Human rights in occupational therapy education: A step towards a more occupationally just global society.

BACKGROUND/AIM: Education on human rights will place occupational therapists in a strong position to address societal inequities that limit occupational engagement for many client groups. The imminent changes to the Minimum Standard for the Education of Occupational Therapists engender efforts towards social change and will require university-level human rights education. This education might enhance the profession's influence on disadvantaging social structures in order to effect social change. To contribute to the evidence base for social change education in occupational therapy, this research aims to understand the knowledge, skills, confidence and learning experiences of occupational therapy students who completed a human rights course. METHODS: Final year occupational therapy students responded to questionnaires which included listing human rights, a human rights scale measuring knowledge and confidence for working towards human rights, and open questions. Numbers of rights listed, knowledge scores and confidence scores were calculated. Responses to the open questions were thematically analysed. RESULTS: After completing a human rights course, students had good knowledge and moderate confidence to work with human rights. Three themes were identified including 'learning about human rights', 'learning about structural, societal and global perspectives on occupational engagement' and 'learning how occupational therapists can work with groups, communities and populations: becoming articulate and empowered'. CONCLUSIONS: Human rights education fosters the development of occupational therapists who are skilled, knowledgeable, confident and empowered to address occupational injustices, according to these research findings. To develop a more occupationally just global society, education that considers iniquitous social structures and human rights is necessary.

Simulation in Occupational Therapy Curricula: A literature review.

BACKGROUND/AIM: Simulated learning experiences are increasingly being used in health-care education to enhance student engagement and provide experiences that reflect clinical practice; however, simulation has not been widely investigated in occupational therapy curricula. The aim of this paper was to: (i) describe the existing research about the use and evaluation of simulation over the last three decades in occupational therapy curricula and (ii) consider how simulation has been used to develop competence in students. METHODS: A literature review was undertaken with searches of MEDLINE, CINAHL and ERIC to locate articles that described or evaluated the use of simulation in occupational therapy curricula. RESULTS/FINDINGS: Fifty-seven papers were identified. Occupational therapy educators have used the full scope of simulation modalities, including written case studies (22), standardised patients (13), video case studies (15), computer-based and virtual reality cases (7), role-play (8) and mannequins and part-task trainers (4). Ten studies used combinations of these modalities and two papers compared modalities. Most papers described the use of simulation for foundational courses, as for preparation for fieldwork, and to address competencies necessary for newly graduating therapists. The majority of studies were descriptive, used pre-post design, or were student's perceptions of the value of simulation. CONCLUSION: Simulation-based education has been used for a wide range of purposes in occupational therapy curricula and appears to be well received. Randomised controlled trials are needed to more accurately understand the effects of simulation not just for occupational therapy students but for longer term outcomes in clinical practice.

Strategies Identified as Effective by Mothers During Occupational Performance Coaching.

AIMS: This study examined strategies mothers reported as effective in facilitating children's successful performance in activities they identified as goals during Occupational Performance Coaching (OPC). METHODS: Twenty-nine mothers of children with occupational performance issues engaged in OPC. A random sample of 44 /157 (28%) coaching sessions were video-recorded from which the audio recording was analyzed using a general inductive approach to explore the nature of strategies reported as effective by mothers. RESULTS: Two major themes emerged: (1) Context-focused; or (2) Child-focused. Context-focused strategies were characterized by mothers' actions that made the performance context more conducive to children's success. The emphasis of mothers' intention in Context-focused strategies was achievement of the task with minimal stress. Context-focused strategies included subthemes of Adjust Manner, Create Distance, Add Structure and Routine, and Teach. Child-focused strategies required higher levels of engagement with children in the application of strategies and were focused on children's skill development. Subthemes included Collaboration and Offer Choice. CONCLUSIONS: Mothers engaged in coaching identified strategies which they found supported children's performance, attesting to the existing capacity of mothers in identifying and evaluating effective ways of enhancing children's performance. Findings suggest the potential of coaching as a capacity-building, context-based intervention to improve children's performance.

Sensory Processing and Its Relationship with Children's Daily Life Participation.

AIMS: To investigate whether children with probable or definite differences in sensory processing (SP) had participation restrictions, and the relationship between Short Sensory Profile (SSP) scores and children's participation. METHODS: The participants were parents of 64 children (mean age 8 years 1 month); 36 with potential impairments in regulating sensory input and filtering out unnecessary stimuli (29 boys, 7 girls) and 28 with typical SP abilities (25 boys, 3 girls). Parents' completed the SSP and Participation in Childhood Occupations Questionnaire (PICO-Q). The SSP score was used to categorize children as potential SP impairment group and typical SP ability group. RESULTS: Children categorized as having probable or definite differences in SP exhibited significantly lower participation levels and enjoyment than children categorized as having typical SP abilities. However, participation frequency between both groups was similar. Six out of the seven SP impairment types had small to moderate correlations with children's participation (r = 0.25-0.48, p < 0.05). Multiple regression analyses indicated that only three impairment types (Underresponsive/Seeks Sensation, Low Energy/Weak, and Visual/Auditory Sensitivity) were significant predictors of PICO-Q participation domains. CONCLUSIONS: The results suggest that children with potential SP impairments have restrictions in the degree of participation and enjoyment. Three SP types were related to specific participation domains, but they explained a small amount of variance or none in some participation domains. Other variables should be considered to identify determinants of children's participation.

Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care.

OBJECTIVE: To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. METHODS: An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. RESULTS: On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. CONCLUSIONS: This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care.

Development and Psychometric Evaluation of a New Measure for Children's Participation in Hand-Use Life Situations.

OBJECTIVE: To describe the development of the Children's Assessment of Participation with Hands, a parent-report questionnaire that assesses children's participation in life situations requiring hand use specifically, and to investigate its construct validity (using Rasch analysis and known-group comparison) and reliability (test-retest reliability and internal consistency). DESIGN: Cross-sectional, validation, and test-retest studies. SETTING: Schools. PARTICIPANTS: Parents/caregivers (N=202) reported on their children aged 2 to 12 years with (n=97) and without disabilities (n=105). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Children's Assessment of Participation with Hands was developed based on a content review of existing children's participation measures and literature, expert review, and pilot testing. The Children's Assessment of Participation with Hands included 37 items measuring participation diversity, frequency, independence, and desire for change in specific hand-use life situations across 4 domains of self-care, recreation, education, and domestic life and community. RESULTS: Evidence for construct validity of the Children's Assessment of Participation with Hands domains was established through Rasch analysis (after removing 2 misfitting items from the recreational domain and 1 item from the domestic life and community domain). Differences in summary scores of each domain between children with and without disabilities were also significant (P<.01). Test-retest reliability of the Children's Assessment of Participation with Hands was moderate to high (intraclass correlation coefficients, .69-.96), except for the desire for change dimension scale of the recreational domain (.40). Internal consistency was varied across the dimensions/domains. CONCLUSIONS: Results provide preliminary evidence for the construct validity and reliability of the Children's Assessment of Participation with Hands that could be used in clinical and research settings to gain a specific understanding of the impact of children's hand-use difficulties on their participation in life situations requiring hand use.

Evaluation of Autism-Related Health Information on the Web.

BACKGROUND: The Internet is a frequently accessed source of information for parents of a child with autism. To help parents make informed decisions about treatment options, websites should contain accurate information. This study aimed to evaluate the quality of information in a sample of autism-relevant websites. MATERIALS AND METHODS: Autism-related keywords were entered into three widely used search engines in April 2013 and the 20 most frequently appearing sites identified. Website quality was rated, by two independent raters, using the DISCERN tool. Websites were also coded according to the type of references/sources provided to support the intervention content presented. RESULTS: The mean DISCERN score was 46.5 (range 23-67.5), of a possible 80. Information about treatment risks and no treatment as an option was rarely described. Only six (30%) websites provided research references when describing intervention options. CONCLUSIONS: Many websites did not meet criteria for quality health information and failed to cite evidence supporting described interventions. Implications of these findings are discussed.

Comparative content review of children's participation measures using the International Classification of Functioning, Disability and Health-Children and Youth.

OBJECTIVE: To evaluate to what extent instruments that intend to measure children's participation actually do so, and to what extent their items can be classified according to the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY). DATA SOURCES: A systematic search was conducted in MEDLINE, CINAHL, PsycINFO, ERIC, and EMBASE and was limited to the period between January 2000 and May 2011. The search terms of participation, outcome measure, and children were used to identify potential children's participation measures. DATA SELECTION: Instruments were included if they (1) evaluated children's participation based on assessment purpose; (2) were suitable for use with children aged 2 to 12 years; (3) were generic assessments that could be used with a range of disabilities; and (4) involved self-report, proxy report, or interview administrations. DATA EXTRACTION: Instruments were obtained from identified full-text articles and were evaluated for inclusion through group discussion. Two researchers further independently reviewed each included instrument to determine which of the items measured participation based on a contemporary definition. These items were also classified using the ICF-CY linking rules to reflect each instrument's content coverage. DATA SYNTHESIS: Sixteen instruments were identified with 11 found to have more than half of their items measuring participation, but only the School Function Assessment-Participation section comprised 100% participation items. The participation items in each instrument captured between 3 and 9 ICF-CY Activities and Participation domains. Only the Child and Adolescent Scale of Participation and the Participation and Environment Measure for Children and Youth covered all domains. Among the ICF-CY Activities and Participation domains, the interpersonal interactions and relationships domain was addressed the least. CONCLUSIONS: This review revealed differences in the inclusion of participation items in existing children's participation measures and their classification according to the ICF-CY. These differences need to be considered when selecting an instrument.

Autism in context 1: Classification, counting and causes.

This review paper describes our current perspective of autism spectrum disorders (ASD), taking into account past, current and future classification systems and the evolving definitions of ASD. International prevalence rates from 1965 to 2012 are presented and key issues, including whether there is an epidemic of autism and what this means in terms of thinking about possible causes of autism, are discussed. Also discussed is the need for high quality national data collection in Australia and the evidence, and lack of evidence, for the many theoretical causes of ASD. The lack of robust classification of autism along with limited high quality evidence base about its prevalence and possible causes leaves ample space for future discoveries.

Autism in context 2: Assessment, intervention and services in Australia.

Continuing from part 1, part 2 of the autism spectrum disorders review explores clinical practice and service delivery aspects of autism spectrum disorders including current assessment approaches in Australia, family-centred models of care, and key service structure and delivery issues. Treatments including behavioural interventions, established and emergent medication, and complementary and alternative therapies are discussed. The key role of paediatricians as both individual child and family care providers and advocates, as well as agents of service reform in Australia, is evident. Much still needs to be done.

Optimizing participation of children with autism spectrum disorder experiencing sensory challenges: a clinical reasoning framework.

BACKGROUND: Remedial sensory interventions currently lack supportive evidence and can be challenging to implement for families and clinicians. It may be timely to shift the focus to optimizing participation of children with autism spectrum disorders (ASD) through accommodation and self-regulation of their sensory differences. PURPOSE: A framework to guide practitioners in selecting strategies is proposed based on clinical reasoning considerations, including (a) research evidence, (b) client- and family-centredness, (c) practice contexts, (d) occupation-centredness, and (e) risks. KEY ISSUES: Information-sharing with families and coaching constitute the basis for intervention. Specific strategies are identified where sensory aversions or seeking behaviours, challenges with modulation of arousal, or sensory-related behaviours interfere with participation. Self-regulatory strategies are advocated. The application of universal design principles to shared environments is also recommended. IMPLICATIONS: The implications of this framework for future research, education, and practice are discussed. The clinical utility of the framework now needs to be tested.

Occupational therapy services for people with autism spectrum disorders: current state of play, use of evidence and future learning priorities.

BACKGROUND: A dramatic increase in the prevalence of autism spectrum disorders and increased funding to support children with autism spectrum disorders have added to the demand for occupational therapy services. This study explored current practices and future learning priorities of Queensland occupational therapists who work in this field. METHOD: A survey in relation to occupational therapy services for people with autism spectrum disorders was distributed to all registered Queensland occupational therapists (N=2547). The development of the survey was informed by a series of focus groups comprising occupational therapy clinicians, supervisors and academics. The survey covered demographics, caseload composition, collaboration, context/setting, service-delivery models, information gathering, goal setting, interventions, perceived challenges and confidence, use of evidence, and experience of professional development and support, and future learning priorities. RESULTS: Of 818 surveys returned, 235 respondents provided services to clients with autism spectrum disorders, with young children being more likely to receive a service than adolescents or adults. A pervasive focus on sensory processing was apparent in relation to assessment, intervention, and key areas of knowledge. Around half the respondents indicated that they lacked confidence at least some of the time. Autism spectrum disorders-specific experience was a significant predictor of confidence. Many therapists reported challenges in finding useful information in the literature and reliance on conferences or workshops as their main source of evidence. Commonly identified learning priorities included new developments in the field, early intervention, school support, sensory processing and clinical reasoning. CONCLUSION: This research highlights the need for comprehensive autism spectrum disorders-specific, face-to-face training focusing on evidence-based and occupation-centred practices.

Early intervention services of children with physical disabilities: complexity of child and family needs.

BACKGROUND/AIM: To gain insight into the special issues confronting parents when accessing early intervention for children with physical disabilities where child and/or family characteristics indicate complex needs within the unique Australian context. METHODS: Qualitative interviews with families receiving early intervention for their children with physical disabilities (N=10). Families with complex circumstances such as having children with high support needs, those from culturally and linguistically diverse backgrounds, and single-parent families were recruited to the study. Families where parents had mental or health issues, parents/other family members had an identified disability, and/or where families lived in regional or rural locations were also purposively sampled. RESULTS: Participants highlighted issues around (i) the nature of early intervention services provided; (ii) the ways in which services were structured; and (ii) managing their child's needs/planning into the future. Parents stressed the importance of having access to a variety of early intervention services aside from therapy. They also emphasised the need for greater clarity about what to expect from services, the intensity of therapy, other services they could access and how long they would be able to receive these. CONCLUSIONS: Despite their complex circumstances and needs, participants' experiences of accessing early intervention services were largely consistent with the broader research literature. Of the parents interviewed, those with health problems and single mothers expressed most apprehension about managing their child's needs and planning for the future.

Attributes of excellence in practice educators: the perspectives of Australian occupational therapy students.

AIM: Occupational therapists frequently undertake the role of practice educator contributing to the development of the future workforce, however, little is known about how they effectively perform this role. This study aimed to elucidate students' perspectives on what makes an excellent practice educator. METHOD: Documentation for 124 Practice Excellence Commendations nominations by Queensland occupational therapy students for Queensland Occupational Therapy Fieldwork Collaborative awards between 2008 and 2011 were analysed. These were based on students' experiences on long block placements (five weeks or more) in their later years of undergraduate or masters' entry study. Written nominations addressing five selection criteria were de-identified and responses to each of these compiled. One independent coder and the two lead authors read the transcripts, identified coding categories and reached consensus regarding emerging themes using standard content and thematic analysis techniques. RESULTS: Providing the 'just right' challenge was the overarching theme that symbolised excellence in practice education from students' perspectives. Three themes emerged that enabled practice educators to provide student support needed to balance the challenges of learning on placement; (i) valuing a reciprocal relationship; (ii) facilitating learning opportunities and experiences; and (iii) encouraging autonomy and independence. CONCLUSION: Findings provided insights into student perceptions about how excellent practice educators facilitated their learning while on placement. These insights can be used to inform practice educators who wish to enhance their supervision skills. Future research should focus on how the attributes of practice educators positively influence student learning outcomes.

Student Practice Evaluation Form-Revised Edition online comment bank: development and reliability analysis.

BACKGROUND/AIM: The reliable evaluation of occupational therapy students completing practice education placements along with provision of appropriate feedback is critical for both students and for universities from a quality assurance perspective. This study describes the development of a comment bank for use with an online version of the Student Practice Evaluation Form-Revised Edition (SPEF-R Online) and investigates its reliability. METHODS: A preliminary bank of 109 individual comments (based on previous students' placement performance) was developed via five stages. These comments reflected all 11 SPEF-R domains. A purpose-designed online survey was used to examine the reliability of the comment bank. A total of 37 practice educators returned surveys, 31 of which were fully completed. Participants were asked to rate each individual comment using the five-point SPEF-R rating scale. RESULTS: One hundred and two of 109 comments demonstrated satisfactory agreement with their respective default ratings that were determined by the development team. At each domain level, the intra-class correlation coefficients (ranging between 0.86 and 0.96) also demonstrated good to excellent inter-rater reliability. There were only seven items that required rewording prior to inclusion in the final SPEF-R Online comment bank. CONCLUSION: The development of the SPEF-R Online comment bank offers a source of reliable comments (consistent with the SPEF-R rating scale across different domains) and aims to assist practice educators in providing reliable and timely feedback to students in a user-friendly manner.

Examining the inter-rater and test-retest reliability of the Student Practice Evaluation Form-Revised (SPEF-R) for occupational therapy students.

BACKGROUND/AIM: The Student Practice Evaluation Form-Revised Edition (SPEF-R) is widely used in Australian universities to evaluate occupational therapy students' performance in practice education. Reliable completion of the SPEF-R by practice educators is critical for students and universities from a quality assurance perspective. This study used standardised video vignettes to examine the inter-rater and test-retest reliability of practice educators when completing the SPEF-R. METHODS: Nine vignettes were developed with three levels of student performance (below expectations, adequate-to-proficient, and outstanding) for each of three scenarios which depicted a multidisciplinary team meeting, a supervision session, and a home visit respectively. Seventy-five occupational therapy practice educators viewed the vignettes and completed an online survey to rate student performance in each vignette using five selected SPEF-R items and using the five-point rating scale. Twenty of these practice educators completed the rating process twice for test-retest reliability purposes. Percentage agreement, t-tests and Rasch Measurement Model were used for analysis. RESULTS: Practice educators exhibited consistent ratings on most of the SPEF-R items, except for rating adequate-to-proficient student performance on three items for inter-rater reliability and eight items for test-retest reliability. Rasch analysis found that the majority of practice educators (96-98.7%) exhibited consistency in their use of the SPEF-R rating scales. Practice educators also demonstrated satisfactory test-retest agreement of severity/leniency in rating student performance in the multidisciplinary team meeting scenario. CONCLUSION: The study findings suggest that the SPEF-R could be used reliably and interpreted consistently by practice educators with diverse backgrounds and levels of experience.

Cross-cultural adaptation of the developmental coordination disorder questionnaire 2007 for German-speaking countries: DCDQ-G.

BACKGROUND: The Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07) is widely used internationally and is a useful measure to assist in the diagnosis of developmental coordination disorder. The aim of this study was to translate the DCDQ'07 into German, test the psychometric properties, and establish cutoff scores for the 5.0 to 7.11 age group. MATERIALS AND METHODS: A six-stage cross-cultural adaptation process was used. The psychometric properties of the DCDQ-German (DCDQ-G) were tested with a clinic sample of 55 children (mean age: 6.1 years) and community sample of 67 children (mean age: 5.6 years). RESULTS: The internal consistency was high. Specificity and sensitivity for the total sample were 52.4 and 90%, respectively. Sensitivity for the clinic sample was 72.7% and specificity was 95%. The community sample had a sensitivity of 30% and a specificity of 86.7%. CONCLUSION: The DCDQ-G is a valid instrument for use with a clinic population in the 5.0 to 7.11 age group. Research into older age groups is ongoing.

A comparison of the play skills of preschool children with and without developmental coordination disorder.

Play is commonly acknowledged as being important to children's development. School-aged children with developmental coordination disorder (DCD) are known to be less involved in play and more socially isolated than their typically developing peers, but little is known about play of preschool children with DCD. Using a quasi-experimental design, developmental play skills and frequency in engagement in play of two independent groups of preschool children aged 4 to 6 years with (n = 32) and without (n = 31) probable DCD were compared. Play skills were assessed using the Revised Knox Preschool Play Scales and the Play Observation Scale based on 30 minutes of videotape of free play at preschool. Preschool children with probable DCD had a lower developmental play age and engaged less frequently in play than their typically developing peers. Given the importance of play, children with DCD need to be identified and supported to enable them to play at preschool similarly to their peers. [OTJR: Occupation, Participation and Health 2013;33(4):198-208.].

Understanding the sensory experiences of young people with autism spectrum disorder: a preliminary investigation.

BACKGROUND/AIM: Unusual responses to sensations can impact upon the daily activities for individuals with autism spectrum disorder. Current understandings of these sensory experiences have been drawn from the proxy reports from parents/caregivers, standardised self-report questionnaires and autobiographical accounts. As sensory experiences are intensely personal, the first-hand accounts of people with autism spectrum disorder may have greater validity than caregiver reports, but these have never been systematically researched. This study explored the utility of using a semi-structured interview protocol augmented with visual cues to facilitate our understanding of the way people with autism spectrum disorder experience sensory input, and use coping strategies to manage sensory issues that interfere with participation. METHOD: A semi-structured interview augmented by visual cues was used to investigate the sensory experiences of three adolescent males with autism spectrum disorder. As is common in this population, two of the participants also had a diagnosis of Attention Deficit Hyperactivity Disorder and were taking stimulant medication. RESULTS: Participants shared a preference for expected, predictable and controllable sensory input, whereas unexpected, unpredictable and uncontrollable sensations were perceived as unpleasant. A heightened awareness of and difficulty filtering extraneous sensory input, high levels of movement seeking and an over-focus on salient sensory input were also described. Strategies employed to manage sensory challenges included avoiding, increasing predictability and control and meta-cognitive adaptations. CONCLUSIONS: Further research involving a larger sample of participants is recommended to determine the utility of using a semi-structured interview protocol augmented with visual cues to understand the sensory experiences of individuals with high-functioning autism spectrum disorder.

Learning experiences on role-emerging placements: an exploration from the students' perspective.

BACKGROUND/AIM: Occupational therapy educators are challenged to provide students with practical experiences which prepare them for ever changing health-care contexts on graduation. Role-emerging placements have been widely used internationally to help meet this challenge, but research into the learning experiences of students during these innovative placements is limited. This research investigated the enablers and barriers to learning from the perspectives of students on such placements from two European universities. METHODS: Two separate qualitative studies tracked 10 final year students. Interviews explored their learning experiences prior to, during and after an eight- or 10-week role-emerging placement in a range of settings. RESULTS: Four themes emerged, which were (1) adapting to less doing, more thinking and planning; (2) understanding the complexity of collaboration and making it work; (3) emotional extremes; and (4) realising and using the occupational therapy perspective. CONCLUSIONS: These placements presented a 'roller coaster' of authentic learning experiences which created the opportunity for students to use occupation in practice and develop skills for collaborative working in an interprofessional environment. Whereas students viewed their role-emerging placement experiences positively, challenges included the emotional responses of students and placement pace. Findings suggest the need for supportive student placement experiences in both established and role-emerging areas to prepare students for a range of opportunities in an uncertain future.