. A heterogenous panel of eight experts provided feedback over four rounds. The starting point for the questionnaire was informed by two systematic literature reviews focusing on available instruments for measuring maternal satisfaction with maternity care and what women value continuity of midwifery models of care.

FINDINGS

The Continuity of Midwifery Care Satisfaction Survey (COMcareSS) was developed after four rounds of feedback with the expert panel. The survey comprises nine domains and fifty-nine questions. The domains include demographics, maternity care outcomes, facilities, the midwife/woman relationship, building capacity-empowerment, decision making and involvement, personalised care, advice care and support and general.

CONCLUSIONS

Consumer satisfaction is an important indicator of quality care. This is the first instrument to be developed that is appropriate to continuity of midwifery models of care. The important next step is to pilot test the instrument to establish its validity and reliability.

Assistive technology for people with PIMD in challenging scenarios

Purpose

The purpose of this study is to examine in what type of scenarios of daily life assistive technology such as the INSENSION system would provide considerable benefit for people with profound intellectual and multiple disabilities (PIMD).

Design/methodology/approach

A series of focus group workshops were held with relatives of people with PIMD and direct support professionals (DSPs), as well as experts in information and communications technology (ICT). They were oriented towards the design thinking approach and moderated as per the Disney method.

Findings

The participants identified transitions from known to unknown caregivers, provision of care during the night and the impact of external factors on a person’s mood as challenging situations within the PIMD context.

Practical implications

Solving these problems would lead to considerable benefits to the affected people. Based on the ideas gathered in workshops, three technological applications for the INSENSION system were derived, i.e. communication application, multimedia player and smart room devices, all of which will provide remedies in specific usage scenarios.

Originality/value

Methods drawing on the participant’s creativity in combination with the workshops’ multi-perspectivity facilitated a direct reference to the daily life of the target group. In this manner, the innovative ICT system INSENSION can be oriented towards the requirements of this vulnerable group.

Senior manager decision-making and interactions with frontline staff in intellectual disability organisations: A Delphi study

Very little is known of the activities of the most senior managers in organisations providing social care in the community to people with intellectual disabilities. Yet the importance of the focus and activities of senior managers in directing and supporting staff practice and staff experiences is likely to be central to an organisation's functioning and support provided for staff and service users. This study employed Delphi methodology with a panel of 11 senior managers, mostly chief executives, managing small to very large organisations providing support for people with intellectual disabilities, in the UK. Answering three rounds of questions, senior managers described their face-to-face and non-face-to-face contacts with staff and decision-making. Narrative data were subject to quantitative and thematic analysis. In the last round, themes were subject to quantitative analysis. Most contacts between senior managers and staff were in formal structured contexts and all managers used social media to promote the organisations' ambitions regarding good practice. The panel focused upon accessing and understanding the informal aspects of their organisations and staff factors. Decisions were both short-term reactive and long-term strategic and an effort to link these was felt to improve organisational functioning. A framework for understanding senior managers' activities emerged showing two sources of demands and opportunity, extra-organisational focused upon meeting legal and regulatory demands and intra-organisational focused upon understanding and influencing informal staff practices/experiences and cultures within their organisations.

Impact of the intellectual disability severity in the Spanish Personal Outcomes Scale

BACKGROUND

The interest in measuring quality of life (QoL) in persons with intellectual disability (ID) has brought about a number of QoL measurements for this population. These measurements need to address two issues that have contributed to enhancing the current instruments. First, the necessity to develop measures with adequate psychometric properties, which has been discussed in recent studies, and second, the agreement between experts in analysing objective and subjective perspectives, as well as the use of self-report to include the participation of the person with ID. The question that we set out to investigate in this paper is whether the measurements function properly for the person with ID, independent of their level of severity. We used the Spanish version of the Personal Outcomes Scale, as it is a psychometrically sound instrument and includes three sources of information (the person with ID, a professional and a family member).

METHOD

The sample was composed of 529 persons with ID (296 men, representing 55.95% of the total sample, and 233 women, with M_age  = 35.03, SD = 10.82) from several regions of Spain, along with their professional of reference and a family member. The severity variable was estimated for each item based on estimations of differential item functioning.

RESULTS

The results showed that several items were undervalued by the assessments if the severity of the ID was greater. Mainly, this difference was observed in the assessments by professionals and in the dimensions of rights, personal development and self-determination.

CONCLUSIONS

This paper focuses on the uses and interpretations of the results of the QoL measurements in the Personal Outcomes Scale. The results indicate that, in our sample, when people with high levels of ID are assessed, the functioning of some items are affected by the severity of this disability. For correct use, these items must be interpreted on the basis of the results obtained. Additionally, it is necessary to thoroughly review the QoL indicators for persons with severe or profound ID.

Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process

Chronic venous disease (CVD) is a common condition with major health consequences that is associated with poor long-term prognosis, significant socioeconomic impact, disabling symptoms and reduced quality of life. To provide practical guidance for diagnosis and management of CVD, a Delphi panel of 5 experts in steering committee and 28 angiologists/vascular surgeons met with the major aim of providing a supplement for established national and international guidelines. A total of 24 statements were voted upon in two rounds, of which consensus was reached on 22 statements, indicating a high level of overall agreement. Consensus was reached on 7 of 8 statements relative to diagnosis (CEAP classification, diagnostic tools, QoL assessment, diagnostic imaging) and on 15 of 16 statements on management (conservative treatments, compressive therapy, pharmacological therapy, surgical treatment). The results of the consensus reached are discussed herein from which it is clear that diagnostic and management approaches utilising personalised therapies tailored to the individual patient should be favoured. While it is clear that additional studies are needed on many aspects of diagnosis and management of CVD, the present Delphi survey provides some key recommendations for clinicians treating CVD that may be useful in daily practice.

Examining operational wastes within Greek banking operations

Purpose

In order to address operational effectiveness in the banking sector caused by the 2008 global economic crisis, the purpose of this paper is to examine the nature of operational wastes that exist within four large Greek banks.

Design/methodology/approach

A Delphi study was undertaken with ten managers and ten employees.

Findings

The waste of underutilised people is found to be the dominant form of waste present and affecting the efficiency of banking operations, and managers and employees consider the waste of underutilised people as having a significant influence on the efficiency of the banking sector.

Practical implications

This has implications for managers of banking operations needing to address efficiencies in an increasingly competitive global economic environment. The paper also highlights the drawbacks of analysing typologies of waste across organisations and industrial sectors.

Originality/value

While some studies have examined the overall efficiency banking sector, to date, none has explored the nature of the inefficiencies that manifest as waste.

Enhancing the Validity of a Quality of Life Measure for Autistic People

Accurate measurement of quality of life (QoL) is important for evaluation of autism services and trials of interventions. We undertook psychometric validation of the World Health Organisation measure-WHOQoL-BREF, examined construct validity of the WHO Disabilities module and developed nine additional autism-specific items (ASQoL) from extensive consultation with the autism community. The sample of 309 autistic people was recruited from the Adult Autism Spectrum Cohort-UK. The WHOQoL-BREF had good psychometric properties, including criterion, convergent, divergent and discriminant validity. The WHO Disabilities module showed adequate construct validity and reliability. The ASQoL items form a unitary factor of QoL, with one global item. Future studies can use the WHO measures alongside the ASQoL items to measure QoL of autistic people.

The quality of life of children with severe developmental disabilities

BACKGROUND

Research examining the quality of life (QoL) of children with severe developmental disabilities (SDD) is limited. The present study examines parent perceptions of child QoL in children with SDD compared with typically developing (TD) children and then examines predictors of QoL for the SDD group.

METHOD

Parents of 246 children with SDD (aged 4 to 19 years) and 210 TD children (aged 4 to 18 years) responded to an online survey. QoL was measured using a composite variable composed of the child's happiness, achievement of potential and friendship quality.

RESULTS

Children with DD had lower QoL ratings than TD children. In children with DD, higher QoL was related to younger age, higher adaptive skills, lower maladaptive behaviour, lower parent psychological distress and higher satisfaction with the child's education.

CONCLUSIONS

Interventions to promote positive outcomes for children with SDD should target both characteristics of the individual and the environment.

Considering quality of life in end-of-life decisions for severely disabled children

BACKGROUND

End-of-life decisions (EoLDs) are very difficult to make. How parents and physicians incorporate quality of life (QoL) considerations into their end-of-life decision making (EoLDM) for children with profound intellectual and multiple disabilities (PIMD) remains unknown.

AIMS

To determine which elements contribute to QoL according to parents and physicians, how QoL is incorporated into EoLDM and how parents and physicians discuss QoL considerations in the Netherlands.

METHODS

Semi-structured interviews were conducted with the physicians and parents of 14 children with PIMD for whom an EoLD had been made within the past two years.

RESULTS

Parents and physicians agreed on the main elements that contribute to QoL in children with PIMD. The way in which QoL was incorporated differed slightly for different types of decisions. Parents and physicians rarely discussed elements contributing to the child's QoL when making EoLDS.

CONCLUSIONS

and Implications Although QoL was highly important during EoLDM for children with PIMD, parents and physicians did not fully explore the elements that contribute to the child's QoL when they made EoLDs. We recommend the development of a communication tool that will help parents and physicians discuss elements that contribute to QoL and the consequences these elements have for upcoming decisions.

A preliminary investigation of the suitability of aquatics for people with severe and profound intellectual disabilities

BACKGROUND

Aquatics is an under-researched but possibly appropriate form of activity for people with severe to profound intellectual disabilities (SPIDs).

AIM

The current pilot study investigates the suitability of an aquatics programme for service users with SPIDs.

METHOD

Four service users with SPID completed an 8-12-session aquatics programme. Front-line staff ( N = 6) were interviewed after the programme to explore its suitability. A thematic analysis of the interviews was utilized.

RESULTS

The thematic analysis unearthed main themes of effects, facilitators, barriers, strengths and needs.

CONCLUSION

Aquatics can be an appropriate and beneficial form of physical activity for people with SPIDs, but there are many barriers to participation. Tailored programmes are required. Further investigation of the experiences of people with SPIDs in relation to physical activity is recommended.

Participation of adults with visual and severe or profound intellectual disabilities: Definition and operationalization

BACKGROUND

The available opinions regarding participation do not appear to be applicable to adults with visual and severe or profound intellectual disabilities (VSPID). Because a clear definition and operationalization are lacking, it is difficult for support professionals to give meaning to participation for adults with VSPID.

AIMS

The purpose of the present study was to develop a definition and operationalization of the concept of participation of adults with VSPID.

METHODS

Parents or family members, professionals, and experts participated in an online concept mapping procedure. This procedure includes generating statements, clustering them, and rating their importance. The data were analyzed quantitatively using multidimensional scaling and qualitatively with triangulation.

RESULTS

A total of 53 participants generated 319 statements of which 125 were clustered and rated. The final cluster map of the statements contained seven clusters: (1) Experience and discover; (2) Inclusion; (3) Involvement; (4) Leisure and recreation; (5) Communication and being understood; (6) Social relations; and (7) Self-management and autonomy. The average importance rating of the statements varied from 6.49 to 8.95. A definition of participation of this population was developed which included these seven clusters.

CONCLUSIONS

The combination of the developed definition, the clusters, and the statements in these clusters, derived from the perceptions of parents or family members, professionals, and experts, can be employed to operationalize the construct of participation of adults with VSPID. This operationalization supports professionals in their ability to give meaning to participation in these adults. Future research will focus on using the operationalization as a checklist of participation for adults with VSPID.

Triangulated Proxy Reporting: a technique for improving how communication partners come to know people with severe cognitive impairment

PURPOSE

This paper explains and demonstrates the pilot application of Triangulated Proxy Reporting (TPR); a practical technique for enhancing communication around people who have severe cognitive impairment (SCI).

METHODS AND RESULTS

An introduction explains SCI and how this impacts on communication; and consequently on quality of care and quality of life. This is followed by an explanation of TPR and its origins in triangulation research techniques. An illustrative vignette explicates its utility and value in a group home for a resident with profound multiple disabilities. The Discussion and Conclusion sections propose the wider application of TPR for different cohorts of people with SCIs, their communication partners and service providers.

CONCLUSIONS

TPR presents as a practical technique for enhancing communication interactions with people who have SCI. The paper demonstrates the potential of the technique for improving engagement amongst those with profound multiple disabilities, severe acquired brain injury and advanced dementia and their partners in and across different care settings. Implications for Rehabilitation Triangulated Proxy Reporting (TPR) shows potential to improve communications between people with severe cognitive impairments and their communication partners. TPR can lead to improved quality of care and quality of life for people with profound multiple disabilities, very advanced dementia and severe acquired brain injury, who otherwise are very difficult to support. TPR is a relatively simple and inexpensive technique that service providers can incorporate into practice to improving communications between clients with severe cognitive impairments, their carers and other support professionals.

A comparison of two assessments of levels of functioning in clients with intellectual disability between occupational therapists and nursing staff within a long-term mental healthcare facility in South Africa

BACKGROUND

The implementation of the South African Mental Health Care Act, which regulates care for clients with intellectual disabilities, impacted on the healthcare services provided to this population. Changes in the Act necessitated planning of new care packages, which resulted in the investigation of the current hospital client profile, as well as assessment data on patient abilities according to the occupational therapist and nursing staff as primary caregivers.

METHODS

A retrospective, descriptive correlation study design was used as information was analysed from an existing database. Descriptive analysis of clients' demographic data, occupational performance and adaptive functioning were done, as well as a Spearman's rank correlation test and cluster analysis to describe the association between the levels of functioning as measured by the different professions.

RESULTS

The results indicated low levels of abilities, as well as a good to excellent correlation between results of the Fairview self-help scale and Creative Participation Assessment.

CONCLUSION

This study provided preliminary evidence that these two tools are valuable instruments for measuring occupational performance and adaptive functioning in institutions that provide care for this vulnerable and under-researched population.

A new scale for the measurement of quality of life in children with intellectual disability

BACKGROUND

Children and adolescents with intellectual disabilities make up a group which is in urgent need of an adequate operationalisation of the quality of life construct, not only to improve individual personal outcomes but also to develop and implement evidence based practices. For that reason, and with the aim of answering the growing demand for an adequate evaluation instrument for this group, the KidsLife scale was developed.

METHOD

This research provides evidence of the reliability and validity of the scale, which is composed of 96 items spread over eight subscales, and completed by a third-party respondent. The validation sample comprised 1060 people with intellectual disability, with ages ranging from 4 to 21 years old (M=13.51; SD=5.04).

RESULTS

The results suggest that the eight quality of life domains assessed on the scale are reliable (Cronbach's alpha ranging from 0.812 to 0.949). The evidence of the validity of the construct provided by Confirmatory Factor Analysis also demonstrated adequate indexes of fit for the eight-domain model.

DISCUSSION

Future lines of research which may use the KidsLife Scale are suggested and discussed.

Joint attention behaviours in people with profound intellectual and multiple disabilities: the influence of the context

BACKGROUND

In spite of the profound cognitive and physical problems, people with profound intellectual and multiple disabilities (PIMD) are able to develop joint attention behaviours (JAB) and benefit from positive interactions.

AIMS

To investigate which context factors influence the JAB of people with PIMD.

METHOD

Based on video recordings of 45 participants, JAB and context factors were analysed.

RESULTS

An unstructured interaction situation produced the most responses of a person with PIMD, whereas a structured interaction situation produced the most initiatives. Furthermore, the familiarity of the partner and the familiarity of objects used in the interaction had no influence on the JAB. The sensitivity of the interaction partner was positively related to the presence of JAB.

CONCLUSIONS

Interaction partners of people with PIMD should be aware of both the ability of people with PIMD to use JAB and the influence of different context factors on these JAB.

Operationalisation of quality of life for adults with severe disabilities

BACKGROUND

The operationalisation of quality of life for people with more severe disabilities has been acknowledged in the published research for more than two decades. This study aims to contribute to our knowledge and understanding of the quality of life of adults with severe disabilities by developing a set of quality of life indicators appropriate to this population using a Delphi method and the eight-domain conceptual model proposed by Schalock & Verdugo (2002).

METHOD

The participating panel in the Delphi method included 12 experts who evaluated each proposed item according to four criteria: suitability, importance, observability and sensitivity. Descriptive analyses were used to select the best items in each of the four rounds of this Delphi study, as well as examining the coefficients of concordance that were calculated for the final pool of items.

RESULTS

The four rounds of the Delphi study resulted in a final pool of 118 items (91 that were considered valid in the first round plus 27 items proposed, reformulated or discussed in the following rounds). Importance and sensitivity were the criteria that received the highest and lowest ratings, respectively, but also the ones that had the highest and lowest mean coefficients of concordance. Experts showed the strongest agreement for items related to material well-being, while the weakest was found for items related to personal development.

CONCLUSIONS

This study further contributes to our understanding of how to operationalise and measure quality of life in adults with severe disabilities. The item pool generated may prove helpful in the development of instruments for the measurement of quality of life-related outcomes in this population.

[Home safety and severe mental disorders: Developing an evaluation tool]

BACKGROUND

Home safety evaluation is an important issue within the context of current perspectives on accommodation for people with a serious mental illness who favour a more independent way of life.

PURPOSE

This paper describes the development and content validation of the Evaluation de la sécurité a domicile et de la gestion des risques (ESGR), an occupational therapy assessment tool for people with a serious mental illness.

METHOD

The ESGR was developed from scientific knowledge and clinical experience. Assessing content validity was done in two phases and involved the consultation of 11 experts.

FINDINGS

In its current form, the ESGR includes 67 items organized into three categories (environment, occupation, person).

IMPLICATIONS

According to the experts consulted, there is a clinical interest in using the ESGR to support occupational therapists in the assessment of home safety for people with serious mental illness. The statements are clear and representative of the concept and the target audience.

The nature of affect attunement used by disability support workers interacting with adults with profound intellectual and multiple disabilities

BACKGROUND

The interactions experienced by adults with profound intellectual and multiple disabilities (PIMD) with their disability support workers (DSWs) may have a large impact on life quality. However, defining good-quality interaction has presented challenges for this group. It has been suggested that in typically developing infant-mother dyads, the presence of affect attunement may be an indicator of quality. Affect attunement refers to the recasting of one person's affect by another with emphasis.

METHOD

The presence and nature of affect attunement in interactions between 21 pairs of adults with PIMD and their DSWs were explored in this study. Natural interactions were videorecorded for 21 pairs of adults with PIMD and their DSWs. The recordings were analysed for the presence and nature of affect attunement incidents, and analysed using descriptive statistics.

RESULTS

Affect attunement incidents were observed in 16 of the pairs. The DSW's attunement behaviour was in response to subtle, short duration behaviours of participants with PIMD.

CONCLUSION

These brief moments of connection may be a basis of good-quality interaction.

Beyond behavioural observations: a deeper view through the sensory reactions of children with profound intellectual and multiple disabilities

BACKGROUND

The present study was aimed at assessing the behavioural and physiological responsiveness of three children with profound intellectual and multiple disabilities to a set of sensory stimuli.

METHODS

Eighteen items, 'believed' by clinicians to be appropriate for routine interventions, were presented to the participants and responsiveness was assessed in terms of: (i) consistent behavioural and electrodermal reactions and (ii) biphasic changes in heart rate.

RESULTS

Results were twofold. First, all participants showed frequent consistent physiological reactions but rare consistent behavioural ones. Second, all participants showed biphasic changes in heart rate, pointing to the possibility of different appraisals (novelty and pleasantness) of most of the presented items.

CONCLUSIONS

Data here presented may have implications for the development and the emotional well-being of individuals with profound intellectual and multiple disabilities in that it suggests that reactions to, and potential appraisals of, sensory stimuli may occur despite the lack of consistent observable behaviours.

Older adult mistreatment risk screening: contribution to the validation of a screening tool in a domestic setting

ABSTRACTThe hidden nature of older adult mistreatment renders its detection in the domestic setting particularly challenging. A validated screening instrument that can provide a systematic assessment of risk factors can facilitate this detection. One such instrument, the "expanded Indicators of Abuse" tool, has been previously validated in the Hebrew language in a hospital setting. The present study has contributed to the validation of the "e-IOA" in an English-speaking community setting in Ontario, Canada. It consisted of two phases: (a) a content validity review and adaptation of the instrument by experts throughout Ontario, and (b) an inter-rater reliability assessment by home visiting nurses. The adaptation, the "Mistreatment of Older Adult Risk Factors" tool, offers a comprehensive tool for screening in the home setting. This instrument is significant to professional practice as practitioners working with older adults will be better equipped to assess for risk of mistreatment.

Developing consensus on important factors associated with lower limb prosthetic prescription and use

PURPOSE

There is an ongoing concern in lower limb prosthetic rehabilitation with underuse and nonuse of prosthetic technology. The aim of this study was to gather expert opinion on the most important outcomes, predictors and facilitators of lower limb prosthetic prescription and use, with a long-term goal of improving satisfaction with prosthetic technology.

METHOD

An electronic Delphi study was conducted using an expert panel of 21 service providers and users and was undertaken over three iterations.

RESULTS

The process resulted in the identification of 13 outcomes, 19 predictor and 34 facilitator factors.

CONCLUSIONS

Psychosocial factors related to service provision and prosthetic use have not been widely recognized or incorporated into clinical practice. We highlight the need for creating standardized measures tha[Box: see text].

Psychometric evaluation of the Dutch version of the Mood, Interest and Pleasure Questionnaire (MIPQ)

Recently, several instruments have been developed to measure the subjective component of the quality of life (QOL) of people with profound intellectual and multiple disabilities (PIMD). A next step, however, must be the further validation of these instruments. The present study aimed at evaluating the psychometric properties of one of these instruments, the Dutch version of the Mood, Interest and Pleasure Questionnaire (MIPQ). The MIPQ is a 25-item Likert scale questionnaire with two subscales (Mood and Interest and Pleasure). The MIPQ and the Aberrant Behavior Checklist were completed on 360 participants with severe or profound intellectual disabilities. About 27% of these participants were included in an examination of test-retest of and the inter-rater reliability of the MIPQ. The results suggest that the proposed two-factor structure did not show an adequate fit to our data. An exploratory factor analysis revealed a three-factor structure with positive mood, negative mood and interest as three correlated but distinct subscales. These results are in concurrence with the literature on positive emotions. High internal consistency (α ≥ .80), high inter-rater (r ≥ .69) and high test-retest reliability (r ≥ .86) were found, which indicates the reliable use of the MIPQ in the population of people with PIMD. Strong negative correlations between the MIPQ total score and the Aberant Behavior Checklist's 'lethargy, social withdrawal' subscale provides some evidence of the construct validity of the MIPQ. However, further validation of the MIPQ including other measures of subjective well-being is warranted.

Psychometric evaluation of a questionnaire to measure the quality of life of people with profound multiple disabilities (QOL-PMD)

Because of a shortage of valid instruments to measure the QOL of people with profound multiple disabilities (PMD), the QOL-PMD was developed. In the present study, possibilities for item reduction as well as the psychometric properties of the questionnaire were examined. One hundred and forty-seven informants of people with PMD participated in the study. Fifty items were removed from the questionnaire on the basis of preset criteria. Internal consistency was good for the total questionnaire as well as for the subscales. Evidence of the construct validity of the questionnaire was found. Correspondence between the groups of informants was moderate. The results of this preliminary analysis of the psychometric properties of the QOL-PMD are encouraging, but further validation of the measure is warranted.

Measuring the quality of life of people with profound multiple disabilities using the QOL-PMD: first results

The present study focused on the objective components of quality of life (QOL) of people with profound multiple disabilities (PMD). More specific, we aimed at evaluating different dimensions of QOL of people with PMD and investigating the association between their QOL and several personal (age, gender, intellectual capabilities, motor limitations, sensory limitations, physical and mental health status) as well as setting characteristics (location of the setting, type of setting, size of the setting, group size, group composition, staffing level and staff turnover). As a measure of the QOL of people with PMD we used the QOL-PMD, a questionnaire that we specifically developed for this purpose. To measure the personal and setting characteristics we also used a self-developed questionnaire. Forty-nine people with PMD were selected. For each of these people three informants were chosen who each filled out the QOL-PMD. To account for the clustered nature of the data, data were analysed by means of mixed models. Characteristics regarding the medical condition of the person with PMD turned out to be most strongly associated with the QOL-PMD scores. Other personal characteristics such as age, gender, motor limitations and sensory limitations did not have a significant effect on the QOL-PMD scores. With regard to the setting characteristics, location of the setting and staffing level turned out to have a significant effect on the QOL-PMD scores.

Establishing the stages and processes of change for weight loss by consensus of experts

The present study aimed to establish, by a consensus of experts, the stages and processes of change for weight management in overweight and obese people. The first step involved developing two questionnaires aimed at assessing stages and processes of change for weight loss in overweight and obese people. The processes-of-change questionnaire consisted of 12 subscales, and contained 107 items. A three-round Delphi study was carried out through a website, where participants were asked to give their opinion about the representativeness and clarity of the scale items. The stages-of-change questionnaire consisted of five items and was presented in the final round of the study. A team of 66 experts in the obesity field from 29 countries participated in the study. They were selected either because they belonged to the organizing committee of international associations related to obesity, or because of their research career. The required changes in the questionnaire were made according to the opinions of the participants. Some of these were the result of the group statistical response, whereas others were due to the suggestions made by the participants. A final version of the questionnaire consisting of 63 items was eventually obtained. The present study produced two questionnaires to assess stages and processes of change for weight management. The strength of the study lies in the consensus reached by the panel of experts in order to establish the required content of the questionnaires. The two measures provide useful tools for practitioners who wish to tailor weight-management interventions according to transtheoretical model constructs.

Persons with multiple disabilities accessing stimulation and requesting social contact via microswitch and VOCA devices: new research evaluation and social validation

The first of these two studies assessed whether 11 participants with multiple disabilities of 5.3-18.2 (M=10.7) years of age would succeed in combining a microswitch for accessing preferred environmental stimuli and a Voice Output Communication Aid (VOCA) for requesting social contact. The second study conducted a social validation assessment of the aforementioned microswitch-VOCA combination. Data showed that all participants learned to use the microswitch and the VOCA. Moreover, the 10 participants, who received a 1-month post-intervention check, largely maintained their responding. The social validation assessment indicated that the raters (i.e., 110 university psychology students) favored the combination of microswitch and VOCA over the microswitch or the VOCA alone, and hypothetical combinations of microswitches or VOCAs.

Three persons with multiple disabilities accessing environmental stimuli and asking for social contact through microswitch and VOCA technology

BACKGROUND

Direct access to environmental stimuli and opportunity to ask for social contact/attention may be considered highly relevant objectives for persons with multiple disabilities. We assessed the possibility of enabling three of these persons (two children and one adolescent) to combine two microswitches (for accessing environmental stimuli) and a Voice Output Communication Aid (VOCA), which allowed them to ask for caregiver's attention.

METHODS

Initially, the participants were required to use each of the two microswitches individually and then together. Thereafter, they were taught to use the VOCA. Eventually, the VOCA was available together with the microswitches, and the participants could use any of the three.

RESULTS

The results, which support preliminary data on this topic, showed that all participants (1) were able to operate the two microswitches as well as the VOCA; and (2) used all three of them consistently when they were simultaneously available.

CONCLUSIONS

Teaching persons with multiple disabilities to combine a VOCA with conventional microswitches may enrich their general input, emphasize their active social role and eventually enhance their social image.