Creating Evidence for Practice Using Data-Driven Decision Making

Exploring occupational therapy practice with children who are picky eaters and their families

Introduction

Picky eating is a complex phenomenon, impacting family routines and relationships. Occupational therapists often work with picky eaters and their families, yet little is understood about the occupational therapy process and reasoning in this context. This study was guided by the following research question: How do Australian occupational therapists choose and deliver interventions for children with picky eating and their families?

Method

This qualitative interpretive descriptive study used in-depth semi-structured online interviews with 10 Australian-based occupational therapists working with children who are picky eaters. Data was analysed inductively following a thematic analysis process, and emergent themes were identified.

Findings

Participants indicated that they used a complex reasoning process, with 'Tailoring Occupational Therapy for Picky Eating' emerging as the central finding. Key factors underpinning these tailored interventions were finding the why; addressing the why; and practising within context.

Conclusion

To our knowledge, this is the first qualitative study to investigate occupational therapists' reasoning processes when working with families impacted by picky eating. Occupational therapists described the complexity of picky eating, and the subsequent reasoning to find suitable interventions. Findings may guide occupational therapists' clinical practice when working with children with picky eating and their families.

Research Knowledge Translation in Sensory Integration-Based Therapy: Exploring Subjectivity of Clinical Expertise

Background. Clinical expertise is the mechanism through which practitioners implement other components of evidence-based practice (EBP). Within occupational therapy practice, intervention approaches that are both closely and loosely aligned with Ayres' Theory of Sensory Integration are widespread, offering a unique opportunity to investigate the subjective nature of clinical expertise in EBP. Purpose. This qualitative study explored motivations to offer sensory integration-based interventions, and factors informing occupational therapists' clinical decision making in relation to an arguably contentious evidence base. Method. Six post-graduate sensory integration trained UK occupational therapists participated in individual semi-structured interviews. Interviews were transcribed, member-checked and analyzed using thematic coding analysis. Findings. Despite sound understanding of theory and continuous efforts to develop clinical knowledge, non-traditional hierarchies of evidence notably inform clinical decisions. The clinical expertise required for integration of patient preferences, clinical state and circumstances, and research evidence is informed by pragmatic responses to facilitators and barriers across contexts, combined with unique profession-specific identity factors. Implications. While empirical healthcare research is ideally undertaken under controlled conditions, realities of clinical practice are rarely so clear cut. Study findings highlight important subjective factors that are central to real-world research knowledge translation and further understanding of the clinical expertise component of EBP.

Improving Standards of Research Reporting in Intervention Research: Considerations for the Rehabilitation Treatment Specification System Model

Replication and application of research in clinical practice require that interventions be described in detail by the producers of that research. Lack of treatment specificity in publications is thought to contribute to the nearly 17-yr gap between the publication and clinical implementation of best practices. In this editorial I explore a means of addressing this problem in the Rehabilitation Treatment Specification System (RTSS) and present an application of the RTSS to sensory integration intervention.

Leveraging Responsible, Explainable, and Local Artificial Intelligence Solutions for Clinical Public Health in the Global South

In the present paper, we will explore how artificial intelligence (AI) and big data analytics (BDA) can help address clinical public and global health needs in the Global South, leveraging and capitalizing on our experience with the "Africa-Canada Artificial Intelligence and Data Innovation Consortium" (ACADIC) Project in the Global South, and focusing on the ethical and regulatory challenges we had to face. "Clinical public health" can be defined as an interdisciplinary field, at the intersection of clinical medicine and public health, whilst "clinical global health" is the practice of clinical public health with a special focus on health issue management in resource-limited settings and contexts, including the Global South. As such, clinical public and global health represent vital approaches, instrumental in (i) applying a community/population perspective to clinical practice as well as a clinical lens to community/population health, (ii) identifying health needs both at the individual and community/population levels, (iii) systematically addressing the determinants of health, including the social and structural ones, (iv) reaching the goals of population's health and well-being, especially of socially vulnerable, underserved communities, (v) better coordinating and integrating the delivery of healthcare provisions, (vi) strengthening health promotion, health protection, and health equity, and (vii) closing gender inequality and other (ethnic and socio-economic) disparities and gaps. Clinical public and global health are called to respond to the more pressing healthcare needs and challenges of our contemporary society, for which AI and BDA can help unlock new options and perspectives. In the aftermath of the still ongoing COVID-19 pandemic, the future trend of AI and BDA in the healthcare field will be devoted to building a more healthy, resilient society, able to face several challenges arising from globally networked hyper-risks, including ageing, multimorbidity, chronic disease accumulation, and climate change.

Autism Spectrum Disorders Across the Life Course and Occupational Therapy Services

The primary purpose of this position statement is to define the role of occupational therapy and the scope of occupational therapy services available for persons on the autism spectrum to audiences external to the occupational therapy profession. In addition, this document is intended to articulate for occupational therapy practitioners the role and support of the practice of occupational therapy for this population.1.

Italian Translation, Cultural Adaptation, and Validation of the Toileting Habit Profile Questionnaire Revised (THPQ-R) in Typically Developing Children: A Cross-Sectional Study

The Toileting Habit Profile Questionnaire Revised (THPQ-R) identifies sensory integration issues in children with defecation problems. Sensory integration issues are recognized as a factor linked to some defecation disorders and identifying such issues is needed to guide the development of an appropriate intervention. The aim of this cross-sectional study was to translate, culturally adapt, and validate the THPQ-R in a population of typically developing (TD) Italian children by measuring its internal consistency and cross-cultural validity. The translation and cultural adaptation were performed according to international guidelines. The questionnaire was administered to the caregivers of TD children, and the analysis was performed on data obtained from 118 TD children. The construct validity of the scale was calculated through the exploratory factor analysis that indicated two factors; Cronbach’s alpha was calculated for internal consistency and showed a value >0.7, demonstrating good internal consistency. Cross-cultural validity was also analyzed and showed higher levels of defecation problems at age 5 years. Italian occupational therapists now have a tool to assess possible sensory issues linked to defecation disorders in children aged 3 to 6 years, which may promote more effective clinical practice in this area. Moreover, it will be possible to compare the results obtained from studies conducted in Italy with those conducted in other countries.

Vamos refletir sobre a prática? A aplicabilidade de uma ferramenta reflexiva para sustentar o raciocínio profissional em terapia ocupacional

Resumo Introdução A reflexão sobre a prática, na perspectiva da epistemologia da racionalidade prática, favorece o ganho de consciência sobre seus aspectos tácitos, como do raciocínio profissional. Estudos que focalizam a reflexão sobre a prática para sustentar o raciocínio profissional de terapeutas ocupacionais têm emergido; porém, eles ainda são incipientes, especialmente no Brasil. Objetivo Analisar o conteúdo e a aplicabilidade de uma ferramenta reflexiva para sustentar o raciocínio profissional no processo de análise situada das necessidades da pessoa em acompanhamento em terapia ocupacional. Método Pesquisa-ação, com participação de 11 terapeutas ocupacionais atuantes na Atenção Básica à Saúde, desenvolvida com as seguintes etapas: elaboração prévia da ferramenta; utilização da ferramenta pelas participantes e análise de seu conteúdo e estrutura; entrevistas individuais após a utilização; análise descritiva e temática; adequação da ferramenta; oficinas de validação; e construção da versão final da ferramenta. Resultados As modificações sugeridas abarcaram alterações de termos, acréscimos e integração de diferentes domínios. A versão final da ferramenta se estruturou em 20 questões, organizadas em sete domínios. As possibilidades de aplicabilidade foram: dar visibilidade para as especificidades da terapia ocupacional no trabalho em equipe; possibilitar a reflexão sobre a prática e melhorar o raciocínio profissional; utilizar a ferramenta em outros contextos de prática e no ensino da prática profissional. Conclusão A ferramenta apresenta aplicabilidade prática, contribuindo para fortalecer o núcleo profissional em terapia ocupacional e o diálogo interprofissional, facilitando a reflexão sobre a prática e ampliando a consciência sobre processos de raciocínio profissional.

Perceptions of School-Based Telehealth in a Rural State: Moving Forward After COVID-19

The purpose of this study was to discern the barriers faced by school-based clinicians, chiefly occupational therapists (OTs) and speech-language pathologists (SLPs) who provided telehealth in a primarily rural state during an unexpected declaration of a state of emergency in response to the COVID-19 pandemic. Survey results found the major barriers to implementation of telehealth services to be lack of practitioner training, a lack of access to technology for students, and concerns that the quality of intervention might not be equivalent to in-person service delivery. This article discusses both the benefits and barriers to providing telehealth services in school-based practice and offers considerations for future studies on this topic.

IQ and Sensory Symptom Severity Best Predict Motor Ability in Children With and Without Autism Spectrum Disorder

Motor challenges are commonly reported in autism spectrum disorder (ASD). Yet, there is substantial heterogeneity in motor ability within ASD, and it is unknown what behavioral characteristics best explain individual differences in motor ability in ASD and related conditions. This observational study examined motor ability as a function of sensory features, attention deficit/hyperactivity symptoms, ASD symptoms, and IQ in 110 children with ASD, typical development, or an intermediate behavioral profile. While motor challenges were more prevalent in the ASD group compared to other groups, sensory symptom severity and IQ across all individuals best predicted motor performance above-and-beyond group status. Therefore, motor challenges may be best characterized by individual variation in sensory features and cognitive abilities rather than diagnostic group.

Learning and Development of Diagnostic Reasoning in Occupational Therapy Undergraduate Students

Background/Aim

One way to facilitate occupational therapy undergraduate students transferring their academic skills of data gathering and analysis to professional settings is to ensure they can competently use diagnostic reasoning. Nevertheless, there are several obvious gaps in empirical evidence related to the learning and development of this style of reasoning in occupational therapy undergraduates. The most important are related to promoting higher-order thinking and the use of information to solve problems in the context of professional practice. This study analyses undergraduates' diagnostic reasoning and its changes during their education.

Materials and Methods

This multicentre study was conducted with a descriptive observational design. The study took place at the University of Coruña (Spain), University of Castilla-La Mancha (Spain), and University of el Valle (Colombia). The sample was n = 247. For data collection, a clinical case was specifically designed. IBM SPSS Statistics (v19) and EPIDAT 3.1 were used for the data analysis.

Results

Participants identified and categorized occupational performance problems. However, they had difficulties when identifying and categorizing the occupational performance components (specifically, the symptoms and signs of the disease presented in the study case). They presented limitations to analyse and synthesize the information collected to develop an explanation of the occupational problems and their causes.

Conclusions

Undergraduate students' ability to analyse and synthesize information during data collection is poorly organized, so it makes the problem formulation difficult. This study contributes to the knowledge of undergraduates' diagnostic reasoning features, specifically the undergraduate students' capacities and limits to process information during the occupational assessment.

Systematic review of sensory processing in preterm children reveals abnormal sensory modulation, somatosensory processing and sensory-based motor processing

AIM

Preterm birth poses concerns in daily functioning and behaviour in childhood, possibly connected to sensory processing disorder. This review aimed to systematically identify assessments, incidence and nature of sensory processing disorder in preterm-born infants and children.

METHODS

We searched literature through CINAHL-EBSCOhost, Cochrane, Ovid/PsychINFO, PubMed/Medline, Scopus and Google Scholar, published until November 2018. We included electronically available, peer-reviewed studies of preterm-born children that applied standardised sensory processing assessments. We excluded studies of preterm-born children with major neurodevelopmental impairments.

RESULTS

We identified 27 studies of premature children, aged from birth to 9 years 7 months. The assessments represented three versions of Sensory Profile questionnaires and three clinical tests, Test of Sensory Functions in Infants, the Miller Assessment for Preschoolers, and the Sensory Integration and Praxis Test. The studies revealed wide variation of atypical sensory processing: 28%-87% in sensory modulation, 9%-70% in somatosensory processing and 20%-70% in sensory-based motor processing.

CONCLUSION

Preterm-born children exhibited elevated risk for sensory processing disorder from infancy into school age. Routine screening of sensory processing, intervention intervals and parental consultations should be considered in ameliorating sensory processing and neurocognitive development. Moreover, a larger body of intervention studies is needed.

Professional Reasoning in Occupational Therapy: A Scoping Review

BACKGROUND/AIM

Professional reasoning in occupational therapy is the process used by practitioners to plan, direct, perform, and reflect on client care. The professional's ability to manage the process of the intervention is structured around it, thereby influencing the effectiveness of the work carried out. The objectives of this research were to identify and describe (a) the historical development of this area of research from 1982 to 2017 and (b) the nature and volume of the scientific literature on professional reasoning in occupational therapy and the evidence that exists today.

METHODS

A scoping review method was used to carry out an historical mapping of research on professional reasoning and to summarise the lines of research explored to date. The review was conducted in five stages following the PRISMA guidelines. After applying the selection criteria, the search identified 303 references.

RESULTS

The results are presented under three headings: (a) nature and volume of publications on professional reasoning in occupational therapy according to number and year of publications, journal, country, author, and line of research; (b) historical trends in the scientific literature on professional reasoning in occupational therapy since 1982; and (c) methodological aspects of the research. Each of them is discussed through statistical analysis.

CONCLUSIONS

The research about professional reasoning in occupational therapy is a field of empirical nature, in which qualitative studies predominate. Principal lines of research are focused on specific fields of practice, undergraduates, and theoretical aspects of professional reasoning. There were identified three historical phases with common features in terms of objectives and research methods.

Identifying Homogeneous Outcome Groups in Adult Rehabilitation Using Cluster Analysis

IMPORTANCE

Adults receiving occupational therapy in inpatient rehabilitation are a heterogeneous population with differing needs, outcomes, and rehabilitation processes. Outcome studies based on what works for all clients may obscure the needs of population subgroups who benefit unequally from rehabilitation services.

OBJECTIVE

To identify subgroups on the basis of client satisfaction and progress in functional self-care among a diverse rehabilitation population and to understand subgroup differences in occupational therapy and rehabilitation processes and client discharge status.

DESIGN

Using an existing dataset, we used K-means cluster analysis of demographics, status at admission, and the outcomes of satisfaction and change in self-care to identify five homogeneous outcome groups. Occupational therapy and rehabilitation processes and discharge status were compared across subgroups.

SETTING

Inpatient rehabilitation hospital.

PARTICIPANTS

The dataset included 1,099 inpatients age 18 yr and older who received occupational therapy over a 27-mo period.

MEASURES

Admission measures included the Inpatient Rehabilitation Facility-Patient Assessment Instrument and self-care items of the FIM™. The Satisfaction with Continuum of Care-Revised was administered after discharge.

RESULTS

Five subgroups showed statistically different patterns of medical complications, functional self-care, rates of progress, satisfaction with intervention, and course of treatment. The profile of each group suggests differing therapeutic needs. Although all groups made significant gains in functional self-care, two groups continued to need physical assistance at discharge.

CONCLUSION

and Relevance: Cluster analysis proved useful in segmenting a typical heterogeneous rehabilitation population into more homogeneous subgroups to enhance understanding of clinical needs and to potentially increase the potency of outcomes research.

WHAT THIS ARTICLE ADDS

This research identified subgroups within a typical population of rehabilitation clients receiving occupational therapy and identified their unique needs and outcomes using cluster analysis techniques.

The toileting habit profile questionnaire: Examining construct validity using the Rasch model

Introduction

Preliminary reports support the hypothesis that sensory issues may be related to atypical defecation habits in children. Clinical practice in this area is limited by the lack of validated measures. The toileting habit profile questionnaire was designed to address this gap.

Methods

This study included two phases of validity testing. In phase 1, we used Rasch analysis of existing data to assess item structural validity, directed content analysis of recent literature to determine the extent to which items capture clinical concerns, and expert review to validate the toileting habit profile questionnaire. Based on phase 1 outcomes, we made adjustments to toileting habit profile questionnaire items. In phase 2, we examined the item structural validity of the revised toileting habit profile questionnaire.

Results

Phase 1 resulted in a 17-item questionnaire: 15 items designed to identify habits linked to sensory over-reactivity and two designed to identify sensory under-reactivity and/or poor perception items. The analysis carried out in phase 2 supported the use of the sensory over-reactivity items. Remaining items can be used as clinical observations.

Conclusion

Caregiver report of behaviour using the revised toileting habit profile questionnaire appears to adequately capture challenging defecation behaviours related to sensory over-reactivity. Identifying challenging behaviours related to sensory under-reactivity and/or perception issues using exclusively the revised toileting habit profile questionnaire is not recommended.

Introduction to the Evaluation in Ayres Sensory Integration® (EASI)

Comprehensive, reliable, and valid assessment is essential for individually tailored, appropriate, and effective intervention planning and implementation. Research, education, and practice using an Ayres Sensory Integration^® (ASI) approach have a long history of prioritizing comprehensive assessment. To meet the need for a set of tests that will fully evaluate the constructs of ASI with psychometrically strong, internationally appropriate, and easily accessible measurement tools, the development of the Evaluation in Ayres Sensory Integration^® (EASI) has been initiated. This article introduces the EASI, describes the overarching plan for its development, and reports the results of promising preliminary analyses of discriminative validity data.

Manualization of Occupational Therapy Using Ayres Sensory Integration® for Autism

This article reports on the development of a Stage 3 manual (following pilot effectiveness study) for implementing occupational therapy using Ayres Sensory Integration® (OT/ASI) for children with autism spectrum disorders to enhance participation in daily occupations. Three stakeholder groups were surveyed to aid in translation of manual from research to practice (i.e., Stage 3 manual) and an expert consensus meeting was held to finalize recommendations. Data indicated that the manuals usability could be improved by including a section on frequently encountered problems and solutions, and by including video case examples. Also recommended were greater chapter uniformity, improved clarity of forms and charts, and inclusion of a glossary. Changes were made and subject to expert review and consensus using modified Delphi process. The Stage 3 manual has been rigorously vetted and is ready for practice and research replication.

Social Work Research in Practice: Lessons Learned

Using data and research to drive and evaluate clinical decision-making continues to slowly gain prominence across social work settings. This article shares insights and recommendations from a novice social work investigator to encourage other social workers to consider the value of researching while in practice. Practitioners new to research need encouragement and support. This article provides ideas for easing the first steps towards research to avoid potentially discouraging pitfalls.

Application of Data-Driven Decision Making Using Ayres Sensory Integration® With a Child With Autism

Health care and educational legislation and policy require that clinicians demonstrate, using measurement and report of outcomes, accountability for services rendered. Clinical algorithms have been developed and are used by various health care professionals to assist with hypothesis generation and systematic clinical reasoning; however, they do not explicitly guide measurement of outcomes as part of the reasoning process. Schaaf and colleagues developed the Data-Driven Decision Making (DDDM) process to address the greater need for outcome measurement, systematically support decision making, target intervention more precisely, and measure and document outcomes. This article describes the application of the DDDM process with a child with ASD who received occupational therapy using Ayres Sensory Integration®.

Linking Sensory Factors to Participation: Establishing Intervention Goals With Parents for Children With Autism Spectrum Disorder

Parents often focus on independence in activities of daily living and social participation when setting goals for their children with autism spectrum disorders. Occupational therapy practitioners use clinical reasoning to translate these goals to define occupation-based outcomes. This article describes an exploratory analysis of 160 parent-identified goals for children with autism. We identified sensory integrative factors hypothesized to influence each goal and then categorized the goals using the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health (ICF). Most goals were at the ICF participation and activity levels. Activities of daily living were the most common area of occupation identified, followed by social participation and play. Sensory reactivity and somatopraxis were the most frequently occurring sensory integrative factors. The value of addressing parent goals using a systematic reasoning process to identify factors affecting participation and the importance of measuring participation outcomes are discussed.