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Brugnaro BH, Fernandes G, De Campos AC, Pavão SL, Pfeifer LI, De Camargo OK, Hlyva O, Rocha NACF. Participação em casa e fatores pessoais e ambientais em crianças e adolescentes com síndrome de Down. Dev Med Child Neurol 2024. [PMID: 38698694 DOI: 10.1111/dmcn.15930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
ResumoObjetivoDescrever a participação em casa atual (frequência, envolvimento) e o desejo do cuidador por mudança na participação em casa de crianças e adolescentes com síndrome de Down, bem como fatores ambientais da casa, e explorar as associações de fatores pessoais e ambientais com a participação atual e o desejo do cuidador por mudança.MétodoOitenta e dois cuidadores (média de idade = 45 anos e 10 meses) de crianças e adolescentes com síndrome de Down (média de idade = 10 anos e 7 meses) foram entrevistados sobre a participação em casa da criança e fatores ambientais utilizando a Medida de Participação e do Ambiente ‐ Crianças e Jovens. Além disso, foram coletados fatores pessoais e ambientais das crianças. Os resultados são relatados por meio de análise descritiva e correlações (coeficientes de correlação de Spearman ou teste U de Mann–Whitney) para descrever a relação entre a participação atual e o desejo do cuidador por mudança, com fatores pessoais e ambientais, para as variáveis ordinais e nominais, respectivamente (p < 0,05).ResultadosA participação das crianças foi maior em cuidados pessoais e menor em atividades relacionadas à escola. A maioria dos cuidadores desejava mudança nas lições de casa e nas tarefas domésticas. Maior frequência de participação foi associada ao sexo masculino, distanciamento social menos rigoroso do cuidador devido à pandemia de covid‐19 e crianças recebendo terapia. O maior envolvimento na participação foi associado a uma idade mais jovem nas crianças e a um maior apoio do ambiente. A idade mais avançada das crianças foi associada ao maior desejo por mudança do cuidador.InterpretaçãoFatores pessoais e ambientais são correlacionados com a participação de formas específicas. Devem ser realizadas estratégias criativas para promover a participação e que considerem os desejos do cuidador.
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Affiliation(s)
- Beatriz Helena Brugnaro
- Departamento de Fisioterrapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Universidade Federal de São Carlos, São Carlos, Brazil
| | - Gesica Fernandes
- Departamento de Fisioterrapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Universidade Federal de São Carlos, São Carlos, Brazil
| | - Ana Carolina De Campos
- Departamento de Fisioterrapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Universidade Federal de São Carlos, São Carlos, Brazil
| | - Silvia Letícia Pavão
- Departamento de Prevenção e Reabilitação em Fisioterapia, Universidade Federal do Paraná, Curitiba, Brazil
| | - Luzia Iara Pfeifer
- Departamento de Terapia Ocupacional, Laboratório de Ensino e Pesquisa em Terapia Ocupacional, Infância e Adolescência, Universidade Federal de São Carlos, São Carlos, Brazil
- Departamento de Neurociências e Ciências do Comportamento da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Olaf Kraus De Camargo
- Departamento de Pediatria, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Oksana Hlyva
- Departamento de Pediatria, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Nelci Adriana Cicuto Ferreira Rocha
- Departamento de Fisioterrapia, Laboratório de Análise do Desenvolvimento Infantil (LADI), Universidade Federal de São Carlos, São Carlos, Brazil
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Brugnaro BH, Fernandes G, De Campos AC, Pavão SL, Pfeifer LI, Kraus de Camargo O, Hlyva O, Rocha NACF. Home participation and personal and environmental factors in children and adolescents with Down syndrome. Dev Med Child Neurol 2024. [PMID: 38526024 DOI: 10.1111/dmcn.15891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 01/14/2024] [Accepted: 02/07/2024] [Indexed: 03/26/2024]
Abstract
AIM To describe current home participation (frequency, involvement) and caregiver's desire for change in home participation of children and adolescents with Down syndrome, as well as home environmental factors, and to explore the associations of personal and environmental factors with current participation and caregiver's desire for change. METHOD Eighty-two caregivers (mean age = 45 years 10 months) of children and adolescents with Down syndrome (mean age = 10 years 7 months) were surveyed about the child's home participation and environmental factors using the Participation and Environment Measure-Children and Youth. Furthermore, children's personal and environmental factors were collected. Results are reported using descriptive analysis and correlations (Spearman's rank correlation coefficients and Mann-Whitney U test) to describe the relationship between current participation and caregiver's desire for change, with personal and environmental factors as ordinal and nominal variables respectively (p < 0.05). RESULTS Children's participation was highest with regard to personal care management and lowest with regard to school-related activities. Most caregivers desired change in homework and household chores. Greater frequency was associated with male sex, caregiver less rigorous social distancing due to the COVID-19 pandemic, and children receiving therapies. Greater involvement was associated with younger age in children and higher environmental support. Older age in children was associated with caregiver's greater desire for change. INTERPRETATION Personal and environmental factors correlated with participation in specific ways. Creative strategies to promote participation that consider caregiver's wishes should be undertaken.
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Affiliation(s)
- Beatriz Helena Brugnaro
- Department of Physical Therapy, Child Development Analysis Laboratory, Federal University of São Carlos, São Carlos, Brazil
| | - Gesica Fernandes
- Department of Physical Therapy, Child Development Analysis Laboratory, Federal University of São Carlos, São Carlos, Brazil
| | - Ana Carolina De Campos
- Department of Physical Therapy, Child Development Analysis Laboratory, Federal University of São Carlos, São Carlos, Brazil
| | - Silvia Letícia Pavão
- Department of Prevention and Rehabilitation in Physical Therapy, Federal University of Paraná, Curitiba, Brazil
| | - Luzia Iara Pfeifer
- Department of Occupational Therapy, Teaching and Research Laboratory in Occupational Therapy, Childhood, and Adolescence, Federal University of São Carlos, São Carlos, Brazil
- Department of Neurosciences and Behavioral Sciences at the Ribeirão Preto Medical School at the University of São Paulo, Ribeirão Preto, Brazil
| | - Olaf Kraus de Camargo
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Oksana Hlyva
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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Kaelin VC, Saluja S, Bosak DL, Anaby D, Werler M, Khetani MA. Caregiver strategies supporting community participation among children and youth with or at risk for disabilities: a mixed-methods study. Front Pediatr 2024; 12:1345755. [PMID: 38425659 PMCID: PMC10902462 DOI: 10.3389/fped.2024.1345755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction The purpose of this mixed-methods study is to examine the role of caregiver strategies to support community participation among children and youth with disabilities and those at risk, from the caregiver perspective. For the quantitative phase, we tested the hypothesized positive effect of participation-focused caregiver strategies on the relationship(s) between participation-related constructs and community participation attendance and involvement. For the qualitative phase, we solicited caregiver perspectives to explain the quantitative findings. Methods An explanatory sequential mixed-methods design (QUAN > qual) was used. For the quantitative phase, we conducted secondary analyses of data collected during a second follow-up phase of a longitudinal cohort study, including 260 families of children and youth (mean age: 13.5 years) with disabilities and those at risk [i.e., 120 families of children and youth with craniofacial microsomia (CFM); 140 families of children and youth with other types of childhood-onset disabilities]. Data were collected through the Participation and Environment Measure-Children and Youth, the Pediatric Quality of Life Inventory, and the Child Behavior Checklist and analyzed using structural equation modeling. For the qualitative phase, we conducted semi-structured interviews with eight caregivers of children and youth with disabilities and those at risk (i.e., three caregivers of children and youth with CFM; five caregivers of children and youth with other childhood-onset disabilities). Interviews were transcribed verbatim and inductively content-analyzed. Results Our model reached acceptable to close model fit [CFI = 0.952; RMSEA = 0.068 (90% CI = 0.054-0.082); SRMR = 0.055; TLI = 0.936], revealing no significant effect of the number of participation-focused caregiver strategies on the relationships between participation-related constructs (e.g., activity competence, environment/context) and community participation in terms of attendance and involvement. The qualitative findings revealed three main categories for how caregivers explained these quantitative results: (1) caregiver workload and supports needed for implementing strategies; (2) caregivers careful strategy quality appraisal; and (3) community setting characteristics hindering successful strategy implementation. Discussion The findings suggest that the insignificant effect of the number of caregiver strategies may be explained by the intensified need for caregiver effort and support to develop and implement quality strategies that are responsive to community setting characteristics.
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Affiliation(s)
- Vera C. Kaelin
- Occupational Therapy, University of Illinois Chicago, Chicago, IL, United States
- Computer Science, University of Illinois Chicago, Chicago, IL, United States
- Children’s Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, United States
- Computing Science, Umeå University, Umeå, Sweden
| | - Shivani Saluja
- Children’s Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, United States
| | - Dianna L. Bosak
- Children’s Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, United States
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, CA, United States
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, CA, United States
| | - Martha Werler
- Epidemiology, Boston University, Boston, MA, United States
| | - Mary A. Khetani
- Occupational Therapy, University of Illinois Chicago, Chicago, IL, United States
- Children’s Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, United States
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, CA, United States
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Krieger B, Ederer F, Amann R, Morgenthaler T, Schulze C, Dawal B. Translation and cross-cultural adaptation of the young children participation and environment measure for its use in Austria, Germany, and Switzerland. Front Pediatr 2024; 11:1258377. [PMID: 38239598 PMCID: PMC10794623 DOI: 10.3389/fped.2023.1258377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
Background Concepts such as participation and environment may differ across cultures. Consequently, cultural equivalence must be assured when using a measure like the Young Children Participation and Environment Measure (YC-PEM) in other settings than the original English-speaking contexts. This study aimed to cross-culturally translate and adapt the YC-PEM into German as it is used in Germany, Austria, and Switzerland. Methods Following international guidelines, two translations were compared, and the research and expert team made the first adaptations. Twelve caregivers of children with and without disabilities from three German-speaking countries participated in two rounds of think-aloud interviews. Data were analyzed by content analysis to look for item, semantic, operational, conceptual, and measurement equivalence to reach a cultural equivalence version in German. Results Adaptations were needed in all fields but prominently in item, operational, and conceptual equivalence. Operational equivalence resulted in graphical adaptations in the instructions and questions to make the German version of YC-PEM, YC-PEM (G), more user-friendly. Conclusion This study presents a cross-cultural translation and adaptation process to develop a German version of the YC-PEM suitable for Germany, Austria, and Switzerland. A culturally adapted YC-PEM (G) is now available for research, practice, and further validation.
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Affiliation(s)
- Beate Krieger
- Institute of Occupational Therapy, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Friedrich Ederer
- Department of Economic and Social Sciences, Institute for Social Medicine, Rehabilitation Sciences and Health Services Research, Nordhausen University of Applied Sciences, Nordhausen, Germany
| | - Ruth Amann
- Department of Occupational Therapy, Graz University Clinic for Pediatrics and Adolescents Medicine, Graz, Austria
| | - Thomas Morgenthaler
- Institute of Occupational Therapy, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Christina Schulze
- Institute of Occupational Therapy, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Britta Dawal
- Department of Education and Social Sciences, South Westphalia University of Applied Sciences, Soest, Germany
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Krieger B, Piškur B, Beurskens AJHM, Moser A. Parents' perceptions: Participation patterns and desires for change for children and adolescents with autism spectrum disorder-A descriptive population-based study from Switzerland. Child Care Health Dev 2024; 50:e13155. [PMID: 37487595 DOI: 10.1111/cch.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 01/21/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Low participation in youth with autism spectrum disorder (ASD) has been reported, but age-related and contextual information is rare. OBJECTIVE This study aimed to describe, from parental perspectives, two patterns of participation and parental desires for change of children (age: 5-11) and adolescents (age: 12-17) with ASD in Switzerland. METHOD A cross-sectional design used the German version of the Participation and Environment Measure-Child and Youth to describe and juxtapose the participation results of 60 children and 55 adolescents with ASD in 45 activities at home, school and in the community and parental desires for change. RESULTS Participation patterns differed between settings and age groups. Both groups were found to participate most at home, followed by school, whereas community participation was either low or nonexistent. Children were more involved at home than adolescents, while school involvement was higher than participation frequency in both age groups. Community participation frequency was generally low but higher in children than in adolescents, while involvement was similarly low in both groups. Half the parents expressed desire for change with three tendencies: (1) widespread desire for change at home due to high support needs, (2) parents of adolescents expressed more desire for change in all settings than those of children and (3) all parents mainly desired to increase participation frequency and involvement. CONCLUSIONS This study informs research and social, health and community service providers to further reshape their programmes to meet parental needs and increase the participation of youth with ASD.
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Affiliation(s)
- Beate Krieger
- School of Health Professions, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Barbara Piškur
- Research Centre for Autonomy and Participation for People with Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Hasselt University, Faculty of Rehabilitation Sciences, Hasselt, Belgium
| | - Anna J H M Beurskens
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Albine Moser
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
- Research Centre for Autonomy and Participation for People with Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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Kaelin VC, Boyd AD, Werler MM, Parde N, Khetani MA. Natural Language Processing to Classify Caregiver Strategies Supporting Participation Among Children and Youth with Craniofacial Microsomia and Other Childhood-Onset Disabilities. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:480-500. [PMID: 37927374 PMCID: PMC10620347 DOI: 10.1007/s41666-023-00149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 07/18/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023]
Abstract
Customizing participation-focused pediatric rehabilitation interventions is an important but also complex and potentially resource intensive process, which may benefit from automated and simplified steps. This research aimed at applying natural language processing to develop and identify a best performing predictive model that classifies caregiver strategies into participation-related constructs, while filtering out non-strategies. We created a dataset including 1,576 caregiver strategies obtained from 236 families of children and youth (11-17 years) with craniofacial microsomia or other childhood-onset disabilities. These strategies were annotated to four participation-related constructs and a non-strategy class. We experimented with manually created features (i.e., speech and dependency tags, predefined likely sets of words, dense lexicon features (i.e., Unified Medical Language System (UMLS) concepts)) and three classical methods (i.e., logistic regression, naïve Bayes, support vector machines (SVM)). We tested a series of binary and multinomial classification tasks applying 10-fold cross-validation on the training set (80%) to test the best performing model on the held-out test set (20%). SVM using term frequency-inverse document frequency (TF-IDF) was the best performing model for all four classification tasks, with accuracy ranging from 78.10 to 94.92% and a macro-averaged F1-score ranging from 0.58 to 0.83. Manually created features only increased model performance when filtering out non-strategies. Results suggest pipelined classification tasks (i.e., filtering out non-strategies; classification into intrinsic and extrinsic strategies; classification into participation-related constructs) for implementation into participation-focused pediatric rehabilitation interventions like Participation and Environment Measure Plus (PEM+) among caregivers who complete the Participation and Environment Measure for Children and Youth (PEM-CY). Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00149-y.
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Affiliation(s)
- Vera C. Kaelin
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL 60612 − 7250 USA
- Department of Computer Science, University of Illinois Chicago, 851 South Morgan Street, Room 1132, Chicago, IL 60607-7042 USA
- Children’s Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL USA
| | - Andrew D. Boyd
- Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, IL USA
| | | | - Natalie Parde
- Department of Computer Science, University of Illinois Chicago, 851 South Morgan Street, Room 1132, Chicago, IL 60607-7042 USA
- Natural Language Processing Laboratory, University of Illinois Chicago, Chicago, IL USA
| | - Mary A. Khetani
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL 60612 − 7250 USA
- Children’s Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL USA
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON Canada
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Villegas VC, Bosak DL, Salgado Z, Phoenix M, Parde N, Teplicky R, Khetani MA. Diversified caregiver input to upgrade the Young Children's Participation and Environment Measure for equitable pediatric re/habilitation practice. J Patient Rep Outcomes 2023; 7:87. [PMID: 37639038 PMCID: PMC10462549 DOI: 10.1186/s41687-023-00627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Practitioner and family experiences of pediatric re/habilitation can be inequitable. The Young Children's Participation and Environment Measure (YC-PEM) is an evidence-based and promising electronic patient-reported outcome measure that was designed with and for caregivers for research and practice. This study examined historically minoritized caregivers' responses to revised YC-PEM content modifications and their perspectives on core intelligent virtual agent functionality needed to improve its reach for equitable service design. METHODS Caregivers were recruited during a routine early intervention (EI) service visit and met five inclusion criteria: (1) were 18 + years old; (2) identified as the parent or legal guardian of a child 0-3 years old enrolled in EI services for 3 + months; (3) read, wrote, and spoke English; (4) had Internet and telephone access; and (5) identified as a parent or legal guardian of a Black, non-Hispanic child or as publicly insured. Three rounds of semi-structured cognitive interviews (55-90 min each) used videoconferencing to gather caregiver feedback on their responses to select content modifications while completing YC-PEM, and their ideas for core intelligent virtual agent functionality. Interviews were transcribed verbatim, cross-checked for accuracy, and deductively and inductively content analyzed by multiple staff in three rounds. RESULTS Eight Black, non-Hispanic caregivers from a single urban EI catchment and with diverse income levels (Mdn = $15,001-20,000) were enrolled, with children (M = 21.2 months, SD = 7.73) enrolled in EI. Caregivers proposed three ways to improve comprehension (clarify item wording, remove or simplify terms, add item examples). Environmental item edits prompted caregivers to share how they relate and respond to experiences with interpersonal and institutional discrimination impacting participation. Caregivers characterized three core functions of a virtual agent to strengthen YC-PEM navigation (read question aloud, visual and verbal prompts, more examples and/or definitions). CONCLUSIONS Results indicate four ways that YC-PEM content will be modified to strengthen how providers screen for unmet participation needs and determinants to design pediatric re/habilitation services that are responsive to family priorities. Results also motivate the need for user-centered design of an intelligent virtual agent to strengthen user navigation, prior to undertaking a community-based pragmatic trial of its implementation for equitable practice.
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Affiliation(s)
- Vivian C Villegas
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA
| | - Dianna L Bosak
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA
| | - Zurisadai Salgado
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA
| | - Michelle Phoenix
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, USA
| | - Natalie Parde
- Department of Computer Science, University of Illinois Chicago, Chicago, IL, USA
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, USA
| | - Mary A Khetani
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA.
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL, 60612-7250, USA.
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Rizk S, Kaelin VC, Sim JGC, Murphy NJ, McManus BM, Leland NE, Stoffel A, James L, Barnekow K, Papautsky EL, Khetani MA. Implementing an Electronic Patient-Reported Outcome and Decision Support Tool in Early Intervention. Appl Clin Inform 2023; 14:91-107. [PMID: 36724883 PMCID: PMC9891850 DOI: 10.1055/s-0042-1760631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The aim of the study is to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs. METHODS An explanatory sequential (quan > QUAL) mixed-methods study was conducted with EI families (n = 6), service coordinators (n = 9), and program leadership (n = 7). Semi-structured interviews and focus groups were used to share select quantitative pragmatic trial results (e.g., percentages for perceived helpfulness of implementation strategies) and elicit stakeholder perspectives to contextualize these results. Three study staff deductively coded transcripts to constructs in the Consolidated Framework for Implementation Research (CFIR). Data within CFIR constructs were inductively analyzed to generate themes that were rated by national early childhood advisors for their relevance to longer term implementation. RESULTS All three stakeholder groups (i.e., families, service coordinators, program leadership) identified thematic supports and barriers across multiple constructs within each of four CFIR domains: (1) Six themes for "intervention characteristics," (2) Six themes for "process," (3) three themes for "inner setting," and (4) four themes for "outer setting." For example, all stakeholder groups described the value of the YC-PEM e-PRO in forging connections and eliciting meaningful information about family priorities for efficient service plan development ("intervention characteristics"). Stakeholders prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes ("process"); and fostering a positive implementation climate ("inner setting"). Service coordinators and program leadership further articulated the value of YC-PEM e-PRO results for improving EI access ("outer setting"). CONCLUSION Results demonstrate the YC-PEM e-PRO is an evidence-based intervention that is viable for implementation. Optimizations to its interface are needed before undertaking hybrid type-2 and 3 multisite trials to test these implementation strategies across state and local EI programs with electronic data capture capabilities and diverse levels of organizational readiness and resources for implementation.
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Affiliation(s)
- Sabrin Rizk
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States
| | - Vera C. Kaelin
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Julia Gabrielle C. Sim
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Natalie J. Murphy
- Department of Health Systems, Management, and Policy, University of Colorado, Aurora, Colorado, United States
| | - Beth M. McManus
- Department of Health Systems, Management, and Policy, University of Colorado, Aurora, Colorado, United States
| | - Natalie E. Leland
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Ashley Stoffel
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States
| | - Lesly James
- Department of Occupational Therapy, Lenoir-Rhyne University, Columbia, South Carolina, United States
| | - Kris Barnekow
- Department of Occupational Therapy, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, United States
| | - Elizabeth Lerner Papautsky
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Mary A. Khetani
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States,Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,CanChild Centre for Childhood Disability Research, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada,Address for correspondence Mary A. Khetani, ScD, OTR/L Department of Occupational Therapy, University of Illinois Chicago1919 West Taylor Street, Room 316A, Chicago, IL 60612-7250United States
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Kaelin V, Villegas V, Chen YF, Murphy N, Papautsky E, Litfin J, Leland N, Maheshwari V, McManus B, Khetani M. Effectiveness and scalability of an electronic patient-reported outcome measure and decision support tool for family-centred and participation-focused early intervention: PROSPECT hybrid type 1 trial protocol. BMJ Open 2022; 12:e051582. [PMID: 34983760 PMCID: PMC8728410 DOI: 10.1136/bmjopen-2021-051582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Early intervention (EI) endorses family-centred and participation-focused services, but there remain insufficient options for systematically enacting this service approach. The Young Children's Participation and Environment Measure electronic patient-reported outcome (YC-PEM e-PRO) is an evidence-based measure for caregivers that enables family-centred services in EI. The Parent-Reported Outcomes for Strengthening Partnership within the Early Intervention Care Team (PROSPECT) is a community-based pragmatic trial examining the effectiveness of implementing the YC-PEM e-PRO measure and decision support tool as an option for use within routine EI care, on service quality and child outcomes (aim 1). Following trial completion, we will characterise stakeholder perspectives of facilitators and barriers to its implementation across multiple EI programmes (aim 2). METHODS AND ANALYSIS This study employs a hybrid type 1 effectiveness-implementation study design. For aim 1, we aim to enrol 223 caregivers of children with or at risk for developmental disabilities or delays aged 0-3 years old that have accessed EI services for three or more months from one EI programme in the Denver Metro catchment of Colorado. Participants will be invited to enrol for 12 months, beginning at the time of their child's annual evaluation of progress. Participants will be randomised using a cluster-randomised design at the EI service coordinator level. Both groups will complete baseline testing and follow-up assessment at 1, 6 and 12 months. A generalised linear mixed model will be fitted for each outcome of interest, with group, time and their interactions as primary fixed effects, and adjusting for child age and condition severity as secondary fixed effects. For aim 2, we will conduct focus groups with EI stakeholders (families in the intervention group, service coordinators and other service providers in the EI programme, and programme leadership) which will be analysed thematically to explain aim 1 results and identify supports and remaining barriers to its broader implementation in multiple EI programmes. ETHICS AND DISSEMINATION This study has been approved by the institutional review boards at the University of Illinois at Chicago (2020-0555) and University of Colorado (20-2380). An active dissemination plan will ensure that findings have maximum reach for research and practice. TRIAL REGISTRATION NUMBER NCT04562038.
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Affiliation(s)
- Vera Kaelin
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Vivian Villegas
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yi-Fan Chen
- Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Natalie Murphy
- Health Systems, Management & Policy, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth Papautsky
- Biomedical & Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jodi Litfin
- Rocky Mountain Human Services, Denver, Colorado, USA
| | - Natalie Leland
- Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Varun Maheshwari
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Beth McManus
- Health Systems, Management & Policy, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Khetani
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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Kaelin VC, Valizadeh M, Salgado Z, Parde N, Khetani MA. Artificial Intelligence in Rehabilitation Targeting the Participation of Children and Youth With Disabilities: Scoping Review. J Med Internet Res 2021; 23:e25745. [PMID: 34734833 PMCID: PMC8603165 DOI: 10.2196/25745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/21/2021] [Accepted: 09/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In the last decade, there has been a rapid increase in research on the use of artificial intelligence (AI) to improve child and youth participation in daily life activities, which is a key rehabilitation outcome. However, existing reviews place variable focus on participation, are narrow in scope, and are restricted to select diagnoses, hindering interpretability regarding the existing scope of AI applications that target the participation of children and youth in a pediatric rehabilitation setting. OBJECTIVE The aim of this scoping review is to examine how AI is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with disabilities or other diagnosed health conditions in valued activities. METHODS We conducted a comprehensive literature search using established Applied Health Sciences and Computer Science databases. Two independent researchers screened and selected the studies based on a systematic procedure. Inclusion criteria were as follows: participation was an explicit study aim or outcome or the targeted focus of the AI application; AI was applied as part of the provided and tested intervention; children or youth with a disability or other diagnosed health conditions were the focus of either the study or AI application or both; and the study was published in English. Data were mapped according to the types of AI, the mode of delivery, the type of personalization, and whether the intervention addressed individual goal-setting. RESULTS The literature search identified 3029 documents, of which 94 met the inclusion criteria. Most of the included studies used multiple applications of AI with the highest prevalence of robotics (72/94, 77%) and human-machine interaction (51/94, 54%). Regarding mode of delivery, most of the included studies described an intervention delivered in-person (84/94, 89%), and only 11% (10/94) were delivered remotely. Most interventions were tailored to groups of individuals (93/94, 99%). Only 1% (1/94) of interventions was tailored to patients' individually reported participation needs, and only one intervention (1/94, 1%) described individual goal-setting as part of their therapy process or intervention planning. CONCLUSIONS There is an increasing amount of research on interventions using AI to target the participation of children and youth with disabilities or other diagnosed health conditions, supporting the potential of using AI in pediatric rehabilitation. On the basis of our results, 3 major gaps for further research and development were identified: a lack of remotely delivered participation-focused interventions using AI; a lack of individual goal-setting integrated in interventions; and a lack of interventions tailored to individually reported participation needs of children, youth, or families.
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Affiliation(s)
- Vera C Kaelin
- Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, IL, United States
| | - Mina Valizadeh
- Computer Science, College of Engineering, University of Illinois at Chicago, Chicago, IL, United States
- Natural Language Processing Laboratory, University of Illinois at Chicago, Chicago, IL, United States
| | - Zurisadai Salgado
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, IL, United States
- Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Natalie Parde
- Computer Science, College of Engineering, University of Illinois at Chicago, Chicago, IL, United States
- Natural Language Processing Laboratory, University of Illinois at Chicago, Chicago, IL, United States
| | - Mary A Khetani
- Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, IL, United States
- Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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Krieger B, Schulze C, Boyd J, Amann R, Piškur B, Beurskens A, Teplicky R, Moser A. Cross-cultural adaptation of the Participation and Environment Measure for Children and Youth (PEM-CY) into German: a qualitative study in three countries. BMC Pediatr 2020; 20:492. [PMID: 33099320 PMCID: PMC7585231 DOI: 10.1186/s12887-020-02343-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/13/2020] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Concepts such as participation and environment may differ across cultures. Consequently, to use a measure like the Participation and Environment Measure for Children and Youth (PEM-CY) in other than the original English-speaking contexts, cultural adaptation needs to be assured. The aim of this study was to cross-culturally translate and adapt the PEM-CY into German as it is used in Germany, Austria and Switzerland. METHODS Fifteen parents of children and adolescents with disabilities from three German speaking countries participated in three rounds of think-aloud interviews. We followed the procedure of cultural equivalence guidelines including two additional steps. Data was analyzed by content analysis using semantic, idiomatic, experiential and conceptual equivalence. RESULTS Results show adaptations mainly focused on experiential and conceptual equivalence, with conceptual equivalence being the most challenging to reach. Examples of experiential equivalence included adapting the examples of activities in the PEM-CY to reflect those typical in German speaking countries. Conceptual equivalence mainly addressed aspects of "involvement" and "environment" of children and adolescents and was reached through adaptations such as enhanced instructions and structures, and additional definitions. CONCLUSIONS This study presents a cross-cultural translation and adaptation process to develop a German version of the PEM-CY that is suitable for Germany, Austria and Switzerland. Using a modified cultural adaptation process, a culturally adapted version of PEM-CY (German) is now available for research, practice and further validation.
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Affiliation(s)
- Beate Krieger
- School of Health Professionals, Zurich University of Applied Sciences, Winterthur, Switzerland. .,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.
| | - Christina Schulze
- School of Health Professionals, Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | | | - Barbara Piškur
- Research Centre for Autonomy and Participation for People with Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Anna Beurskens
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | | | - Albine Moser
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.,Research Centre for Autonomy and Participation for People with Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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Çankaya Ö, Kerem Günel M, Özdemir P. Construct-concurrent validity and reliability of the European Child Environment Questionnaire (ECEQ) in a sample of Turkish children with cerebral palsy. Disabil Rehabil 2020; 44:2104-2112. [PMID: 32988240 DOI: 10.1080/09638288.2020.1822930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the construct-concurrent validity and reliability of the Turkish version of the European Child Environment Questionnaire (ECEQ-T) in children with cerebral palsy (CP). METHODS Mean age 9.53 ± 4.45 years 306 children with CP and their parents participated in the study. While construct validity was assessed using confirmatory factor analysis, concurrent validity was investigated using the correlation between ECEQ-T and Pediatric Evaluation of Disability Inventory (PEDI) with Spearman's correlation analysis. For test-retest reliability, ECEQ-T was administered twice to 65 parents with an interval of two weeks. Cronbach's alpha (α) and Intraclass Correlation Coefficient (ICC) were used for reliability. RESULTS Construct validity (RMSEA > 0.080; GFI ≥ 0.90) and concurrent validity (r: -0.533 to -0.293; p < 0.05) were confirmed as acceptable. Eight items were dropped out as they did not fit the model and finally ECEQ-T contains 54 items in three domains. High Cronbach's α and ICC values were found (Cronbach αPE: 0.960/ICCPE: 0.959, Cronbach αSS: 0.955/ICCSS: 0.954), Cronbach αA: 0.822/ICCA: 0.802, Cronbach αT: 0.957/ICCT: 0.955). CONCLUSION ECEQ-T has demonstrated good psychometric properties and can be used as a reliable and valid measure to assess environmental factors. We believe that ECEQ-T is a useful and detailed questionnaire to determine barriers-facilitators for increasing activity and participation in Turkish children with CP.IMPLICATIONS FOR REHABILITATIONThe Turkish version of ECEQ has acceptable construct validity and moderate concurrent validity for evaluating environmental factors in children with cerebral palsy.The Turkish version of ECEQ provides valuable information, which could be helpful to guide public health services and government policies in order to optimize the participation of children with CP.Environmental factors may play an important role in activity and participation in children with cerebral palsy. Turkish version of the ECEQ can be used for evaluating the environmental factors to determine barriers of activity and participation.
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Affiliation(s)
- Özge Çankaya
- Faculty of Physical Therapy and Rehabilitation, Department of Cerebral Palsy and Pediatric Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem Günel
- Faculty of Physical Therapy and Rehabilitation, Department of Cerebral Palsy and Pediatric Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Pınar Özdemir
- Department of Basic Medical Sciences, Department of Biostatistics, Hacettepe University, Ankara, Turkey
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Jarvis JM, Kaelin VC, Anaby D, Teplicky R, Khetani MA. Electronic participation-focused care planning support for families: a pilot study. Dev Med Child Neurol 2020; 62:954-961. [PMID: 32259292 PMCID: PMC7332406 DOI: 10.1111/dmcn.14535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the feasibility, acceptability, and preliminary effects of Participation and Environment Measure-Plus (PEM+) 2.0, an optimized version of a web-based, participation-focused, care-planning tool. METHOD Twenty-two caregivers of children aged 0 to 5 years receiving rehabilitation services, who reported dissatisfaction with their child's participation, had internet access, and could read and write English, were recruited for this 2-week, single-arm pilot trial. Feasibility was assessed through retention rates, completion time, percentage of care plans developed relative to caregiver reported need, and independent completion of PEM+ 2.0. Acceptability was assessed by the Usefulness, Satisfaction, and Ease of Use Questionnaire. Preliminary effects were assessed by two items on caregiver reported impact of PEM+ 2.0 on confidence for addressing their child's participation. RESULTS Eighteen caregivers completed at least one iteration of PEM+ 2.0; of those, 17 were female and 15 were 30 to 39 years old. The median completion time was 12.99 minutes (quartile 1, 6.30; quartile 3, 17.33), mean care plan creation relative to need was 50% (standard deviation [SD] 31), and 17 completed PEM+ 2.0 independently. Mean acceptability scores were 3.80 to 4.97 (SD 1.25-1.97) and mean preliminary effect scores were 4.61 to 4.72 (SD 1.85-2.24), out of 7.0. There were strong and significant positive associations between two of the three estimates of PEM+ 2.0 acceptability and caregiver confidence (r=0.577-0.793, p<0.01). INTERPRETATION Electronic health tools have the potential for facilitating family-centered care in pediatric rehabilitation. PEM+ 2.0 is a feasible tool within pediatric rehabilitation and has potential to be an acceptable tool for improving caregiver confidence for promoting their child's participation in valued activities. WHAT THIS PAPER ADDS Participation and Environment Measure-Plus (PEM+) 2.0 is feasible for collaboratively engaging caregivers in the care-planning process. Caregivers perceived PEM+ 2.0 as helpful for thinking about their child's participation and what can be done to improve it. Feasibility and acceptability results will inform PEM+ 2.0 optimizations.
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Affiliation(s)
- Jessica M Jarvis
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vera C Kaelin
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Mary A Khetani
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, IL, USA
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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Vänskä N, Sipari S, Haataja L. What Makes Participation Meaningful? Using Photo-Elicitation to Interview Children with Disabilities. Phys Occup Ther Pediatr 2020; 40:595-609. [PMID: 32138590 DOI: 10.1080/01942638.2020.1736234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS The purpose of this study was to describe meaningful participation in everyday life from the perspectives of children with disabilities. METHODS Nine children (5-10 years, mean age 7.2 years, 5 boys, 4 girls) with disabilities participated in individual photo-elicitation interviews. The interview data was transcribed verbatim and analyzed with inductive content analysis. RESULTS The children's meaningful participation mainly comprised free leisure activities that fostered enjoyment, capability, autonomy and social involvement with family and friends. The children's emotions and physical sensations, opportunities to influence, knowledge about the activity and the participation context, presumptions and previous experiences of the activity and the environment played a vital role in their decisions to participate. CONCLUSION The meaningful participation facilitated enjoyment and self-determination for the children. Identifying personal and environmental factors supporting or restricting participation from the child's perspective emerges as important in order to provide opportunities for the child's meaningful participation in everyday life. The photo-elicitation interviews demonstrated the potential to act as a tool to identify and explore the children's views about participation in a real-life context.
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Affiliation(s)
- Nea Vänskä
- Department of Rehabilitation and Examination, Metropolia University of Applied Sciences and University of Helsinki, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Salla Sipari
- Department of Wellbeing, Metropolia University of Applied Sciences, Helsinki, Finland
| | - Leena Haataja
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Children´s Hospital, and Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
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Bosak DL, Jarvis JM, Khetani MA. Caregiver creation of participation-focused care plans using Participation and Environment Measure Plus (PEM+), an electronic health tool for family-centred care. Child Care Health Dev 2019; 45:791-798. [PMID: 31313843 DOI: 10.1111/cch.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Family-centred care (FCC) is a model for rehabilitation practice that focuses on collaborative partnerships between providers and clients (i.e., children and their caregivers). FCC is a best-practice standard and is expected to yield better outcomes for children and greater caregiver satisfaction with rehabilitation services. A commonly cited barrier to implementing FCC is perceptions about caregiver capability to contribute to designing an initial plan of care, due to lack of skill and/or interest. OBJECTIVES The aim of this study is to address FCC barriers through three objectives: (a) report the proportion of caregivers that created multiple care plans using PEM+, an electronic health tool, (b) assess the proportion of caregivers that created complete and participation-focused care plan(s) and that exceeded criteria of a complete plan, and (c) describe characteristics of caregivers that did not create a complete care plan. METHODS Study objectives were addressed via secondary analyses of a subset of data from the PEM + pilot trial. Participants were caregivers (N = 18) of children with developmental disabilities (aged 0-5 years) receiving rehabilitation services in an early childhood programme. A deductive analytic approach was used to code care plan content to criteria and to determine proportion of caregivers with a complete and participation-focused care plan and those that exceeded the criteria. RESULTS Multiple care plans were created by 72% of the caregivers, 83% caregivers created at least one care plan that was complete and participation-focused per criteria, and 83% exceeded the criteria. CONCLUSION The high occurrence of caregivers who developed multiple care plans and who developed high-quality care plans, in their completeness and participation-focused features, suggests that caregivers are interested and capable of participating in a collaborative goal setting process when using PEM+. This indicates that FCC is feasible to implement in clinical workflow with the use of an electronic health tool, which may better facilitate such care. PEM+ warrants further efficacy testing prior to implementation.
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Affiliation(s)
- Dianna L Bosak
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois
| | - Jessica M Jarvis
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Mary A Khetani
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois
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Jarvis JM, Gurga A, Greif A, Lim H, Anaby D, Teplicky R, Khetani MA. Usability of the Participation and Environment Measure Plus (PEM+) for Client-Centered and Participation-Focused Care Planning. Am J Occup Ther 2019; 73:7304205130p1-7304205130p8. [PMID: 31318677 PMCID: PMC9563087 DOI: 10.5014/ajot.2019.032235] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The Participation and Environment Measure Plus (PEM+) is a new electronic health application to help caregivers contribute to client-centered and participation-focused care planning for their young child. The PEM+ is designed to help caregivers build on their participation assessment by determining priority activities, setting specific goals, and identifying strategies for goal attainment. OBJECTIVE To examine the usability of the PEM+. DESIGN A single-arm usability trial. SETTING Two early intervention and early childhood educational programs. PARTICIPANTS Six caregivers of children ages 0-3 yr with developmental delay and receiving rehabilitation services. INTERVENTION Caregivers who were eligible and enrolled were given access to the PEM+ for 1 wk and instructed to complete one iteration. OUTCOMES AND MEASURES Usability was assessed according to caregivers' report of PEM+'s technical effectiveness and ease of use, ease of learning, and user satisfaction via the Usefulness, Satisfaction, and Ease of Use questionnaire. RESULTS All caregivers completed the PEM+ online once and in its entirety (mean completion time = 13.6 min). Mean technical effectiveness ratings ranged from 5.7 to 6.3 out of 7.0, and mean ease of use, ease of learning, and user satisfaction ratings were 4.4, 5.4, and 4.2 out of 6.0, respectively. CONCLUSIONS AND RELEVANCE Caregivers of young children can navigate the PEM+. Trends in survey feedback informed optimizations for the PEM+ before further feasibility testing. WHAT THIS ARTICLE ADDS This study provides preliminary evidence for a promising tool that can help to customize the way practitioners partner with families to create a plan for occupational therapy services.
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Affiliation(s)
- Jessica M Jarvis
- Jessica M. Jarvis, PhD, is Postdoctoral Associate, Department of Occupational Therapy, University of Illinois at Chicago
| | - Andrea Gurga
- Andrea Gurga, MS, is Graduate Research Assistant, Department of Occupational Therapy, University of Illinois at Chicago
| | - Alexa Greif
- Alexa Greif, MS, is Graduate Research Assistant, Department of Occupational Therapy, University of Illinois at Chicago
| | - Heather Lim
- Heather Lim, BS, is Graduate Research Assistant, Department of Occupational Therapy, University of Illinois at Chicago
| | - Dana Anaby
- Dana Anaby, PhD, is Associate Professor, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Rachel Teplicky
- Rachel Teplicky, MS, is Business and Engagement Officer, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Mary A Khetani
- Mary A. Khetani, ScD, is Associate Professor, Department of Occupational Therapy, University of Illinois at Chicago;
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Chien CW, Li-Tsang CWP, Cheung PPP, Leung KY, Lin CY. Development and psychometric evaluation of the Chinese version of the Participation and Environment Measure for Children and Youth. Disabil Rehabil 2019; 42:2204-2214. [PMID: 31081396 DOI: 10.1080/09638288.2018.1553210] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To adapt the Participation and Environment Measure for Children and Youth for use with Chinese children and youths, and to investigate its psychometric properties.Materials and methods: The Participation and Environment Measure for Children and Youth was translated into Chinese using a cultural adaptation process. Parents of 69 children aged 5-12 years with disabilities and 319 children without disabilities completed the questionnaires. Internal consistency, test-retest reliability, factorial structure, and known-group validity were examined using Cronbach's alpha, intraclass correlation coefficient, confirmatory factor analysis and t-test, respectively.Results: We added and/or replaced activities with culturally-relevant activities in the Chinese version. Internal consistency was acceptable for most of the scales (0.55-0.86). Test-retest reliability of the summary scores was moderate to high (0.70-0.84). Data-model fit was confirmed in a one-factor structure for the participation scales and a two-factor structure for the environment scales. There were also significant differences in the summary scores between 65 gender- and age-matched pairs of children with and without disabilities on the school participation scales and all the environment scales.Conclusion: This study provides psychometric evidence supporting the use of the Participation and Environment Measure for Children and Youth to assess Chinese children's participation and environmental supports/barriers.Implications for rehabilitationThe Chinese version of the Participation and Environment Measure for Children and Youth was developed through a rigorous translation and cultural adaptation process.There is evidence for the reliability (internal consistency and test-retest reliability) and construct validity (factorial structure and known-group validity) of the Chinese version of the Participation and Environment Measure for Children and Youth.The Chinese version of the Participation and Environment Measure for Children and Youth can be used to assess children's participation in home, school and community settings and to identify environmental barriers that require further intervention.
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Affiliation(s)
- Chi-Wen Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Cecilia W P Li-Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Phoebe Pui Pui Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Ka-Yan Leung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), China
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Khetani MA, Lim HK, Corden ME. Caregiver Input to Optimize the Design of a Pediatric Care Planning Guide for Rehabilitation: Descriptive Study. JMIR Rehabil Assist Technol 2017; 4:e10. [PMID: 29066421 PMCID: PMC5676028 DOI: 10.2196/rehab.7566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/21/2017] [Accepted: 08/25/2017] [Indexed: 11/25/2022] Open
Abstract
Background Caregiver input has informed the design of a valid electronic patient-reported outcome (PRO) measure for use in pediatric rehabilitation. This proxy assessment may be further developed to expedite and enhance patient-centered care planning processes, but user input is first needed to finalize the core requirements that will guide its design. Objective The objective of this study was to examine the feasibility of a stepwise process for building on a baseline assessment of young children's participation in activities to develop a care plan relevant to pediatric rehabilitation. Methods A cross-sectional descriptive study design was employed using qualitative methods. Data were collected via Web-based technology and by telephone. Twenty-five caregivers of young children (9 with developmental delays, 16 without delays) and between 1 and 7 years were recruited from a subsample of parents who had previously enrolled in a Web-based validation of a PRO on children’s participation and provided consent for future contact. Each caregiver completed a demographic questionnaire and Young Children’s Participation and Environment Measure (YC-PEM) online, followed by a 20- to 60-min semistructured and audiotaped phone interview to review and build upon PRO results as summarized in an electronic report. Interview data were content coded to the interview guide and reviewed by multiple research staff to estimate feasibility according to stepwise completion rates, perceptions of difficulty in step completion, and perceptions of overall utility. Results Half of the participants in the final study sample (N=25) fully completed a stepwise process of building on their baseline PRO assessment to develop an initial care plan for their child. In most cases, similar stepwise completion rates and trends in the approaches taken for step completion were found regardless of the child’s disability status. However, more parents of children with disabilities reported difficulties in rank ordering their priorities for change and identified child-focused strategies for goal attainment. Nearly 77% (19/25) of users were willing to use the process to develop and communicate intervention priorities and strategies with professionals, family, and friends. Conclusions Results informed revisions to the care planning guide before usability and feasibility testing of an initial Web-based prototype that is now underway.
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Affiliation(s)
- Mary A Khetani
- Children's Participation in Environment Research Lab, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Heather K Lim
- Children's Participation in Environment Research Lab, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Marya E Corden
- Children's Participation in Environment Research Lab, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, United States
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Chien CW, Rodger S, Copley J. Differences in patterns of physical participation in recreational activities between children with and without intellectual and developmental disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 67:9-18. [PMID: 28599254 DOI: 10.1016/j.ridd.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/06/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Children with intellectual and developmental disability (IDD) are at risk of experiencing limited participation in recreational activities, where they may be present but not physically engaged. AIM To compare patterns of physical engagement in recreational activities between children with and without IDD. METHODS AND PROCEDURES Fifty children with IDD (26 boys, 24 girls; mean age 8.7 years) were matched for age and sex with 50 typically developing children. Parents completed a questionnaire which captured participation in 11 recreational activities involving hand use as an indication of physical engagement. OUTCOME AND RESULTS More than 80% of children in both groups participated physically in eight recreational activities, but fewer children with IDD participated in six activities when compared with typically developing children. Children with IDD also participated less frequently in five activities and required more assistance to participate in all the 11 activities. Parents wanted their child with IDD to participate in 10 recreational activities with less assistance. CONCLUSIONS AND IMPLICATIONS The difference between the groups related to participation frequency, independence, and parents' desire for changes in their child's participation. Greater efforts are needed to address these differences and to support recreational participation in children with IDD.
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Affiliation(s)
- Chi-Wen Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region.
| | - Sylvia Rodger
- Occupational Therapy Division, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Jodie Copley
- Occupational Therapy Division, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
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Lim CY, Law M, Khetani M, Pollock N, Rosenbaum P. Establishing the Cultural Equivalence of the Young Children's Participation and Environment Measure (YC-PEM) for Use in Singapore. Phys Occup Ther Pediatr 2016; 36:422-39. [PMID: 26642891 PMCID: PMC5176101 DOI: 10.3109/01942638.2015.1101044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Establishing the cultural equivalence of clinical assessments is critical to ensuring culturally competent care. Developed in North America, the Young Children's Participation and Environment Measure (YC-PEM) is a caregiver questionnaire of participation in home, preschool, and community activities and perceptions of environmental impact on participation. The purpose of this study is to establish the cultural equivalence of YC-PEM content for use in Singapore. METHODS We conducted semi-structured interviews with ten early childhood and healthcare providers and cognitive interviews with ten parents in Singapore to examine the relevance of original YC-PEM content (activities, environmental factors, item wording). Interviews were transcribed, summarized, and categorized according to item, semantic, conceptual, and operational dimensions of the Applied Cultural Framework that served as a decision-making guide to keep, modify, or delete the items. RESULTS Providers and parents agreed on conceptual, item and semantic changes but less on operational changes. Significant changes were made to improve comprehension of the YC-PEM. CONCLUSIONS Despite using the same language, the majority of the YC-PEM items needed modification to be relevant to the Singapore culture. Cultural adaptation of the YC-PEM is important because there are cultural differences in children's participation and their environments, as well as the way people understand words.
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Affiliation(s)
- Chun Yi Lim
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Mary Law
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Mary Khetani
- b Department of Occupational Therapy , Colorado State University , Fort Collins , Colorado , USA
| | - Nancy Pollock
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Peter Rosenbaum
- c Department of Pediatrics , McMaster University , Hamilton , Ontario , Canada
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Khetani MA, Graham JE, Davies PL, Law MC, Simeonsson RJ. Psychometric properties of the Young Children's Participation and Environment Measure. Arch Phys Med Rehabil 2015; 96:307-16. [PMID: 25449189 PMCID: PMC4306635 DOI: 10.1016/j.apmr.2014.09.031] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/03/2014] [Accepted: 09/18/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties of the newly developed Young Children's Participation and Environment Measure (YC-PEM). DESIGN Cross-sectional study. SETTING Data were collected online and by telephone. PARTICIPANTS Convenience and snowball sampling methods were used to survey caregivers of children (N=395, comprising children with [n=93] and without [n=302] developmental disabilities and delays) between the ages of 0 and 5 years (mean age±SD, 35.33±20.29 mo) and residing in North America. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The YC-PEM includes 3 participation scales and 1 environment scale. Each scale is assessed across 3 settings: home, daycare/preschool, and community. Data were analyzed to derive estimates of internal consistency, test-retest reliability, and construct validity. RESULTS Internal consistency ranged from .68 to .96 and .92 to .96 for the participation and environment scales, respectively. Test-retest reliability (2-4 wk) ranged from .31 to .93 for participation scales and from .91 to .94 for the environment scale. One of 3 participation scales and the environment scale demonstrated significant group differences by disability status across all 3 settings, and all 4 scales discriminated between disability groups for the daycare/preschool setting. The participation scales exhibited small to moderate positive associations with functional performance scores. CONCLUSIONS Results lend initial support for the use of the YC-PEM in research to assess the participation of young children with disabilities and delays in terms of (1) home, daycare/preschool, and community participation patterns; (2) perceived environmental supports and barriers to participation; and (3) activity-specific parent strategies to promote participation.
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Affiliation(s)
- Mary A Khetani
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO.
| | - James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Patricia L Davies
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO
| | - Mary C Law
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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