A randomised controlled trial of an iPad-based application to complement early behavioural intervention in Autism Spectrum Disorder.

BACKGROUND: Technology-based interventions for Autism Spectrum Disorder (ASD) have proliferated, but few have been evaluated within the context of a randomised controlled trial (RCT). This RCT evaluated the efficacy of one technology-based early intervention programme (Therapy Outcomes By You; TOBY) in young children with ASD. METHODS: TOBY is an app-based learning curriculum designed for children and parents as a complement to early behavioural intervention. Eighty children (16 female) were recruited to this RCT within 12 months of receiving a diagnosis of ASD (M age = 3.38; SD = 0.69) and randomised to receive either treatment-as-usual (community-based intervention, n = 39) or the TOBY therapy (at least 20 min/day) plus treatment-as-usual (n = 41) for a period of 6 months. Outcomes were assessed at 3 and 6 months postbaseline. (Australian New Zealand Clinical Trials Registry: ACTRN12614000738628; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365463). RESULTS: Children in the TOBY intervention group averaged 19 min/day engaging with the app in the first 3 months, but only 2 min/day during the second 3 months. There was no group difference in scores on the primary outcome, the Autism Treatment Evaluation Checklist, at either the 3- or 6-month follow-up. However, significant improvements at the 6-month follow-up were observed in the TOBY intervention group relative to the treatment-as-usual group on three secondary outcomes: the Fine Motor and Visual Reception subscales of the Mullen Scale of Early Learning and the Total Words Understood scale of the MacArthur-Bates Communicative Development Index. Statistical trends towards improvement in the TOBY intervention group were observed on measures of adaptive function, although these decreased in magnitude from the 3- to 6-month follow-up. CONCLUSIONS: This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD. However, sustained use of the app over the full 6-month period was a challenge for most families.

Randomised controlled trial of an iPad based early intervention for autism: TOBY playpad study protocol.

BACKGROUND: Evidence for early intensive behavioural interventions (EIBI) by therapists as an effective treatment for children with an Autism Spectrum Disorder (ASD) is growing. High-intensity and sustained delivery of quality EIBI is expensive. The TOBY (Therapy Outcomes by You) Playpad is an App-based platform delivering EIBI to facilitate learning for young children with ASD, while enabling parents to become co-therapists. Intervention targets include increasing joint attention, imitation and communication of children with ASD. The primary aim of the study presented in this protocol is to determine the effectiveness of the TOBY App in reducing ASD symptoms when used as a complement to conventional EIBI. The secondary aim is to examine parental attributes as a result of TOBY App use. METHODS AND DESIGN: Children aged less than 4;3 years diagnosed with ASD and parents will be recruited into this single-blind, randomised controlled trial using a pragmatic approach. Eligible participants will be randomised to the treatment group 'TOBY therapy + therapy as usual' or, the control group 'therapy as usual' for six months. The treatment will be provided by the TOBY App and parent where a combination of learning environments such as on-iPad child only (solo), partner (with parent) and off-iPad - Natural Environment (with parent) Tasks will be implemented. Parents in the treatment group will participate in a TOBY training workshop. Treatment fidelity will be monitored via an App-based reporting system and parent diaries. The primary outcome measure is the Autism Treatment Evaluation Checklist. The secondary outcome measures involve diagnostics, functional and developmental assessments, including parent questionnaires at baseline (T0), three months (T1) and six months (T2). DISCUSSION: This trial will determine the effectiveness of the TOBY App as a therapeutic complement to other early interventions children with ASD receive. The trial will also determine the feasibility of a parent delivered early intervention using the iPad as an educational platform, and assess the impact of the TOBY App on parents' self-efficacy and empowerment in an effort to reduce children's ASD symptoms. The outcomes of this trial may have EIBI services implications for newly diagnosed children with ASD and parents. TRIAL REGISTRATION: ACTRN12614000738628 retrospectively registered on 1st of July, 2014. UTN: U1111-1158-6423.

Preparing for EQUIP by Measuring Mammography Image Quality.

PURPOSE: To determine the feasibility of objectively critiquing mammography images and quantitatively assessing technologist performance, and to determine whether results can be compared to analyze performance. METHODS: The authors assessed mammography examinations performed by 3 experienced technologists using a quality improvement method to track factors that affect image quality. A total of 147 examinations were evaluated prior to the technologists receiving standardized positioning training, and an equal number of examinations were evaluated 2 months after the training. During the evaluations, data was collected that described the quality of the examinations and the technologists' behavior during the pre-exposure, acquisition, and postexposure process that affected image quality. RESULTS: The authors selected 7 out of more than 140 prominent examples to demonstrate a methodology to evaluate image quality, to use the results to empower the technologist to improve their performance in areas that indicate positioning and compression weakness, and to track the technologist's improvement over time. Technologist 1 demonstrated the most dramatic improvement between the pre- and posteducational evaluations in the length of the pectoral muscle on the mediolateral oblique projection. Technologist 3 improved inclusion of the inframammary fold region by 18% between evaluations. Posteducational evaluations also demonstrated a decrease in the percent of examinations that passed posterior nipple line measurements. Compression force did not significantly change. DISCUSSION: Identifying specific technologist actions that positively or negatively affect the quality of mammography examinations and then providing this information to the technologist with a suggested plan of corrective action can improve mammography service. CONCLUSION: This clinical validation study for mammography quality improvement demonstrated that technologist performance affecting image quality can be measured when examination and threshold variables are controlled.

An Analysis of a Biometric Screening and Premium Incentive-Based Employee Wellness Program: Enrollment Patterns, Cost, and Outcome.

Since 2012, a large health care system has offered an employee wellness program providing premium discounts for those who voluntarily undergo biometric screenings and meet goals. This study evaluates the program impact on care utilization and total cost of care, taking into account employee self-selection into the program. A retrospective claims data analysis of 6453 employees between 2011 and 2015 was conducted, categorizing the sample into 3 mutually exclusive subgroups: Subgroup 1 enrolled and met goals in all years, Subgroup 2 enrolled or met goals in some years but not all, and Subgroup 3 never enrolled. Each subgroup was compared to a cohort of employees in other employer groups (N = 24,061). Using a difference-in-difference method, significant reductions in total medical cost (14.2%; P = 0.014) and emergency department (ED) visits (11.2%; P = 0.058) were observed only among Subgroup 2 in 2015. No significant impact was detected among those in Subgroup 1. Those in Subgroup 1 were less likely to have chronic conditions at baseline. The results indicate that the wellness program enrollment was characterized by self-selection of healthier employees, among whom the program appeared to have no significant impact. Yet, cost savings and reductions in ED visits were observed among the subset of employees who enrolled or met goal in some years but not all, suggesting a potential link between the wellness program and positive behavior changes among certain subsets of the employee population.

Using the International Classification of Functioning, Disability and Health framework to categorise goals and assess goal attainment for transition care clients.

AIM: To classify goals according to the International Classification of Functioning, Disability and Health (ICF) and to examine factors associated with goal attainment for transition care program (TCP) clients. METHODS: Recorded goals at admission were rated at discharge as achieved, partially achieved or not achieved. Two researchers independently linked each statement to the most closely corresponding ICF categories. RESULTS: Of 268 TCP clients, 215 had 851 goal statements recorded. Of these, 794 (93%) statements were linked to 12 different ICF categories. A total of 515 (61.4%) were attained at discharge, 117 (14%) were partially attained and 207 (24.6%) were not attained. Multivariate analysis identified number of goals, TCP length of stay and high or very high case manager perception of goal attainment to be significant predictors for goal attainment. CONCLUSIONS: The ICF framework can be used to identify and structure clients' goals in transitional care. Goal attainment can be used to determine overall functional improvement.

TOBY play-pad application to teach children with ASD - A pilot trial.

PURPOSE: To investigate use patterns and learning outcomes associated with the use of Therapy Outcomes By You (TOBY. Playpad, an early intervention iPad application. METHODS: Participants were 33 families with a child with an autism spectrum disorder (ASD) aged 16 years or less, and with a diagnosis of autism or pervasive developmental disorder - not otherwise specified, and no secondary diagnoses. Families were provided with TOBY and asked to use it for 4-6 weeks, without further prompting or coaching. Dependent variables included participant use patterns and initial indicators of child progress. RESULTS: Twenty-three participants engaged extensively with TOBY, being exposed to at least 100 complete learn units and completing between 17% and 100% of the curriculum. CONCLUSIONS: TOBY may make a useful contribution to early intervention programming for children with ASD delivering high rates of appropriate learning opportunities. Further research evaluating the efficacy of TOBY in relation to independent indicators of functioning is warranted.

Mobility criteria for upright sitting with patients in the neuro/trauma intensive care unit: an analysis of length of stay and functional outcomes.

BACKGROUND AND PURPOSE: Few studies have explored optimal advancement and variation in mobility and length of stay (LOS) data with critically ill patients in the intensive care unit (ICU). The purpose of this study was to analyze the outcomes and LOS of critically ill patients in the neurotrauma ICU involved in rehabilitation. METHODS: A bidirectional case-control study of a total of 30 patients admitted to a level 1 trauma hospital in the metropolitan Chicago area with Glasgow Coma Score (GCS) of ≤12 (3-12) were studied. Functional outcomes of a structured mobility group were compared at first upright sitting and at ICU discharge using the functional independence measure (FIM). Retrospective LOS review of a group (n = 15) with unstructured activity advancement was compared. RESULTS: The main outcome measures were FIM scores and LOS in number of days. In the structured mobility group, a significant increase in functional performance between first upright sitting and ICU discharge was found (P < .005). Length of stay was shorter in the structured mobility groups but the difference was not statistically significant. CONCLUSIONS: Results from this study revealed favorable functional outcomes for patients involved in a structured mobility program with physical therapy in the neuro/trauma ICU.