Effectiveness and cost-effectiveness of embedded simulation in occupational therapy clinical practice education: study protocol for a randomised controlled trial.

BACKGROUND: Clinical placements are a critical component of the training for health professionals such as occupational therapists. However, with growing student enrolments in professional education courses and workload pressures on practitioners, it is increasingly difficult to find sufficient, suitable placements that satisfy program accreditation requirements. The professional accrediting body for occupational therapy in Australia allows up to 200 of the mandatory 1000 clinical placement hours to be completed via simulation activities, but evidence of effectiveness and efficiency for student learning outcomes is lacking. Increasingly placement providers charge a fee to host students, leading educators to consider whether providing an internal program might be a feasible alternative for a portion of placement hours. Economic analysis of the incremental costs and benefits of providing a traditional versus simulated placement is required to inform decision-making. METHODS/DESIGN: This study is a pragmatic, non-inferiority, single-blind, multicentre, two-group randomised controlled trial (RCT) with an embedded economic analysis. The RCT will compare a block of 40 hours of simulated placement (intervention) with a 40-hour block of traditional placement (comparator), with a focus on student learning outcomes and delivery costs. Six universities will instigate the educational intervention within their respective occupational therapy courses, randomly assigning their cohort of students (1:1 allocation) to the simulated or traditional clinical placements. The primary outcome is achievement of professional behaviours (e.g. communication, clinical reasoning) as assessed by a post-placement written examination. Secondary outcomes include proportions passing the placement assessed using the Student Practice Evaluation Form-Revised, changes in student confidence pre-/post-placement, student and educator evaluation of the placement experience and cost-effectiveness of simulated versus traditional clinical placements. Comprehensive cost data will be collected for both the simulated and traditional placement programs at each site for economic evaluation. DISCUSSION: Use of simulation in health-related fields like occupational therapy is common, but these activities usually relate to brief opportunities for isolated skill development. The simulated clinical placement evaluated in this trial is less common because it encapsulates a 5-day block of integrated activities, designed and delivered in a manner intended to emulate best-practice placement experiences. The planned study is rare due to inclusion of an economic analysis that aims to provide valuable information about the relationship between costs and outcomes across participating sites. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001339448 . Registered 26 September 2016.

Personal Care Participation Assessment and Resource Tool: Clinical utility for inpatient rehabilitation

BACKGROUND: Evidence supports validity of the Personal Care Participation Assessment and Resource Tool (PC-PART), but clinical utility remains unverified. PURPOSE: This study aimed to investigate occupational therapists' perceptions about the PC-PART's clinical utility for inpatient rehabilitation. METHOD: Using mixed methods, occupational therapists who had used the PC-PART as part of a research study in an inpatient rehabilitation setting completed a questionnaire (n = 9) and participated in a focus group (n = 6) to explore their perspectives about its clinical utility. Quantitative data were summarized and qualitative data analyzed using inductive thematic analysis. FINDINGS: Quantitative data highlighted both positive and negative aspects of the PC-PART's clinical utility. Five themes emerged from the qualitative data: nature of information gathered; familiarity with the instrument; perceived time and effort; item phrasing, interpretation, and presentation; and external influences on clinical use. IMPLICATIONS: The PC-PART was perceived to support gathering of clinically useful information, helpful to intervention and discharge planning. Recommendations for improving some item phrasing, operational definitions, and instructions were identified. Although standardized assessments were valued, use in routine practice was challenging, requiring a knowledge translation strategy.

Personal Care Participation Assessment and Resource Tool: Clinical utility for inpatient rehabilitation.

BACKGROUND: Evidence supports validity of the Personal Care Participation Assessment and Resource Tool (PC-PART), but clinical utility remains unverified. PURPOSE: This study aimed to investigate occupational therapists' perceptions about the PC-PART's clinical utility for inpatient rehabilitation. METHOD: Using mixed methods, occupational therapists who had used the PC-PART as part of a research study in an inpatient rehabilitation setting completed a questionnaire ( n = 9) and participated in a focus group ( n = 6) to explore their perspectives about its clinical utility. Quantitative data were summarized and qualitative data analyzed using inductive thematic analysis. FINDINGS: Quantitative data highlighted both positive and negative aspects of the PC-PART's clinical utility. Five themes emerged from the qualitative data: nature of information gathered; familiarity with the instrument; perceived time and effort; item phrasing, interpretation, and presentation; and external influences on clinical use. IMPLICATIONS: The PC-PART was perceived to support gathering of clinically useful information, helpful to intervention and discharge planning. Recommendations for improving some item phrasing, operational definitions, and instructions were identified. Although standardized assessments were valued, use in routine practice was challenging, requiring a knowledge translation strategy.

Responsiveness, construct and criterion validity of the Personal Care-Participation Assessment and Resource Tool (PC-PART).

BACKGROUND: The Personal Care-Participation Assessment and Resource Tool (PC-PART) was designed to measure participation restrictions in activities of daily living required for community life. Rasch analysis has confirmed that the PC-PART contains two unidimensional scales providing interval-level measurement: the Self Care and Domestic Life scales. This study investigated validity and responsiveness of these PC-PART scales using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) approach. METHODS: Thirteen hypotheses about Self Care and Domestic Life scale scores were established prior to conducting the analyses. Data from a prospective randomized controlled trial of additional (weekend) inpatient rehabilitation in Melbourne, Australia, were used. The 996 participants had a mean (SD) age of 74 (13) years and were admitted with orthopaedic (n = 581), neurological (n = 203) or other disabling impairments (n = 212). Self Care and Domestic Life scores were compared to functional independence (FIM), comorbidity (Charlson Comorbidity Index), whether activities of daily living goals were met, and discharge destination. RESULTS: Low to moderate correlations between FIM and PC-PART scales' scores supported hypotheses that the PC-PART measures a different construct from functional independence: Self Care r s -0.52(95 % CI -.46 to -.57) and Domestic Life r s -0.32(95 % CI -.25 to -.38). The scales had low to moderate discriminative ability for discharge destination, with the area under the curve for Self Care, 0.70 (95 % CI 0.62-0.78), and Domestic Life, 0.72 (95 % CI 0.64-0.80). The discharge to community living cut-off scores for Self Care: 5.50 (sensitivity .83, specificity .53) and Domestic Life: 7.50 (sensitivity .75, specificity .60), represented patients having no participation restrictions. Change scores from admission to discharge demonstrated larger effect sizes for the Self Care (1.67) and Domestic Life (1.50) scales than for the FIM (1.10), supporting hypotheses about responsiveness. Ten of the 13 hypotheses were supported. CONCLUSIONS: This study provided evidence supporting construct validity, criterion validity and responsiveness of the PC-PART Self Care and Domestic Life scales for inpatient rehabilitation. Clinicians, managers and researchers who wish to measure the patterns and extent of people's participation restrictions in activities of daily living and the associated burden of care, before and/or after intervention, can be somewhat confident about the PC-PART's validity and responsiveness for this purpose. TRIAL REGISTRATION: Data used in this research were gathered during a registered randomized controlled trial: Australian and New Zealand Clinical Trials Registry ACTRN12609000973213.

Evaluation of the internal construct validity of the Personal Care Participation Assessment and Resource Tool (PC-PART) using Rasch analysis.

BACKGROUND: The Personal Care Participation Assessment and Resource Tool (PC-PART) is a 43-item, clinician-administered assessment, designed to identify patients' unmet needs (participation restrictions) in activities of daily living (ADL) required for community life. This information is important for identifying problems that need addressing to enable, for example, discharge from inpatient settings to community living. The objective of this study was to evaluate internal construct validity of the PC-PART using Rasch methods. METHODS: Fit to the Rasch model was evaluated for 41 PC-PART items, assessing threshold ordering, overall model fit, individual item fit, person fit, internal consistency, Differential Item Functioning (DIF), targeting of items and dimensionality. Data used in this research were taken from admission data from a randomised controlled trial conducted at two publically funded inpatient rehabilitation units in Melbourne, Australia, with 996 participants (63% women; mean age 74 years) and with various impairment types. RESULTS: PC-PART items assessed as one scale, and original PC-PART domains evaluated as separate scales, demonstrated poor fit to the Rasch model. Adequate fit to the Rasch model was achieved in two newly formed PC-PART scales: Self-Care (16 items) and Domestic Life (14 items). Both scales were unidimensional, had acceptable internal consistency (PSI =0.85, 0.76, respectively) and well-targeted items. CONCLUSIONS: Rasch analysis did not support conventional summation of all PC-PART item scores to create a total score. However, internal construct validity of the newly formed PC-PART scales, Self-Care and Domestic Life, was supported. Their Rasch-derived scores provided interval-level measurement enabling summation of scores to form a total score on each scale. These scales may assist clinicians, managers and researchers in rehabilitation settings to assess and measure changes in ADL participation restrictions relevant to community living. TRIAL REGISTRATION: Data used in this research were gathered during a registered randomised controlled trial: Australian and New Zealand Clinical Trials Registry ACTRN12609000973213. Ethics committee approval was gained for secondary analysis of data for this study.

Measurement properties of the Personal Care Participation Assessment and Resource Tool: a systematic review.

PURPOSE: To systematically review research investigating measurement properties of the Personal Care Participation Assessment and Resource Tool (PC-PART), formerly the Handicap Assessment and Resource Tool (HART). DATA SOURCES: Seven databases were searched using (i) HART or PC-PART terms and (ii) known authors. Reference list searches, citation searches and author contact were secondary search methods. STUDY SELECTION: Searches retrieved 492 articles. Those investigating at least one HART or PC-PART measurement property were selected. Three articles met review criteria. Secondary searching produced four additional studies. DATA EXTRACTION: Two reviewers independently critiqued each article, using published quality criteria for (i) study methods and (ii) each measurement property. RESULTS: There was positive evidence supporting content validity of the PC-PART in adult in-patient and community based, sub/acute health settings. Clinical utility was largely supported. There was inconclusive evidence for inter-rater reliability, construct validity and responsiveness. CONCLUSIONS: The PC-PART shows promise as a clinically relevant and useful assessment to aid decision making about admission or discharge from health care settings. Further research is needed to establish the PC-PART's place in clinical practice across a range of patient groups and settings using sound methods to investigate structural validity, reliability, criterion validity, construct validity, clinical utility and responsiveness.