Psychometric Evaluation of the Persian Version of the Functional Mobility Scale: Assessing Validity and Reliability.

AIM: This study aimed to assess the content, concurrent validity, test-retest, and intra-rater reliability of the Persian version of the Functional Mobility Scale (FMS) for evaluating functional mobility in children and adolescents with cerebral palsy (CP). METHODS: Following international standards for measurement translation, we developed a Persian version of the FMS. A total of 160 participants took part in this study. Concurrent validity was assessed using Spearman's coefficient to correlate with the Gross Motor Function Classification System (GMFCS). Test-retest (n = 30) and intra-rater (n = 30) reliability of the FMS were also examined by Cohen's weighted kappa coefficient. RESULTS: Concurrent validity ranged from -0.912 to -0.941 for children and -0.912 to -0.936 for adolescents. Test-retest ranged from 0.902 to 1. Intra-rater ranged from 0.933 to 0.987. CONCLUSION: The Persian version of the FMS demonstrates very strong validity and almost perfect reliability for assessing and classifying functional mobility in children and adolescents with CP. These findings suggest that this tool could be a useful addition to clinical practice and research for the Persian-speaking population.

Spirituality as a Neglected Core in Occupational Therapy Practice: An Iranian Exploratory Survey.

Spirituality has received more attention in recent decades from different health disciplines. Occupational Therapy (OT), as a health discipline, believes that all aspects of human experience, including physical, psychological, social, and spiritual, are considered essential aspects of health. OT supports the fact that incorporating spirituality can promote health, well-being, and quality of life. Various researchers have attempted to investigate and explain occupational therapists' views on spirituality. In Iran's OT curriculum, spirituality has not been incorporated directly. The purpose of this study is to acquire information about the knowledge and opinions of Iranian occupational therapists about spirituality. This is a cross-sectional exploratory descriptive survey study in which 125 occupational therapists participated through convenience sampling. Inclusion criteria were, namely (a) at least one-year clinical experience of OT, (b) being educated in Iran, and (c) working in Iran. The Occupational Therapy Assessment of Spirituality (OTAS) questionnaire was used for data collection. The answers to the quantitative questions were analyzed through descriptive statistics. Most of the participants believed that spirituality should be incorporated by occupational therapists, but more than half of the participants disagreed that formal education prepared them to pay any attention to spirituality in their practice. Analyzing qualitative data by frequencies of their repetitions, led to four categories and sixteen subcategories, accordingly. The four categories are (1) the barriers to applying spirituality in OT, (2) the need to acquire knowledge and apply spirituality in OT, (3) the benefits of incorporating spirituality for a client, and (4) the benefits of incorporating spirituality for the occupational therapist. The findings indicate that academic education has failed to prepare Iranian occupational therapists to meet spiritual needs of their clients. However, OTs tend to get information about spirituality from other sources and find it helpful for themselves and their clients. There are also barriers to applying spirituality; therefore, an educational package is needed to address these problems.

Validity and reliability of the Persian version of greenspan social-emotional growth chart.

Background: The estimated prevalence of mental health disorders in children and adolescents is between 10% and 20%. Furthermore, a quarter of very premature infants exhibit socioemotional delays in infancy and childhood. The objective of this study was to determine the validity and reliability of Greenspan social-emotional growth chart (GSEGC) in Persian children aged 1-42 months. Materials and Methods: After translation procedures, the face validity, content validity, construct validity, test-retest reliability, and internal consistency of the GSEGC questionnaire were evaluated. The quality of translating items was obtained using the suggestions of the research group. The face validity of the GSEGC was performed by interviewing with 10 mothers in the target group. To evaluate content validity quantitatively, content validity ratio (CVR) and content validity index (CVI) were used after reviewing the face and content validity and pilot study, 264 parents of children aged 1-42 months completed the GSEGC questionnaire to assess the construct validity and internal consistency. In order to determine the test-retest reliability, after 2 weeks, 18 parents completed the questionnaire again. Results: Eleven questions were changed according to the interviews (questions 1-6, 9-11, and 15-16). The lowest CVR was related to items 30 and 20 (0.636), and other items had an acceptable CVR. The lowest CVI value was related to item 1 of clarity and simplicity (0.818), and other items had an acceptable CVI. Intra-class correlation coefficient was 0.988 for all items of questionnaire. Furthermore, Cronbach's alpha coefficient was 0.952 for all items. In factor analysis, two factors were extracted from the items in questionnaire. Conclusion: The Persian version of GSEGC questionnaire has acceptable face, content and, constructs validity, test-retest reliability and high internal consistency in the target population. Therefore, the Persian version of the GSEGC can be used as a tool to assess 1-42 months sensory processing and socio-emotional development.

Sensory retraining improves light touch threshold of the paretic hand in chronic stroke survivors: a single-subject A-B design.

Background: Light touch, one of the primary and basic sensations, is often neglected in sensory retraining programmes for stroke survivors.Objective: This study aimed to investigate the effects of sensory retraining on the light touch threshold of the hand, dexterity and upper limb motor function of chronic stroke survivors.Methods: Five chronic stroke survivors with sensory impairment participated in this single-subject A-B design study. In baseline (A) phase, they only received standard rehabilitation. In the treatment (B) phase, they received a 6-week sensory retraining intervention in addition to standard rehabilitation. In both phases, they were evaluated every 3 days. Light touch threshold, manual dexterity and upper limb motor function were assessed using Semmes-Weinstein Monofilaments, Box-Block Test and Fugl-Meyer Assessment, respectively. Visual analysis, nonparametric Mann-Whitney U test and, c-statistic were used for assessing the changes between phases.Results: All participants indicated changes in trend or slope of the total score of light touch or both between the two phases. The results of the c-statistic also showed the statistical difference in the total score of light touch between baseline and treatment in all participants (p < 0.001). Also, the results of the c-statistic and Mann-Whitney U test supported the difference of manual dexterity and motor function of the upper limb between baseline and treatment in all participants (p < 0.001).Conclusion: Current findings showed that sensory retraining may be an effective adjunctive intervention for improving the light touch threshold of the hand, dexterity and upper limb motor function in chronic stroke survivors.

Knowledge about and Attitudes of Interdisciplinary Team Members toward Occupational Therapy Practice: Implications and Future Directions.

OBJECTIVES: In Kuwait, knowledge and attitudes of the health care teams toward occupational therapy practice (OTP) have not been investigated. This current study sought to explore the knowledge about and attitudes of interdisciplinary team members toward OTP. SUBJECTS AND METHODS: This cross-sectional study involved developing and validating a tool to serve the purpose of the study. We used a modified Delphi method to develop a tool that assessed occupational therapy (OT) knowledge (OT areas of practice, domains, and philosophy) as well as attitudes toward OTP. Descriptive statistics were utilized, and nonparametric tests were used to compare knowledge and attitudes along with the demographic data. RESULTS: A convenience sample of 98 participants from various disciplines participated in this study. The tool was found to have an adequate content validity for a total of 27 items and satisfactory reliability (internal consistency); Cronbach's α-values for the knowledge and attitudes subscales were 0.88 and 0.74, respectively. The overall knowledge level of OTP among the participants was limited, whereas their attitudes were favorable. Characteristics of being a female (p = 0.01), a nurse (p = 0.02), and working experiences ≥10 years (p = 0.01) contributed significantly to the knowledge of OTP. The results further indicated that participants working in general hospitals (p = 0.02) and working with occupational therapists (p < 0.001) showed significantly better attitudes toward OTP. CONCLUSION: For effective collaborative practice and better patients' outcomes, the study findings recommend the development of interprofessional initiative committees targeting educational settings as well as clinical environments.

A Comparison of the Quality of Life of Arab Mothers of Children with and without Chronic Disabilities.

AIM: To compare the quality of life (QoL) of Arab mothers in Kuwait who had children with chronic disabilities and those whose children had no disabilities and provide recommendations for how occupational therapists can assist in enhancing the mothers' QOL. METHODS: The case group included 71 mothers of children with chronic disabilities and a control group of 86 mothers of children without disabilities. Mothers' QoL was assessed using the Arabic WHOQOL-BREF questionnaire and the support systems of mothers of children with disabilities using a support questionnaire. RESULTS: The QoL of mothers of children with disabilities was significantly lower than that of mothers of healthy children (p < .001) in all four domains of WHOQOL-BREF (physical health, psychological wellbeing, social relationships, and environment). Mothers of children with disabilities reported that they received most support from their nuclear family. There was a lack of formal support systems in place in Kuwait. CONCLUSION: Mothers of children with disabilities perceive their QoL as poor and they have limited support systems. Occupational therapists are encouraged to serve as a resource for families, sharing information including available services and community resources, and supporting mothers as competent caregivers.

Occupational balance: A study of the sociocultural perspective of Iranian occupational therapists.

BACKGROUND: The concept of occupational balance has always been important to occupational therapists and occupational scientists, but it is often interpreted differently by professionals, particularly in relation to practice. PURPOSE: This study focused on the understanding of occupational balance of a group of experienced occupational therapists who held positions at the time in Iran. METHOD: A preliminary qualitative study from within an interpretive paradigm was employed. A focus group was used for data collection, and the data were analyzed using thematic networks analysis in relation to occupational science concepts. FINDINGS: Four organizing themes were uncovered: integrity in being, equilibrium in doing, contentedness in becoming, and harmony in belonging. The global theme of "fluidity" describes the dynamic nature of occupational balance. IMPLICATIONS: The concept of occupational balance needs to be further explored in different communities. Identifying similarities and differences in its meaning and application will inform culturally relevant client-centred education and practice.

Does Disability Correlate With Impairment After Hand Injury?

BACKGROUND: Any loss or deviation in body function and structure is considered impairment, whereas limitations on activities are fundamental to the definition of disability. Although it seems intuitive that the two should be closely related, this might not be the case; there is some evidence that psychosocial factors are more important determinants of disability than are objective impairments. However, the degree to which this is the case has been incompletely explored. QUESTIONS/PURPOSES: The purpose of this study was to determine if disability (as measured by the Disabilities of the Arm, Shoulder and Hand [DASH] and the Michigan Hand Questionnaire [MHQ]) and pain intensity correlate with impairment (as measured by the American Medical Association [AMA] impairment guide). Secondary study questions addressed the effect of pain intensity and symptom of depression on predicting disability. METHODS: Impairment and disability were evaluated in a sample of 107 hand-injured patients a mean of 11 months after injury. Impairment rating was performed prospectively. From the patients who came for therapy, they were invited to fill out the questionnaire and evaluated for impairment rating. Response variables of DASH, MHQ, and visual analog scale pain intensity values were collected at the same setting. Other explanatory variables included demographic, injury-related, and psychological factors (symptoms of depression measured with the Beck Depression Inventory). Initial bivariate and multivariate analyses were performed to determine correlations of disability and pain to impairment rating and other exploratory variables. RESULTS: Disability as measured by the DASH showed intermediate correlation with AMA impairment (r = 0 .38, beta = 0.36, p = 0.000). Together with gender, it accounted for only 22% of the variability in DASH scores. Similarly, MHQ score correlated with impairment rating (r = -0.24, beta = -0.23, p < 0.05). However, together with age, injured hand accounted for only 19% of the variability in MHQ scores. However, pain intensity did not correlate with impairment (r = -0.46, p > 0.05). Interestingly, pain intensity did correlate with the time passed from surgery but it was correlated with symptom of depression (r(2) = 0.10, beta = 0.33, p = 0.001). CONCLUSIONS: The limited correlation between impairment and disability emphasizes the importance of factors other than pathophysiology in human illness behavior. These may include physical (pain, dominant injured hand) and conditional factors (time since surgery) or psychological factors such as depression and adapting; all mentioned can be considered as personal factors that may be different in each patient. So considering personal difference and any other condition except the impairment alone can help to better plan interventions and also diminish disability level. LEVEL OF EVIDENCE: Level III, therapeutic study.

Effect of cognitive intervention on children with ADHD.

Although not considered a diagnostic criterion in DSM-IV, motor difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD) are commonly reported. Prevalence of co-morbidity of ADHD and Developmental Coordination Disorder is as high as 50%. Cognitive Orientation to daily Occupational Performance (CO-OP) is a problem-solving approach originally developed for children with Developmental Coordination Disorder. In this approach, therapists support children to use cognitive strategies in a process of guided discovery to solve occupational performance problems. A single case experimental design (multiple baselines) was used to examine the influence of a 12-week intervention using CO-OP with six children with ADHD. Outcome measures included the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling and the Bruininks-Oseretsky Test of Motor Proficiency and Performance (BOTMP). The results of this study demonstrated improvements in both goals and motor performance in the participants due to the intervention. These results provide some support for the use of CO-OP with children with ADHD. Further research into the application of CO-OP with children with ADHD is warranted based on these preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties.

Effect of Dynamic Elastomeric Fabric Orthoses on Postural Control in Children With Cerebral Palsy.

PURPOSE: The aim of this study was to evaluate the effect of dynamic elastomeric fabric orthoses (DEFOs) on postural control in children with cerebral palsy (CP). METHODS: Ten children with spastic diplegic CP and 10 children with typical development participated. Knee extension was measured using electrogoniometry. The standard deviation of excursion and phase plane portraits of velocity in the anteroposterior and mediolateral directions were calculated from force platform signals as center of pressure parameters with or without a DEFO. RESULTS: Maximum standing knee extension for children with CP improved after 6 weeks of wearing DEFOs (P < .05). Center of pressure parameters did not improve when comparing pre- to 6 weeks post-DEFO use (P < .05). CONCLUSION: The DEFO can reduce the crouch position without any negative effect on postural stability in children with CP. However, postural control does not improve in a 6-week timeframe.

Social participation experiences of mothers of children with cerebral palsy in an Iranian context.

BACKGROUND/AIM: Social participation is increasingly of interest in research that investigates the impact of caring for a child with a disability. Little has been investigated about the social participation experiences of mothers of children with cerebral palsy (CP). This study explored social participation among Iranian mothers of children with CP. METHODS: The conventional qualitative content analysis method was utilised. Data were collected via in-depth semi-structured interviews with 14 mothers (aged 26-45 years) of children with CP with the gross motor function classification system expanded & revised levels III-V. Constant comparative analysis was deployed for data analysis. RESULTS: The results were identified and classified into three main themes: (i) polarisation of positive and negative feelings; (ii) challenges to mothers' social activity; and (iii) striving to engage in society. CONCLUSION: In the Iranian context, mothers of children with CP are facing many challenges to social participation and seem to have been neglected by the health-care system. One of the priorities of Iranian health policy makers may be developing, establishing and implementing social support to enable the mothers to participate in social activities. Furthermore, occupational therapists can contribute and guide mothers' social participation by creating programs to develop and utilise skills for them.

Factors affecting ethical behavior in pediatric occupational therapy: A qualitative study.

BACKGROUND: It is the responsibility of each occupational therapist to always act ethically and professionally in a clinical setting. However, there is little information available concerning the factors influencing ethical behavior of occupational therapists at work. Since no study has been conducted in Iran on this topic, this qualitative study aimed to identify the factors influencing ethical behavior of pediatric occupational therapists. METHODS: Twelve pediatric occupational therapists participated in this study. The sampling was purposeful, and the interviews continued until reaching data saturation. All interviews were recorded and transcribed. The data were analyzed by qualitative content analysis, and the ethics of qualitative research was considered. RESULTS: The factors influencing ethical behavior were classified into four main categories including organizational factors, therapist related factors, client's family issues, and social factors. CONCLUSION: This study identified numerous factors influencing the ethical behavior of pediatric occupational therapists that could be used to train occupational therapists, human resources managers, professional policy makers, and could also be used to conduct future researches, and produce tools.

The meaning of work in people with severe mental illness (SMI) in Iran.

BACKGROUND: Work is the key component for most people in regard to financial, social and wellbeing matters. Employment is an important factor underpinning mental health disorders. However, unemployment remains an unsolved issue worldwide. Numerous studies have focused on employment outcomes in people with severe mental illness (SMI) but, only a few have explored their perspective on employment. Therefore, this study aimed to clarify the meaning of work among clients with SMI in Iran. METHODS: A qualitative research approach was used to conduct this research. Ten participants who were consumers of mental health services took part in this study. Data were analyzed by inductive content analysis approach. RESULTS: Four themes emerged from data including: acquiring identity, work as a drive, passing the time and financial independence. CONCLUSION: Meaning of work in studied people with SMI was probably similar to the general population. The different finding in this study refers to the dominancy of family relationships and spiritual believes which could cover some problems and in turn affect the meaning of work. Highlighting these meanings could direct mental health professionals to better planning for their clients have better understanding of their clients' work future and in turn provide more precise plan for them.

Experiences of occupational therapy students in the first fieldwork education: a qualitative study.

BACKGROUND: Fieldwork education is a core part of all occupational therapy curriculums around the world to enable the students meet minimum competencies required for their professional life. Student experience is a valuable source to explore the nature of fieldwork training and plan more efficient curriculums in the future. This study aimed to explore the students' experiences in the first fieldwork education. METHODS: Data were collected through a focus group and series of semi-structured interviews with 16 occupational therapy students who had passed the first semester of fieldwork education at three occupational therapy departments in Iran. The interviews were transcribed line by line and analyzed according to inductive content analysis. RESULTS: Following the analysis of the data, three main themes were identified including the importance of supervisors' management, deficits in the current curriculum and challenges in the educational environment. Each theme included different categories to show students' concerns and challenges in the first fieldwork education experience and their suggestions for more efficient trainings. CONCLUSION: The research argues that several combined key factors determine the nature and utility of occupational therapy (OT) fieldwork experiences of the students. However, further studies are needed to clarify the experiences of the supervisors, department managers and others involved in the fieldwork education.

Supporting-emotional needs of Iranian parents with premature infants admitted to Neonatal Intensive Care Units.

BACKGROUND: Having an infant in the neonatal intensive care unit (NICU) is a stressful and painful experience. Unlike to normal births, this birth is associated with admission and separation of infant from parents. The aim of this study was to compile the supporting-emotional needs of Iranian parents who have a premature infant admitted in (NICU). METHODS: This study was performed using qualitative research approach. Twelve participants including 9 parents whose infant had been hospitalized in NICU; two nurses and one physician were also selected for sampling purposes. Data were gathered using semi-structured interview. Data were analyzed by inductive content analysis approach. RESULTS: Four subcategories emerged from data analysis expressed supporting-emotional needs of parents of premature infants admitted in NICU. These subcategories were: Need for interaction with infant, Need to medical team's empathy, need to exchange support with spouse, and Need to get help from others. CONCLUSION: In order to develop mutual bonding with infant and attain parental roles, parents need to be close their neonate, also receive empathy and support to find a way to meet their needs. Participants in this study announced that resolving these needs can help parents to feel more confidence in infant's care and reduce their negative feelings.

Parental self-support: A study of parents' confront strategy when giving birth to premature infants.

BACKGROUND: This study aimed to understand the confront strategies of parents of premature infants hospitalized in NICU. METHODS: This study was performed using qualitative content analysis approach. Twelve participants including nine parents whose infants were hospitalized in NICU, two nurses and one physician, all selected by purposive sampling method were interviewed by a female expert occupational therapist. Data were gathered by semistructured interviews. Data were analyzed by inductive content analysis approach. RESULTS: One category, six subcategories and twenty one themes emerged from data analysis expressed confront strategies of parents of premature infants admitted in NICU. These categories were: taking assurance, stop thinking to bad things, diverting mind, taking supports, emotional expression, complaining from staff. CONCLUSION: Premature infant's parents announced that they do not receive adequate formal support to manage their feelings and needs. So, they seek for other informal resources of support and apply some special strategies including self-support.

Factor structure of Participation Behavioural Questionnaire (PBQ) in patients with hand injuries.

BACKGROUND: Participation is considered a critical outcome of successful rehabilitation and should be evaluated. OBJECTIVE: We aimed to evaluate the structural validity of the Participation Behaviour Questionnaire (PBQ) in people with hand injuries. METHODOLOGY: The PBQ contains 30 items that measure participation as conceptualized in the ICF. PBQ was developed with Rasch analysis to measure participation in hand injured. A sample of 404 patients with hand injuries and a mean age of 37 (16.0) participated and was randomly split for exploratory and confirmatory factor analysis (EFA/CFA). RESULTS: Both EFA and CFA confirmed a four factor-solution. These factors were named: Social Participation and Interpersonal Relationships, Autonomy and Role, Subjective Satisfaction with Participation, Recreational, Sport, and Leisure Time. The value of Cronbach's alpha was 0.96 for the total scale and >0.85 for each subscale. CONCLUSIONS: The structural validity of the PBQ was confirmed using both EFA and CFA. The PBQ measures four dimensions of participation.

Does covid-19 pandemic tell us something about time and space to meet our being, belonging and becoming needs?

BACKGROUND: People's perceptions of events like a pandemic are shaped by individual experiences within their socio-cultural context. Attributing negative or positive meanings to an experience may influence the sense of Being, Belonging and Becoming. AIM AND OBJECTIVES: To investigate the impact of the isolation/social distancing measures on people's sense of Being, Belonging, Becoming and overall sense of Occupational Wholeness compared to the time before the Covid-19 Pandemic as it is perceived by an Iranian population. METHODS: The Model of Occupational Wholeness used to inform the theoretical basis of this study and development of the survey questions. An internet-based survey using a convenient and snowball sampling method was conducted. A self-administered questionnaire was published using a software named Porsline. A sample of 1624 members of the general population in Iran (67% response rate) completed the questionnaire within the first four weeks of the isolation/social distancing period starting on 18 March 2020. The Data was analysed by the SPSS 22. RESULTS: The participants showed a more positive perceived level of Being and Belonging as well as an overall sense of Occupational Wholeness, and no difference in the perceived sense of Becoming during the isolation/social distancing period compared to the time before the Covid 19 pandemic. CONCLUSIONS: The findings show that the isolation/social distancing measures were perceived by participants as an opportunity to meet some of their Being, and Belonging needs that contribute to an overall sense of OccupationalWholeness.This highlights the role that Occupational science and Occupational therapy may have in helping people in situations when they need to rethink and replan for what they Do and the way they attribute meaning to their experiences.

Exploratory factor analysis and psychometric evaluation of the teacher reporting attitude scale for child sexual abuse.

This paper presents an evaluation of an instrument to measure teachers' attitudes toward reporting child sexual abuse and discusses the instrument's merit for research into reporting practice. Based on responses from 444 Australian teachers, the Teachers' Reporting Attitude Scale for Child Sexual Abuse was evaluated using exploratory factor analysis. The scale isolated three dimensions: commitment to the reporting role, confidence in the system's response to reports, and concerns about reporting. These three factors accounted for 37.5% of the variance in the 14-item measure. Alpha coefficients for the subscales were 0.769 (commitment), 0.617 (confidence), and 0.661 (concerns). The findings provide insights into the complexity of studying teachers' attitudes toward reporting of child sexual abuse and have implications for future research.

Cognitive Orientation to Daily Occupational Performance (CO-OP) in Children with Cerebral Palsy: A Systematic Review with Meta-analysis.

Background: Cognitive orientation to daily occupational performance (CO-OP) is a client-centered treatment approach that was developed in the 1990s by occupational therapists. Purpose: Exploring current evidence about the effectiveness of CO-OP on children with cerebral palsy (CP). Method: Major electronic databases were searched. A narrative synthesis of current literature and meta-analyses on randomized control trials (RCTs) were conducted on changes in occupational performance. Findings: Seven studies with 103 participants were included. Four studies were RCTs with moderate levels of evidence, and three studies had single-subject designs. Although beneficial effects of CO-OP on goal achievement and transferring learned skills were reported, meta-analyses showed that CO-OP had no significant effect on the performance (WMD = 1.52, 95% CI = -1.58 to 4.63, P = .33) and satisfaction domains (WMD = 1.71, 95% CI = -1.14 to 4.57, P = .24) of Canadian Occupational Performance Measure scores compared to alternative interventions. Implications: CO-OP improves occupational performance but not more than alternative interventions. Results are inconclusive due to small sample sizes and heterogeneity of alternative interventions and participants. Therefore, research with a larger number of participants with sound RCT methods is needed.