Effectiveness of Robotic Intervention on Improving Social Development and Participation of Children with Autism Spectrum Disorder - A Randomised Controlled Trial.

Evidence-based robotic intervention programmes for children with autism spectrum disorder (ASD) have been limited. As yet, there is insufficient evidence to inform therapists, teachers, and service providers on effectiveness of robotic intervention to enhance social development and participation of children with ASD in a real context. This study used a randomised controlled trial to test the efficacy of robotic intervention programmes in enhancing the social development and participation of children with ASD. 60 children with ASD were included. The participants were randomly assigned to the following groups: (1) robotic intervention programme (n = 20), (2) human-instructed programme (n = 20), and (3) control group (n = 20). Both the performance-based behavioural change in social communication and parent-reported change in social responsiveness were evaluated. The participants in the robotic intervention group demonstrated statistically significant changes in both the performance-based assessment and parent-reported change in social participation. Significant differences were found in the communication and reciprocal social interactions scores between the experimental group and the control and comparison groups in the performance-based assessment (p < 0.01). The effectiveness of robotic intervention programme to enhance the social communication and participation was confirmed. Future studies may also consider adding a maintenance phase to document how the effects of the intervention carry over to the participants over a longer period. (Clinical trial number: NCT04879303; Date of registration: 10 May 2021).

Building and Testing of a Conceptual Model to Describe and Measure the Health of People as Affected by Post-traumatic Stress Disorder During Social Unrest: A Confirmatory Factor Analysis and Structural Equation Modeling.

Background: Social unrest affects people's health and well-being. People's health-related needs during social unrest are concerns in both research and clinical practice. This study aimed to build and test a framework to describe and understand the health status and needs of people with post-traumatic stress disorder (PTSD) during social unrest. Methods: This study was a cross-sectional survey. A total of 460 people who had experienced post-traumatic distress as a result of the social unrest in 2019 and 2020 were included. A conceptual model comprised four essential areas, namely posttraumatic distress symptoms, participation restrictions, perceived stigma and functional disability, was built from literature. Part 1 validated four instruments that evaluate and define the factor structure of these four areas, In Part II, structural equation modeling was used to test and validate a combined model. Results: Factors underlying the four areas were defined. Analysis using structural equation modeling confirmed a best fit of the model. PTSD symptoms, perceived stigma and participation restriction during social unrest contributed significantly to functional disability; PTSD symptoms exerted a direct effect on participation restriction and perceived stigma; and the effect of PTSD symptoms on functional disability was mediated through its influence on perceived stigma during social unrest. Conclusions: A community-based inclusive approach is essential to understand the holistic needs of people with PTSD during social unrest. To improve health and well-being in addition to evaluating mental health impacts, considering interactions with the rapid change and stressful social environment is essential.

Effect of human library intervention on mental health literacy: a multigroup pretest-posttest study.

BACKGROUND: Mental health literacy (MHL) is an evolving concept encompassing knowledge of mental illness, help-seeking options, perceived stigma, and discrimination. This study aimed to test the effectiveness of a human library intervention at enhancing MHL. A human library intervention was adopted to enhance MHL in this study. The human library intervention aims to establish a positive framework and safe space for dialogue between readers and a 'human book'. It works to promote dialogue, reduce prejudice, and encourage understanding of people who are regarded as disadvantaged or in a minority group. METHODS: An experimental approach with a multigroup pretest-posttest design was adopted. Forty-five participants aged between 18 and 23 years were recruited and randomly assigned to the experimental group (human library intervention), comparison group (didactic teaching session), or control group (no intervention). Adapted vignette-based MHL scale scores were used as the outcome measures. The overall and subscale scores were included in the analysis. RESULTS: The human library intervention group showed a significant improvement in overall MHL compared with the other two groups. In a multivariate analysis of the variance in subscale scores, the intervention was shown to significantly reduce stigma and preferred social distance, but had no significant effect on knowledge acquisition. CONCLUSIONS: The human library intervention is effective at enhancing overall MHL and reducing stigma and preferred social distance. Further studies are suggested to further develop the MHL construct, human library interventions, and the MHL scales for consolidating evidence-based practice.

Facilitating learning of community-based rehabilitation through problem-based learning in higher education.

BACKGROUND: The quality of community-based rehabilitation (CBR) personnel is one of the key factors that contributes to the success of CBR programs. Integrating knowledge and practical skills in various stages of the learning process is essential in community-based rehabilitation. Problem-based learning (PBL) is a pedagogical strategy that uses real-world situations as the basis for developing knowledge and problem-solving skills. Through PBL, learners are guided and facilitated in assuming active problem-solving roles in real-world situations. This study developed and tested a framework and a PBL protocol for use in teaching community-based rehabilitation (CBR) in higher education. METHODS: Part I of this study focused on the development of a framework and a protocol for PBL. An initial framework for the development of this protocol was formed based on a review of relevant literature. Concrete guidelines were delineated to describe the application, process, and delivery of teaching and learning. PBL was implemented in three CBR related courses. Students were facilitated to learn CBR in passing various stages of PBL through a self-directed learning process. The cumulative efforts of each group were compiled, recorded, and displayed using e-portfolios. In Part II, the processes and outcomes of using this new learning mode were evaluated using a case study approach to examine the protocol's efficacy. Focus group interviews, a questionnaire, and a detailed examination of the e-portfolios were administered for evaluation. RESULTS: One hundred thirty-three students from three CBR related courses were recruited. PBL was regarded as an effective, realistic and practical method that enables critical thinking in CBR. Practicality was addressed by covering context-related materials with the use of real cases or examples. Participants were actively engaged in the learning process and their CBR competence was enhanced. CONCLUSIONS: Through the new protocol, the students were equipped with active learning, critical thinking, and problem-solving skills that should facilitate success in CBR.

Identifying evidence to define community-based rehabilitation practice in China using a case study approach with multiple embedded case study design.

BACKGROUND: This study examined community-based rehabilitation (CBR) practice in China on the basis of the development of an evaluation system using current evidence in a real context. METHODS: A multiple embedded case study design was used to interpret both quantitative and qualitative data. In Part 1, a thematic analysis was conducted to identify the different levels of evidence available in CBR programs in China. Identified themes were then associated with the literature to form a system to code, categorise, and rank the obtained evidence. In Part 2, CBR practice was examined in 12 CBR programs by using the developed evaluation system with the CBR matrix and CBR framework. RESULTS: Six themes under three categorised levels of evidence for demonstrating quality of practice were found. An evaluation system of program practice, based on existing standards to define levels of evidence, was created and used with the CBR matrix and CBR framework to evaluate the quality of practice in 12 CBR programs. The results of a within-case analysis revealed the strengths and areas for improvement in each program. An across-case analysis by using identified correlations revealed the characteristics of CBR practice in China, as demonstrated in the interaction of core CBR components. The content elements of CBR programs were significantly correlated with health outcomes, social development, education, and empowerment. Empowerment was significantly correlated with participant governance and community ownership. CONCLUSION: The proposed evaluation system, as developed in a real context, is feasible for monitoring and identifying the strengths of and areas for improvement in CBR programs. This study described the characteristics and interaction of different CBR components in CBR practice in China and is pertinent for enhancing the evidence-based practices and quality of CBR programs in China.

Validation of two scales for measuring participation and perceived stigma in Chinese community-based rehabilitation programs.

BACKGROUND: The World Health Organization has asserted the importance of enhancing participation of people with disabilities within the International Classification of Functioning, Disability and Health framework. Participation is regarded as a vital outcome in community-based rehabilitation. The actualization of the right to participate is limited by social stigma and discrimination. To date, there is no validated instrument for use in Chinese communities to measure participation restriction or self-perceived stigma. This study aimed to translate and validate the Participation Scale and the Explanatory Model Interview Catalogue (EMIC) Stigma Scale for use in Chinese communities with people with physical disabilities. METHODS: The Chinese versions of the Participation Scale and the EMIC stigma scale were administered to 264 adults with physical disabilities. The two scales were examined separately. The reliability analysis was studied in conjunction with the construct validity. Reliability analysis was conducted to assess the internal consistency and item-total correlation. Exploratory factor analysis was conducted to investigate the latent patterns of relationships among variables. A Rasch model analysis was conducted to test the dimensionality, internal validity, item hierarchy, and scoring category structure of the two scales. RESULTS: Both the Participation Scale and the EMIC stigma scale were confirmed to have good internal consistency and high item-total correlation. Exploratory factor analysis revealed the factor structure of the two scales, which demonstrated the fitting of a pattern of variables within the studied construct. The Participation Scale was found to be multidimensional, whereas the EMIC stigma scale was confirmed to be unidimensional. The item hierarchies of the Participation Scale and the EMIC stigma scale were discussed and were regarded as compatible with the cultural characteristics of Chinese communities. CONCLUSION: The Chinese versions of the Participation Scale and the EMIC stigma scale were thoroughly tested in this study to demonstrate their robustness and feasibility in measuring the participation restriction and perceived stigma of people with physical disabilities in Chinese communities. This is crucial as it provides valid measurements to enable comprehensive understanding and assessment of the participation and stigma among people with physical disabilities in Chinese communities.

The Outcomes and Impact of a Post-Earthquake Rehabilitation Program in China: A Qualitative Study.

This study evaluated the outcomes and impact of a post-earthquake rehabilitation program in Sichuan, China. A case-study approach was adopted to conduct an in-depth examination of the program. The results show that the program effectively enhanced the functional outcomes of earthquake survivors. However, the empowerment of earthquake survivors with disabilities requires further consideration, and the local community's ownership of the program must also be addressed. A combination of institution- and community-based approaches was advocated in developing the post-earthquake rehabilitation program to enhance its impact on the local community.

A framework for evaluating community-based rehabilitation programmes in Chinese communities.

PURPOSE: The primary aim of this study was to develop an evaluation framework that could effectively describe the quality of community-based rehabilitation (CBR) practice in Chinese communities. METHOD: This study adopted a case study approach to build and validate a CBR evaluation framework. Core elements of CBR programmes were defined from the literature to form an Initial Framework. Domains and elements of the Initial Framework were then verified with examples of CBR programmes cited in published articles. The revised framework was then further tested for relevance and appropriateness in the real life context through testing in five Chinese CBR programmes. RESULTS: A final framework for evaluating CBR programmes was developed. It consists of 5 domains, 25 categorised core elements and 72 indicators. CONCLUSION: A comprehensive CBR evaluation framework was built and initially verified with domains, elements and indicators, and is ready for use in Chinese CBR settings.

When East meets Wests: community-based rehabilitation in Chinese communities.

PURPOSE: Community-based rehabilitation (CBR) has been practiced in mainland China for over three decades. This study reviews the development of CBR and describes its practice in Chinese communities in order to discuss current controversies within CBR practice internationally and in the Chinese context. METHOD: Review of literature. Development of CBR, its principles and controversies internationally and in the Eastern world is reviewed. CBR practice in Chinese communities is examined. RESULTS: Shifting ideology and practices mean many different activities are labelled CBR. Variation across contexts has led to many controversies, specifically: the lack of evidence to support practice; ownership of programs; conceptual differences surrounding autonomy and participation and cultural issues. Contemporary Chinese cultural values and Chinese CBR are shaped by traditional peasant culture, traditional Chinese philosophy and socialist ideology. CONCLUSION: The review indicates that Western CBR concepts and philosophy cannot be directly applied to the Chinese context. An appropriate model or framework is needed to fit the unique Chinese cultural context and to guide practice in Chinese communities.