Psychometric Evaluation of the Persian Version of the Functional Mobility Scale: Assessing Validity and Reliability

AIM

This study aimed to assess the content, concurrent validity, test-retest, and intra-rater reliability of the Persian version of the Functional Mobility Scale (FMS) for evaluating functional mobility in children and adolescents with cerebral palsy (CP).

METHODS

Following international standards for measurement translation, we developed a Persian version of the FMS. A total of 160 participants took part in this study. Concurrent validity was assessed using Spearman's coefficient to correlate with the Gross Motor Function Classification System (GMFCS). Test-retest (n = 30) and intra-rater (n = 30) reliability of the FMS were also examined by Cohen's weighted kappa coefficient.

RESULTS

Concurrent validity ranged from -0.912 to -0.941 for children and -0.912 to -0.936 for adolescents. Test-retest ranged from 0.902 to 1. Intra-rater ranged from 0.933 to 0.987.

CONCLUSION

The Persian version of the FMS demonstrates very strong validity and almost perfect reliability for assessing and classifying functional mobility in children and adolescents with CP. These findings suggest that this tool could be a useful addition to clinical practice and research for the Persian-speaking population.

Does covid-19 pandemic tell us something about time and space to meet our being, belonging and becoming needs?

BACKGROUND

People's perceptions of events like a pandemic are shaped by individual experiences within their socio-cultural context. Attributing negative or positive meanings to an experience may influence the sense of Being, Belonging and Becoming.

AIM AND OBJECTIVES

To investigate the impact of the isolation/social distancing measures on people's sense of Being, Belonging, Becoming and overall sense of Occupational Wholeness compared to the time before the Covid-19 Pandemic as it is perceived by an Iranian population.

METHODS

The Model of Occupational Wholeness used to inform the theoretical basis of this study and development of the survey questions. An internet-based survey using a convenient and snowball sampling method was conducted. A self-administered questionnaire was published using a software named Porsline. A sample of 1624 members of the general population in Iran (67% response rate) completed the questionnaire within the first four weeks of the isolation/social distancing period starting on 18 March 2020. The Data was analysed by the SPSS 22.

RESULTS

The participants showed a more positive perceived level of Being and Belonging as well as an overall sense of Occupational Wholeness, and no difference in the perceived sense of Becoming during the isolation/social distancing period compared to the time before the Covid 19 pandemic.

CONCLUSIONS

The findings show that the isolation/social distancing measures were perceived by participants as an opportunity to meet some of their Being, and Belonging needs that contribute to an overall sense of OccupationalWholeness.This highlights the role that Occupational science and Occupational therapy may have in helping people in situations when they need to rethink and replan for what they Do and the way they attribute meaning to their experiences.

Spirituality as a Neglected Core in Occupational Therapy Practice: An Iranian Exploratory Survey

Spirituality has received more attention in recent decades from different health disciplines. Occupational Therapy (OT), as a health discipline, believes that all aspects of human experience, including physical, psychological, social, and spiritual, are considered essential aspects of health. OT supports the fact that incorporating spirituality can promote health, well-being, and quality of life. Various researchers have attempted to investigate and explain occupational therapists' views on spirituality. In Iran's OT curriculum, spirituality has not been incorporated directly. The purpose of this study is to acquire information about the knowledge and opinions of Iranian occupational therapists about spirituality. This is a cross-sectional exploratory descriptive survey study in which 125 occupational therapists participated through convenience sampling. Inclusion criteria were, namely (a) at least one-year clinical experience of OT, (b) being educated in Iran, and (c) working in Iran. The Occupational Therapy Assessment of Spirituality (OTAS) questionnaire was used for data collection. The answers to the quantitative questions were analyzed through descriptive statistics. Most of the participants believed that spirituality should be incorporated by occupational therapists, but more than half of the participants disagreed that formal education prepared them to pay any attention to spirituality in their practice. Analyzing qualitative data by frequencies of their repetitions, led to four categories and sixteen subcategories, accordingly. The four categories are (1) the barriers to applying spirituality in OT, (2) the need to acquire knowledge and apply spirituality in OT, (3) the benefits of incorporating spirituality for a client, and (4) the benefits of incorporating spirituality for the occupational therapist. The findings indicate that academic education has failed to prepare Iranian occupational therapists to meet spiritual needs of their clients. However, OTs tend to get information about spirituality from other sources and find it helpful for themselves and their clients. There are also barriers to applying spirituality; therefore, an educational package is needed to address these problems.

Factor structure of Participation Behavioural Questionnaire (PBQ) in patients with hand injuries

BACKGROUND

Participation is considered a critical outcome of successful rehabilitation and should be evaluated.

OBJECTIVE

We aimed to evaluate the structural validity of the Participation Behaviour Questionnaire (PBQ) in people with hand injuries.

METHODOLOGY

The PBQ contains 30 items that measure participation as conceptualized in the ICF. PBQ was developed with Rasch analysis to measure participation in hand injured. A sample of 404 patients with hand injuries and a mean age of 37 (16.0) participated and was randomly split for exploratory and confirmatory factor analysis (EFA/CFA).

RESULTS

Both EFA and CFA confirmed a four factor-solution. These factors were named: Social Participation and Interpersonal Relationships, Autonomy and Role, Subjective Satisfaction with Participation, Recreational, Sport, and Leisure Time. The value of Cronbach's alpha was 0.96 for the total scale and >0.85 for each subscale.

CONCLUSIONS

The structural validity of the PBQ was confirmed using both EFA and CFA. The PBQ measures four dimensions of participation.

Efficacy of Occupational Performance Coaching with and without Four Quadrant Model of Facilitated Learning for mothers of children with specific learning disorder: Study protocol for a randomized controlled trial

Background

In addition to academic problems, children with a specific learning disability (SLD) encounter problems with participation in activities outside school.

Purpose

To investigate the efficacy of Occupational Performance Coaching (OPC) with and without Four Quadrant Model of Facilitated Learning (4QM) in the mothers of children with SLD.

Method

A single-blinded, parallel-group randomized clinical trial will be carried out. Mothers of children with SLD will constitute the participants and be allocated to experimental (OPC+4QM) and control (OPC alone) groups.

Key issues

Children's occupational performance and satisfaction, participation in activities outside school, goals attainment, executive function, and academic achievement along with self-efficacy of mothers will be measured in baseline, post-intervention, and one-month follow-up stages.

Implications

An OPC intervention protocol may improve children's participation in activities outside school and may help clarify whether 4QM promotes maternal empowerment and better results for children with SLD.

Trial registration

Clinical Trials, IRCT20140416017301N9. (https://en.irct.ir/trial/55842)

Cognitive Orientation to Daily Occupational Performance (CO-OP) in Children with Cerebral Palsy: A Systematic Review with Meta-analysis

Background: Cognitive orientation to daily occupational performance (CO-OP) is a client-centered treatment approach that was developed in the 1990s by occupational therapists. Purpose: Exploring current evidence about the effectiveness of CO-OP on children with cerebral palsy (CP). Method: Major electronic databases were searched. A narrative synthesis of current literature and meta-analyses on randomized control trials (RCTs) were conducted on changes in occupational performance. Findings: Seven studies with 103 participants were included. Four studies were RCTs with moderate levels of evidence, and three studies had single-subject designs. Although beneficial effects of CO-OP on goal achievement and transferring learned skills were reported, meta-analyses showed that CO-OP had no significant effect on the performance (WMD = 1.52, 95% CI = -1.58 to 4.63, P = .33) and satisfaction domains (WMD = 1.71, 95% CI = -1.14 to 4.57, P = .24) of Canadian Occupational Performance Measure scores compared to alternative interventions. Implications: CO-OP improves occupational performance but not more than alternative interventions. Results are inconclusive due to small sample sizes and heterogeneity of alternative interventions and participants. Therefore, research with a larger number of participants with sound RCT methods is needed.

The effect of "Elder Care by Elderly People Program" on life satisfaction and quality of life among institutionalized senior citizens

INTRODUCTION

Improving participation in life meaningful roles is one of the most important predictors of quality of life (QOL) and life satisfaction (LS) in later life. The purpose of this study was to investigate the effect of Elder Care by Elderly People (ECP) on LS and QOL among institutionalized senior citizens.

MATERIAL AND METHOD

This was an interventional study involving a targeted sample of 36 older adults in Ghods nursing home in Tehran in 2018. WHOQOL-OLD 24-item and LS 40-item questionnaires were used to measure LS and Olathe repeated-measures ANOVA and descriptive was employed to obtain the objectives.

RESULTS

The participants were 36 older adults in Ghods nursing home. The mean age of older adults was 67.27 (standard deviation [SD] = 7.6), of whom about 77.8% were male. The mean score of QOL increased from 74.38 (SD = 13.09) pre intervention to 83.72 (SD = 11.43) 2 months post intervention, with most significant change of 9.3 QOL points between pre intervention and 2 months post intervention alone (P < 0.01). Similarly, LS increased from 114.19 (SD = 26.93) pre intervention to 133.94 (SD = 20.49) 2 months post intervention, with most significant change of 19.7 LS points between pre intervention and 2 months post intervention alone (P < 0.001).

CONCLUSIONS

The results of this study showing the evidence of the positive impact of the ECP Programmed for the elderly, therefore, it is suggested that the programmer is evaluated in future studies.

Mothers’ experience of being involved with the transfer of the CO-OP approach: A qualitative study

Introduction

Since mothers are the best persons to facilitate transfer in their children, it is important to understand their experience with implementing the cognitive orientation to daily occupational performance approach at home. Therefore, this study aims to explore mothers’ experiences in facilitating transfer during implementing cognitive orientation to daily occupational performance approach at the home in children with specific learning disorder.

Method

A semi-structured interview was applied for mothers of children receiving cognitive orientation to daily occupational performance. The interviews were transcribed verbatim and the data were analyzed using a continuous comparison technique and inductive content analysis.

Results

Five themes emerged which described the mothers’ experiences of being involved with the transfer of cognitive orientation to daily occupational performance approach at home including (1) mothers’ feelings toward themselves; (2) supportive therapist; (3) supportive social settings; (4) multidimensional educational content; and (5) educational methods.

Conclusion

Mothers expressed that cognitive orientation to daily occupational performance approach was simple, but they needed deeper information and skills. They provided suggestions for increasing the involvement during cognitive orientation to daily occupational performance intervention to increase transfer.

The COVID-19 Pandemic May Force the World to Reflect on the Pre-Pandemic Style of Life

Introduction: The COVID-19 pandemic has caused a lot of changes on an individual and societal level. The current study was designed to investigate the impact of the isolation/ social distancing period on people’s sense of Being, Belonging, and Becoming at the early stages of the COVID-19 measures. Methods: A cross-sectional survey study design was employed utilizing a researcher-developed questionnaire with items developed based on the Model of Occupational Wholeness to investigate the changes that may have happened to what people have been doing during the COVID-19 measures compared to the time before. A sample of 1206, using snowball sampling, responded to the online questionnaire. Results: Findings indicated that participants at the early stage of the COVID-19 pandemic had changed the pattern of their doings. The change of pattern, which was considered positive, was in relation to people valuing their health, having more time to take care of themselves, and doing activities which they had never had enough time to do before. Conclusion: While these findings are not generalizable, they provide some insights into how the post-pandemic lifestyle of many people does not permit doing a lot of activities that could help with their health and well-being. While enforced isolation may have negative consequences, it is also clear that the pre-COVID-19 pandemic lifestyle did not fully support healthy living. Reflecting on the COVID-19 lockdown experience provides an opportunity to review the essential personal and societal elements for living a healthy life.

Validity and reliability of Persian version of the Arm Function in Multiple Sclerosis Questionnaire

Introduction

This study aimed to determine the validity and reliability of the Persian version of the Arm Function in Multiple Sclerosis Questionnaire which is a self-report questionnaire for persons with multiple sclerosis (MS).

Method

This methodological study was performed in the following stages: translation, validity, internal consistency, and test–retest reliability of Persian-AMSQ. The Nine-Hole Peg Test (9HPT), Coin Rotation Task (CRT), and Functional Independence Measure (FIM) for construct validity were used. Psychometric testing was done to ascertain the validity and reliability of the questionnaire.

Results

In this study, 155 people with MS participated. There were no major linguistic or cultural difficulties in the translation of AMSQ. Face and content validity confirmed by experts and people with MS. The internal consistency was high (Cronbach’s α = 0.99). Test–retest reliability, as measured with intra-class coefficient, was 0.98. Correlations with 9HPT (r = 0.54), CRT (r = 0.16), and FIM (r = −0.54) were significant ( p < 0.05).

Conclusion

The Persian-AMSQ appears to be a valid and reliable questionnaire for measuring upper extremity dysfunction in MS.

Occupational Therapy Assessment of Spirituality questionnaire: translation into Persian and psychometric testing

Background/aims

Occupational therapy is a profession that uses holistic and person-centered approaches that deal with all aspects of daily life. Clients' needs fall into four areas, and one of them is spirituality. Therefore, occupational therapists should pay attention to this area, but there is little information on the status of occupational therapists' knowledge and use in clinical practice. The aim of this study was to translate the occupational therapy assessment of spirituality questionnaire into Persian and determine its validity, factor analysis and reliability.

Methods

This is a psychometric study that was conducted between June and September 2018. The Occupational Therapy Assessment of Spirituality is a self-report, 25-item questionnaire, with self-exploratory scoring that investigates occupational therapists' views on four factors: spirituality in the scope of practice following its addition in the theoretical framework; formal education and training on spirituality; need for future educational opportunities and training to address spirituality; and awareness of assessments and evaluations in occupational therapy that incorporate clients' spirituality. The International Quality of Life Assessment approach was used for translation. Content validity was performed with 10 occupational therapists regarding qualitative content validity, content validity index and content validity ratio. Exploratory factor analysis and internal consistency with a sample size of 125 people and test–retest coefficient with a sample size of 25 people were computed for reliability.

Results

Qualitative content validity was confirmed, with content validity index greater than 0.79 and content validity ratio greater than 0.62. During the exploratory factor analysis process, the number of factors was reduced to three factors and the number of questions were reduced from 21 to 15 questions. Internal consistency was good (0.88). Test–retest coefficient was 0.96, with a high level of significance (P<0.001).

Conclusions

The Persian version of the Occupational Therapy Assessment of Spirituality is a reliable and valid questionnaire and can be used among Iranian occupational therapists in different clinical settings.

A web-based daily care training to improve the quality of life of mothers of children with cerebral palsy: A randomized controlled trial

BACKGROUND

Mothers of moderately to severely affected children with cerebral palsy (CP) have to spend a long time to take care of their children. This time-consuming responsibility affects their physical and psychosocial health. Therefore, mothers as caregivers are required to receive special training to take care of their children.

AIMS

The aim of this study was to evaluate the effectiveness of a developed web-based intervention for daily care training of children with CP on their mothers' quality of life (QOL), anxiety, depression, stress, and their musculoskeletal pain.

METHODS AND PROCEDURES

This study was a single blind randomized controlled trial. 91 mothers of children with CP with Gross Motor Function Classification System (GMFCS) levels III, IѴ, and Ѵ, who aged from 4 to 12 years were assigned to the intervention and control groups using block randomization. Mothers in the control group received their routine face to face occupational therapy intervention and mothers in the intervention group received 12 weeks web-based intervention. QOL, depression, anxiety, stress, and pain were measured before and after the intervention in both groups.

OUTCOMES AND RESULTS

The results of analysis of covariance showed that after controlling the mean score of pretest of pain, the mean score of post-tests in the intervention and control groups was significantly different (P < 0.05). The mean scores of physical health and total QOL scores of post-tests in the intervention group were significantly higher than the control group with controlling pretest scores.

CONCLUSIONS AND IMPLICATIONS

Designed web-based intervention affects the caregivers' QOL and pain significantly. This intervention can be used to provide daily care training for mothers of children with CP.

The effects of anxiety and dual-task on upper limb motor control of chronic stroke survivors

This study was designed to investigate the effects of anxiety and dual-task on reach and grasp motor control in chronic stroke survivors compared with age- and sex-matched healthy subjects (HC). Reach and grasp kinematic data of 68 participants (high-anxiety stroke (HA-stroke), n = 17; low-anxiety stroke (LA-stroke), n = 17; low-anxiety HC, n = 17; and high-anxiety HC, n = 17) were recorded under single- and dual-task conditions. Inefficient reach and grasp of stroke participants, especially HA-stroke were found compared with the control groups under single- and dual-task conditions as evidenced by longer movement time (MT), lower and earlier peak velocity (PV) as well as delayed and smaller hand opening. The effects of dual-task on reach and grasp kinematic measures were similar between HCs and stroke participants (i.e., increased MT, decreased PV that occurred earlier, and delayed and decreased hand opening), with greater effect in stroke groups than HCs, and in HA-stroke group than LA-stroke group. The results indicate that performing a well-learned upper limb movement with concurrent cognitive task leads to decreased efficiency of motor control in chronic stroke survivors compared with HCs. HA-stroke participants were more adversely affected by challenging dual-task conditions, underlying importance of assessing anxiety and designing effective interventions for it in chronic stroke survivors.

Cognitive Assessments Used in Occupational Therapy Practice: A Global Perspective

This exploratory study was aimed at evaluating the current status of global occupational therapy practice on the use of assessments for clients with cognitive impairments and providing recommendations for ongoing evidence. We targeted international occupational therapy clinicians working with clients experiencing neurocognitive impairments. 323 occupational therapists from a wide range of clinical practice areas participated in the study. A large number of therapists used noncognitive specific assessments with a focus on functional approaches. The most commonly used standardized assessments were the COPM (56.7%), followed by MMSE (54.2%) and MoCA (45.5%), while the nonstandardized assessments were clinical observation (38.4%) and generic ADL assessment (34.1%). The use of main assessments was significantly different across world regions (p < 0.05), as were the reasons for choosing them (p < 0.05). The occupational therapists' use of assessment tools with clients suffering from neurocognitive impairments is inconsistent across the globe. The identification of international best practices for selecting and implementing proper outcome measures is warranted. It is essential to promote the development of an occupational therapy initiative to support the use of appropriate assessments at the international levels to facilitate consistent best practice.

Content Validity and Reliability of the Persian Version of School Function Assessment in Children With Cerebral Palsy Aged 7-12 Years

Objective: Cerebral Palsy is one of the most common neurodevelopmental disorders in children. Due to the increase in the number of students with Cerebral Palsy (CP) entering ordinary schools and facing problems with independent functioning, there is a need for a valid and comprehensive assessment tool for their successful entry as well as providing a proper treatment plan. The School Function Assessment (SFA), by measuring many school-related functional skills, can identify the strengths and weaknesses affecting the students’ independence and participation in school assignments. It has 320 items and three main parts of participation, task support, and activity performance. The test score can be reported in general or based on each part, separately. The purpose of this study is to examine the validity and reliability of the Persian version of the SFA in children with CP. Materials & Methods: This is a cross-sectional study with methodological design. The study population consists of all children with CP aged 7-12 years in Tehran. Of these, 120 were selected from exceptional public school using a convenience sampling method. The inclusion criteria were: CP diagnosed by a neurologist, age between 7 and 12 years, no other disabilities (e.g. deafness or blindness), and the willingness of children’s parents to participate in the study. A demographic form and the Persian SFA were used for data collection through interview. In order to measure the content validity, Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated according to the standard protocol of International Quality of Life Assessment. In this regard, 8 experts in the field of pediatrics completed the Persian SFA. To determine the test-retest reliability, the questionnaire was completed by the parents of children with a 4-week interval. The internal consistency and test-retest reliability were examined by using Cronbach’s alpha coefficient and Intra-class Correlation Coefficient (ICC), respectively. Data was analyzed in SPSS V. 22 software. Results: Participants were 64 boys and 56 girls with CP (mean age= 9.4 years). The distribution of CP was as follows: 10% hemiplegic CP, 27.5% diplegic CP, 5.8% monoplegic CP, and 56.7% quadriplegic CP. Eighty hundred-eight percent of respondents were the mothers of students. The CVR and CVI values were in a range of 0.7-1 and 0.87-1, respectively indicating an acceptable validity. All the items had acceptable content validity. The Cronbach’s alpha coefficient was obtained 0.95 for participation, 0.95-0.99 for task support, 0.83-0.99 for activity performance, and 0.92 in total. Moreover, the ICC value was reported 0.90 for participation; 0.84-0.91 for task support; 0.84-0.97 for activity performance; and 0.89 for the overall test. Conclusion: The Persian version of SFA has acceptable content validity and reliability (internal consistency and test-retest) for children with CP. Therefore, it can be applied as a research and clinical tool to assess the school-related performance of these children.

Sensory retraining improves light touch threshold of the paretic hand in chronic stroke survivors: a single-subject A-B design

Background: Light touch, one of the primary and basic sensations, is often neglected in sensory retraining programmes for stroke survivors.Objective: This study aimed to investigate the effects of sensory retraining on the light touch threshold of the hand, dexterity and upper limb motor function of chronic stroke survivors.Methods: Five chronic stroke survivors with sensory impairment participated in this single-subject A-B design study. In baseline (A) phase, they only received standard rehabilitation. In the treatment (B) phase, they received a 6-week sensory retraining intervention in addition to standard rehabilitation. In both phases, they were evaluated every 3 days. Light touch threshold, manual dexterity and upper limb motor function were assessed using Semmes-Weinstein Monofilaments, Box-Block Test and Fugl-Meyer Assessment, respectively. Visual analysis, nonparametric Mann-Whitney U test and, c-statistic were used for assessing the changes between phases.Results: All participants indicated changes in trend or slope of the total score of light touch or both between the two phases. The results of the c-statistic also showed the statistical difference in the total score of light touch between baseline and treatment in all participants (p < 0.001). Also, the results of the c-statistic and Mann-Whitney U test supported the difference of manual dexterity and motor function of the upper limb between baseline and treatment in all participants (p < 0.001).Conclusion: Current findings showed that sensory retraining may be an effective adjunctive intervention for improving the light touch threshold of the hand, dexterity and upper limb motor function in chronic stroke survivors.

Construct validity of the Persian version of the Child Occupational Self-Assessment in children with attention-deficit/hyperactivity disorder in Iran

Objective

This study aimed to assess the construct validity of the Child Occupational Self-Assessment, translated to Persian that could provide occupational therapists with a tool to evaluate occupational competence and values of children in Iran.

Methods

A total of 250 children (87 girls and 163 boys) with attention deficit hyperactivity disorder aged 7.5–11 years referred from two specialised children’s hospitals were included. The researchers read the questions to the children and they identified their own answers. The data were analysed based on the Rasch Rating Scale Model.

Results

Four of the items showed misfit and as a result of deleting these items the Persian version of the questionnaire has 21 items with an appropriate validity.

Conclusion

The Persian version of Child Occupational Self-Assessment can be used with new items format. It could be also useful to replace the missing question to develop the tool further.

Validity and reliability of the Persian version of the Eating and Drinking Ability Classification System

Background/Aims

The ability to eat and drink is the most important factor in health, survival and longevity. Children with cerebral palsy can suffer from severe dysphagia, which can lead to a high risk of aspiration and choking. As classifying eating and drinking ability in children with cerebral palsy is important in research and treatment, the aim of this study was to determine the cross-cultural validation and reliability of the Persian version of the Eating and Drinking Ability Classification System.

Methods

After translation procedures, the face validity, content validity, test–retest reliability and interrater reliability of the Eating and Drinking Ability Classification System were evaluated. In total, 130 parents of children with cerebral palsy and 34 therapists participated in the evaluation of the scale's reliability. The 73 boys and 57 girls with cerebral palsy were aged 3–20 years (mean age 4.4 years) and had various types of cerebral palsy. They were classified according to the Eating and Drinking Ability Classification System by both their parents and the therapists.

Results

The overall results indicated that the words and sentences used were simple, clear, understandable, relevant and necessary. The intraclass correlation coefficients for test–retest reliability for parents, occupational therapists and speech therapists were 0.98, 0.98 and 0.995, respectively. The interrater reliability between parents and occupational therapists was 0.96, between parents and speech therapists was 0.95, and between occupational therapists and speech therapists was 0.985.

Conclusions

The Persian version of the Eating and Drinking Ability Classification System seems to be valid and reliable. This system may be used to evaluate children with cerebral palsy.

Cross-cultural psychometric properties of the Persian version of the Measure of Processes of Care for Service Providers questionnaire

Background

The Measure of Processes of Care is the most widely used tool for measuring family-centredness and perceptions of the care process. This study assessed the psychometric properties of the Persian language version of the Measure of Processes of Care for Service Providers questionnaire.

Methods

In a cross-sectional study, the Measure of Processes of Care for Service Providers questionnaire was translated three times based on a backward–forward method. The Persian version of the Measure of Processes of Care for Service Providers was used with 150 health providers in Iran. The Pearson correlation coefficient, Cronbach alpha and interclass correlation coefficient were used for reliability analysis. Content validity index and content validity ratio and confirmatory factor analysis was used for validity assessments.

Results

The test-retest correlation was higher than 0.95 and the interclass correlation coefficient was higher than 0.8 in all domains. The consistency coefficient was calculated as r=0.989 and the Cronbach alpha calculated as 0.994, which varied from 0.978 to 0.994. The content validity index average was 0.97, which varied from 0.90 to 0.99. Moreover, the content validity ratio average calculated 0.726 and ranged from 0.60 to 0.95. The goodness of fit index was acceptable as CMIN =χ2: 411.52, df; 280, P<0.001, CMIN/df; 1.47, root mean square error of approximation: 0.056; P value: 0.19, goodness of fit index and Tucker–Lewis index was 0.951 and 0.938 respectively.

Conclusion

The Persian translation of the Measure of Processes of Care for Service Providers questionnaire is a standard tool for assessing family-centred care with acceptable reliable and valid. It could be used in all health, clinical and rehabilitation centres to assess family-centred care in health care providers and can be an incentive to improve the quality of family-related services.

Knowledge about and Attitudes of Interdisciplinary Team Members toward Occupational Therapy Practice: Implications and Future Directions

OBJECTIVES

In Kuwait, knowledge and attitudes of the health care teams toward occupational therapy practice (OTP) have not been investigated. This current study sought to explore the knowledge about and attitudes of interdisciplinary team members toward OTP.

SUBJECTS AND METHODS

This cross-sectional study involved developing and validating a tool to serve the purpose of the study. We used a modified Delphi method to develop a tool that assessed occupational therapy (OT) knowledge (OT areas of practice, domains, and philosophy) as well as attitudes toward OTP. Descriptive statistics were utilized, and nonparametric tests were used to compare knowledge and attitudes along with the demographic data.

RESULTS

A convenience sample of 98 participants from various disciplines participated in this study. The tool was found to have an adequate content validity for a total of 27 items and satisfactory reliability (internal consistency); Cronbach's α-values for the knowledge and attitudes subscales were 0.88 and 0.74, respectively. The overall knowledge level of OTP among the participants was limited, whereas their attitudes were favorable. Characteristics of being a female (p = 0.01), a nurse (p = 0.02), and working experiences ≥10 years (p = 0.01) contributed significantly to the knowledge of OTP. The results further indicated that participants working in general hospitals (p = 0.02) and working with occupational therapists (p < 0.001) showed significantly better attitudes toward OTP.

CONCLUSION

For effective collaborative practice and better patients' outcomes, the study findings recommend the development of interprofessional initiative committees targeting educational settings as well as clinical environments.

Investigate the Effect of Psychological Factors in Development of Complex Regional Pain Syndrome Type I in Patients with Fracture of the Distal Radius: A Prospective Study

Background: To investigate the role of psychological factors (anxiety and depression) and pain measured on a visual analogue scale (VAS) in the development of complex regional pain syndrome type I (CRPS I) following the distal radius fracture (DRF).

Methods: A consecutive sample of patients (N=60) with a distal radius fracture was measured for signs of CRPS by Budapest criteria weekly till 8 weeks and then another follow-up one year after injury to determine the incidence and predictors of developing CRPS I in a prospective cohort study and also to discover whether there is difference between pain, depression, and anxiety level in the patients with and without CRPS I. The most of the patients were treated by Pin stabilization. The Beck depression inventoryshort form (BDI), State-Trait Anxiety Inventory, and Numerical pain rating scale were used to determine the patients’ psychological features and pain intensity at the base line and 8 weeks after the fracture.

Results: CRPS I developed in 15 (25%) patients after eight weeks and just last in 10 (16.67%) patients after one year. No difference was found between the two groups (CRPS and non-CRPS group) in terms of state (STAI-I) and trait (STAI-II) anxiety, and BDI score. Pain at the base line was the most important risk factor in developing CRPS (odds ratio [OR] =1.52; 95% CI).

Conclusions: After fracturing the distal radius, patients who have high pain intensity have a higher risk of developing CRPS I. To following these patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions.

Randomized controlled trial of occupational performance coaching for mothers of children with cerebral palsy

Introduction

The purpose of this study was to assess the efficacy of occupational performance coaching in mothers of children with cerebral palsy.

Method

A randomized controlled trial was used. Thirty mothers of children with cerebral palsy were randomly assigned to an occupational performance coaching group or control group. The Canadian Occupational Performance Measure and Sherer General Self-efficacy Scale were measured before and after the study.

Results

Occupational performance coaching had significant effects on participants’ occupational performance and self-efficacy. In child-related goals, there was also a statistically significant difference between two groups ( p = 0.05).

Conclusion

The results indicated that occupational performance coaching could be an effective intervention to increase the self-efficacy of mothers and improve the occupational performance of children and mothers of children with cerebral palsy. This trial is registered at NCT02915926 at clinicaltrials.gov

Validation of Persian Caregivers' Report of Quality of Life questionnaire for adolescents with cerebral palsy

Background/Aims:

There is no tool in Persian to examine quality of life for adolescents with cerebral palsy based on their specific conditions. Therefore, the purpose of this study was to assess the psychometric properties of the Persian version of the caregivers' report of the Quality of Life questionnaire for adolescents with cerebral palsy (CP QOL).

Methods:

In this psychometric measurement study, the CP QOL (caregivers' report) was translated into Persian, and then its content validity, and construct validity were examined. A convenience sample of subjects including 82 parents of adolescents with cerebral palsy (13–18 years) were recruited for this study. Then, the relationship between the participants' quality of life and their level of gross motor and hand function was assessed.

Findings:

Internal consistency for all the questions of the questionnaire were high (0.78–0.92). There was also a significant and weak correlation between all domains of quality of life and the adolescents' gross motor function and manual abilities.

Conclusions:

The Persian version of the caregivers' report of the CP QOL-Teen has acceptable content validity. It is a useful tool for evaluating the quality of life of adolescents with cerebral palsy.

Effectiveness of cognitive orientation to (daily) occupational performance (CO-OP) on children with cerebral palsy: A mixed design

BACKGROUND

Cerebral palsy (CP) is the most common cause of physical disabilities during childhood. Therapeutic interventions mainly focus on impairment reduction to address motor-based difficulties. In contrast, Cognitive Orientation to daily Occupational Performance (CO-OP) is a cognitive approach, providing intervention at the level of activity and participation.

AIMS

This study aims to determine whether the CO-OP approach improves motor skills and achievement in motor-based occupational performance goals in children with CP.

METHODS AND PROCEDURES

In this mixed design research (i.e., a multiple baseline single case experimental design and a one-group pretest-posttest design), five children with CP participated in 12 CO-OP intervention sessions. Repeated measures of motor skills for the multiple baseline single case experimental design were taken using the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP); pre- and post-measures of parent/child perception of performance and satisfaction were identified using the Canadian Occupational Performance Measure (COPM); level of achievement was identified using Goal Attainment Scaling (GAS).

OUTCOMES AND RESULTS

According to the BOTMP results, all children were able to engage in the CO-OP intervention to improve motor performance. Significant differences after treatment were found in both performance and performance satisfaction ratings using the COPM as rated by parents and children. The GAS results showed progress in achievement levels for all children; all goals were achieved or exceeded.

CONCLUSIONS AND IMPLICATIONS

CO-OP intervention can be helpful in improving motor skills and achieving self-identified, motor-based goals in children with CP.

Occupational therapists' perception of the concept of occupational balance

INTRODUCTION

Occupational balance is one of the concepts used by occupational therapists with no consensus on its definition. Literature demonstrates different perspectives when this concept is applied in practice and in its link to other concepts such as health and well-being. This study aims to explore how the concept of occupational balance is perceived and practised by occupational therapy practitioners.

METHOD

A qualitative methodology was employed. Fourteen occupational therapists volunteered for the study. Nine occupational therapy practitioners were interviewed individually and five attended a focus group. Thematic analysis was applied to analyze the data.

RESULTS

Six themes were identified as follows: (1) occupational balance: what it is; (2) how occupational balance is formed; (3) occupational balance and well-being (4); subjective and objective representations of occupational balance (5); what disrupts/affects occupational balance; and (6) occupational balance/imbalance and occupational therapy practice.

CONCLUSIONS

Both objective and subjective experiences of occupational balance need to be considered in order to make an informed decision in practice. The right occupational balance for each individual should be based on his/her values but with consideration of the principal of no harm to others.

Managing Upper Limb Hypertonicity: Factors Influencing Therapists' Decisions

This study employed social judgement theory to identify and determine the relative importance of factors influencing occupational therapists' subjective decision making when managing children and adolescents with cerebral palsy and upper limb hypertonicity. An extensive literature review was conducted to identify potential factors that might be used. Two clinical experts were then asked to review and refine these factors. Finally, 12 experienced occupational therapists who had worked with people with cerebral palsy for at least 5 years were asked to add or exclude factors and then to rank them. Thirty-seven factors that might influence therapists' decision making were identified and ranked.

The reason for referral and family's goals were ranked as the first and second most important factors respectively. Agreement among therapists was significant, but low (Kendall's W = 0.38; p<0.0001). When participants were divided into two groups, those who were very experienced (mean = 13 years, SD = 6.95) and those with less experience (mean = 5.6 years, SD = 0.55), the ranking of the factors did not differ significantly. These findings are discussed with respect to research in clinical decision making, the training of occupational therapists and the education of students.

Effect of an Educational Workshop on Health Care Professionals' Perceptions of the Role of Occupational Therapy

Date Presented 4/8/2016

A focus on preparing health care professionals as well as students (future health care professionals) for understanding the value of interprofessional collaborations and its direct effect on the therapeutic process should be incorporated within the academic and clinical environments.

Primary Author and Speaker: Naser Alotaibi

Contributing Authors: Fahad Manee, Lisa Broom, Mehdi Rassafiani

A Comparison of the Quality of Life of Arab Mothers of Children with and without Chronic Disabilities

AIM

To compare the quality of life (QoL) of Arab mothers in Kuwait who had children with chronic disabilities and those whose children had no disabilities and provide recommendations for how occupational therapists can assist in enhancing the mothers' QOL.

METHODS

The case group included 71 mothers of children with chronic disabilities and a control group of 86 mothers of children without disabilities. Mothers' QoL was assessed using the Arabic WHOQOL-BREF questionnaire and the support systems of mothers of children with disabilities using a support questionnaire.

RESULTS

The QoL of mothers of children with disabilities was significantly lower than that of mothers of healthy children (p < .001) in all four domains of WHOQOL-BREF (physical health, psychological wellbeing, social relationships, and environment). Mothers of children with disabilities reported that they received most support from their nuclear family. There was a lack of formal support systems in place in Kuwait.

CONCLUSION

Mothers of children with disabilities perceive their QoL as poor and they have limited support systems. Occupational therapists are encouraged to serve as a resource for families, sharing information including available services and community resources, and supporting mothers as competent caregivers.

Leisure time activities of Iranian patients with multiple sclerosis: a qualitative study

BACKGROUND

Leisure time is one of the most important aspects of life, especially for people with chronic diseases. The concept and types of leisure have frequently been evaluated in different socio-cultural populations. The aim of this study was to identify the nature of leisure activities among a sample of Iranian patients with multiple sclerosis (MS) and classify the identified types of activities in the context of Iranian culture.

METHODS

In this qualitative study, semi-structured interview was applied to gather data from 34 MS patients that were selected through purposive sampling. The interviews were continued up to the point of saturation. Content analysis was used to explore experiences of the interviewees regarding their leisure activities.

RESULTS

Six categories of leisure activities were extracted for the studied patients with MS i.e.physical, social, individual, art/cultural, educational and spiritual/religious.

CONCLUSION

The results represented the range and heterogeneity of leisure activities amongst the MS patients. Considering participation in spiritual/religious and social activities as leisure time undertaking might reflect cultural diversity in the perception and use of time for recreation. For mental health promotion purposes, paying special attention to the types of activities that people of different socio-cultural background choose for their refreshment could help health care providers in giving tailored advice for patients with MS and other chronic debilitating disease.

The relationship between gross motor function ability and time use in mothers of children with cerebral palsy

Introduction

According to the World Health Organization, the balanced usage of time contributes to the health and welfare of individuals. Caring for a child with cerebral palsy imposes an extra pressure on parents, especially mothers as the main caregiver. Therefore, this study aims to investigate the relationship between gross motor function ability of children with cerebral palsy and time use of their mothers.

Method

Sixty mothers of children with cerebral palsy, sampled conveniently, participated in this cross-sectional study. Children aged between 6 and 11 years with a mean age of 9.04 years old (SD = 2.8). The Farsi version of Mothers’ Time Use Questionnaire and the Gross Motor Function Classification System (GMFCS) were utilized to collect data. The Spearman correlation coefficient was calculated.

Results

The results demonstrated that the allocated time for childcare ( rs = 0.44) and leisure ( rs = −0.37) activities in mothers have significant correlations with gross motor function abilities of their children ( P < 0.05).

Conclusion

Mothers who have children with higher scores according to the GMFCS, had to invest more time to meet needs of childcare activities. Consequently, they were not able to follow their interests and they felt an imbalanced use of time in their life.

Factors Associated with Quality of Life in Mothers of Children with Cerebral Palsy in Iran

Objective/Background

Children with cerebral palsy (CP) need more attention and care, especially from their mothers. This can affect the mothers’ quality of life (QOL) adversely. This study aimed to assess the QOL of Iranian mothers who have a child with CP, compared with mothers with a healthy child, focusing on some individual and social underlying factors.

Methods

Using a cluster-sampling approach, two groups of eligible mothers having children aged 4–12 years, with and without CP, from Tehran's randomly selected clinics, were chosen in a convenient way and enrolled in a cross-sectional study. A group of mothers with healthy children whose demographics closely matched with the group of mothers having children with CP were selected and recruited in the study. The group with mothers with children with CP was selected randomly from a convenience sample in 14 rehabilitation and occupational therapy clinics in Tehran, Iran. To collect data on characteristics of interest, mothers were interviewed, and the SF-36 Questionnaire was used to measure their QOL. The relationship between each characteristic and the mothers’ level of QOL was assessed, and the crude odds ratios (ORs) and adjusted ORs were measured by logistic regression.

Results

Sixty mothers with CP children, and 60 mothers with healthy children participated in this study. Their mean (±standard deviation) age was 33.79 (±6.02) years, and their children's mean age was 7.11 (±2.71). The two groups were significantly different in QOL mean score (57.35 ± 18.39 vs. 71.7 ± 13.58; p ≤ .001). It was shown that having a child with CP with intellectual disability is significantly related to a worse level of QOL of mothers (adjusted OR = 5.4, p ≤ .001), whereas having full-time jobs is reversely associated with it (adjusted OR = 0.2, p = .02).

Conclusion

Two important factors that lead to a worse QOL of mothers with a CP child are the unemployment of mothers and having a CP child with concurrent intellectual disabilities. To diminish the adverse effects of having a CP child on QOL of mothers, unemployed women who have a CP child with concurrent intellectual disabilities need more psychological support and help.

Exploring the Relation Between Impairment Rating by AMA Guide and Activity and Participation Based on ICF in the Patients with Hand Injuries

The aim of this paper is to analyze the relation between components of disability with distinguished score of impairment, activity and participation questionnaire based on clinical data of persons with hand injuries. Impairment was evaluated by use of AMA guide 6th edition and disability by DASH questionnaire on Convenience sample of patients (N = 117), with chronic hand injuries. Linking and allocating items of the DASH were done based on the ICF Core Set for Hand Conditions and the opinions of a group of experts from different related fields. Data was analyses by using Kappa index, Chi square test and a set of Pearson, Part and Partial correlations coefficient. Most of the DASH items were allocated to the activity; one to four of the items could not be classified and 0 to 22 were classified as having overlap. Participation and activity scores correlated positively with each other (r > 0.80). Impairment had high correlation with activity and participation scores (>73). With controlling the effect of each or both construct, this relation between them with impairment diminished but still significant between activity and impairment. There is a huge overlap in definition of activity and participation. The most effecting item in relation of disability and impairment is activity restriction. Participation had no relation with impairment.

Factors affecting ethical behavior in pediatric occupational therapy: A qualitative study

BACKGROUND

It is the responsibility of each occupational therapist to always act ethically and professionally in a clinical setting. However, there is little information available concerning the factors influencing ethical behavior of occupational therapists at work. Since no study has been conducted in Iran on this topic, this qualitative study aimed to identify the factors influencing ethical behavior of pediatric occupational therapists.

METHODS

Twelve pediatric occupational therapists participated in this study. The sampling was purposeful, and the interviews continued until reaching data saturation. All interviews were recorded and transcribed. The data were analyzed by qualitative content analysis, and the ethics of qualitative research was considered.

RESULTS

The factors influencing ethical behavior were classified into four main categories including organizational factors, therapist related factors, client's family issues, and social factors.

CONCLUSION

This study identified numerous factors influencing the ethical behavior of pediatric occupational therapists that could be used to train occupational therapists, human resources managers, professional policy makers, and could also be used to conduct future researches, and produce tools.

Co-occupations: The caregiving challenges of mothers of children with cerebral palsy

Introduction

This study was conducted in an Iranian context to explore the co-occupations of mothers of children with cerebral palsy as experienced by them.

Method

This qualitative study was conducted using content analysis methodology. Sixteen mothers of children with cerebral palsy participated in the study. Data was collected via in-depth, semi-structured interviews. Constant comparative analysis was deployed for data analysis.

Results

The results were classified into nine sub-categories and four main categories that were identified as (1) coping with self-care problems, (2) effort to gain treatment follow-up, (3) coping challenges of educational care, and (4) limited parental personal leisure time.

Conclusion

Understanding the challenges of caring for a child with cerebral palsy and the experiences of mothers when engaging in co-occupations with their child, provides a broader perspective of the potential impact on participation and engagement of mothers. However, more research is required to understand the various factors influencing participation and co-occupations and interaction effects between these factors.