Measure of Early Vision Use: development of a new assessment tool for children with cerebral palsy.

PURPOSE: To report the development of an assessment tool to describe "how vision is used" for children with cerebral palsy. METHOD: Measurement development consisted of three steps: (i) an online survey to explore the relevance and comprehensiveness of visual behaviours identified in a previous conceptualisation study; (ii) construction of items and a rating scale for the new measure; and (iii) cognitive interviews to explore comprehensibility and refine the measure in preparation for field testing. Survey respondents were 130 parents of children with cerebral palsy, eight adults with cerebral palsy, and 108 clinicians (n = 246). Nine parents participated in the interviews. RESULTS: The new tool, the Measure of Early Vision Use, is a 14-item descriptive measure of typical performance of visual behaviours observable in everyday activities, as rated by parent/caregiver observation. Each item is rated on a 4-point ordinal scale. CONCLUSIONS: This new measure is conceptually grounded within the Activity level domain of the International Classification of Functioning, Disability and Health as a measure of a single visual ability construct. The target population is children with cerebral palsy, and using parent report the Measure of Early Vision Use describes both strengths and limitations in using vision. This study addressed the selection of items and response options for the new scale, and provides evidence to support content relevance, comprehensiveness and comprehensibility from key stakeholders. Further research will explore psychometric properties and clinical utility.Implications for rehabilitationThe ability to use vision in daily activities is relevant to the development and learning of all children, so the availability of a method for describing visual abilities has potential for diverse research and clinical purposes.The Measure of Early Vision Use is a parent-report tool that provides a criterion-referenced method for quantifying and describing how children use vision in typical daily activities to support intervention planning.Clinicians and parents wishing to measure vision use in children with cerebral palsy can be confident about the rigorous methods used to develop this tool, including consultation with key stakeholders.

Economic evaluation of simulated and traditional clinical placements in occupational therapy education.

INTRODUCTION: This economic evaluation complements results of the randomised controlled trial that established non-inferiority of the learning outcomes of a one-week simulated clinical placement (SCP) in occupational therapy qualifying degrees in comparison to an equivalent traditional clinical placement (TCP). This companion study presents detailed cost analyses of two placement alternatives and a cost-benefit study to assess the value for money of SCP. An economic evaluation of simulated versus traditional placements has not previously been conducted in Australia. METHODS: Nine SCP/TCP rounds were conducted by six Australian universities. Costs were collected using study-specific instruments. Public health sector costs were sourced from available literature. Willingness-to-pay for SCP/TCP was estimated using both a Discrete Choice Experiment and a Contingent Valuation method. These methods were employed to assess a comparative 'value' of SCP/TCP from the perspective of heads of occupational therapy departments (N = 28), who were asked to put a monetary value on the broader range of benefits associated with SCP/TCP. RESULTS: From the universities' perspective the average cost per student ranged from AUD$460 to AUD$1511 for simulated and AUD$144 to AUD$1112 for traditional placement. From the health care sector perspective, the difference in costs favoured simulated placements for four implementations and traditional placements for five. In the Discrete Choice Experiment respondents preferred traditional rather than simulated placement and would pay additional AUD$533. The estimated monetary value of simulated placements from a contingent valuation ranged from AUD$200 to AUD$1600. CONCLUSIONS: For universities that procure TCPs predominately at public health care facilities and sustain high administrative overheads, the SCP program could be a cost-saving alternative. From a broader value-for-money perspective, respondents favoured TCP over SCP, yet placed importance on placement availability and opportunity to demonstrate competence for students during the placement. Results should be interpreted with caution and further research with larger sample sizes is required.

Characteristics Influencing Diversity of Participation of Children in Activities Outside School.

OBJECTIVE: A cross-sectional survey was conducted to determine which personal and environmental characteristics influenced diversity of participation in activities outside school for typically developing children and adolescents. METHOD: Four hundred twenty-two (215 boys) typically developing Australian children (mean = 11.0 yr) completed the Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activity of Children to describe their participation on five activity types: Recreational, Active Physical, Social, Self-Improvement, and Skill-Based. Linear regression analyses were conducted. RESULTS: Predictors of participation diversity were age and preference for Recreational (aR² = .44); preference for Active Physical (aR²= .19); gender, school type, and preference for Social (aR² = .19); preference for Skill-Based (aR² = .25); and gender, school style, socioeconomic score, and preference for Self-Improvement (aR² = .24). CONCLUSION: Preference plays a key role in determining the diversity of participation in activities outside school.

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.

Prospective study of the participation patterns of Grade 6 and Year 8 students in Victoria, Australia in activities outside of school.

BACKGROUND: Positive participation outcomes are deemed the ultimate goal of health care and specifically of occupational therapy. Knowledge of the typical participation patterns of children in Australia will provide essential information to support our understanding of participation and the goal of maximising children's engagement. AIMS: This study investigated the participation of Grade 6 and Year 8 Victorian students in activities outside school and explored differences between genders and between students in different year levels. Secondarily, we began to establish Australian normative data on the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children. METHODS: This cross sectional survey methods study recruited students from a random selection of public schools. Participation was measured using the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children questionnaires. RESULTS: Participants included 84 (37 female, 47 male) students in Grade 6 (n = 43) and Year 8 (n = 41). Differences between year levels were only evident for participation in Recreational and Active Physical activities. Grade 6 students did more activities, more intensely than Year 8 students, but with no difference in enjoyment. The mean number of Recreational activities done by Grade 6 students was 8.5 (95%CI: 7.9-9.1) compared to Year 8 students 6.9 (95%CI: 6.1-7.7; P = 0.001). Gender differences were evident in the participation patterns within Social, Skill-Based and Self-Improvement activities. CONCLUSION: The findings suggested that gender was a more important influence on participation patterns than a 2-year age gap, with participation patterns being relatively stable between Grade 6 and Year 8.

Evaluation of the Australian adaptation of the Keeping It Together (KIT-Australia) information package with carers of children with special needs.

BACKGROUND: Australian carers of children with special needs have expressed concerns about the limited availability and accessibility of suitable information resources. The 'Keeping It Together' (KIT) information package was developed and trialled in Canada and found to be effective in meeting the information needs of this population. AIM: The study aimed to evaluate the KIT-Australian Adaptation (KIT-Australia) to determine if it met its purpose of providing carers of children with special needs with strategies to access resources, organise information and communicate with others about their child. The study also aimed to determine whether additional changes were required to increase the KIT-Australia's utility. METHODS: Eighteen carers of children with special needs participated in the study. All participants had accessed services from the Royal Children's Hospital, Melbourne, Victoria. Demographic information was collected and carers were orientated to the KIT-Australia prior to using it. After eight weeks, a telephone survey interview was completed with each participant. A content analysis of qualitative and quantitative data provided the results. RESULTS: Most participants stated that they would continue to use the KIT-Australia, and would recommend it to other carers. Six key themes were identified: getting started, accessing resources, organising and storing information, communicating information about my child to others, recommendations and non-use of the KIT-Australia. CONCLUSIONS: Preliminary data from this study suggests that the KIT-Australia met its purpose of assisting carers of children with special needs, to access resources, organise information and communicate with others about their child. Participant recommendations to improve the usability of the KIT-Australia should be implemented for future editions of the resource. Further research may be required to adapt and facilitate use of the KIT-Australia in other Australian states and territories.