Comparing Telerehabilitation and In-Person Interventions in School-Based Occupational Therapy for Specific Learning Disorder A Randomized Controlled Trial.

Objective: This study investigated the efficacy of telerehabilitation (TR) in school-based Occupational Therapy (OT) for children with Specific Learning Disorder (SLD), focusing on occupational competence and parental satisfaction, aiming to contribute empirical insights to the discourse on the educational well-being of this population. Materials & Methods: The study adopted a Randomized Controlled Trial (RCT) design involving 31 children diagnosed with SLD, implementing TR and in-person interventions alongside a control group. Outcome measures included the School Self-Concept Inventory, Child Occupational Self-Assessment (COSA), and Canadian Occupational Performance Measurement (COMP), analyzed using descriptive and inferential statistics (ANOVA, post hoc tests). Results: Both TR and in-person interventions exhibited significant enhancements in academic self-efficacy (F=23.96, p<0.001, Partial ȵ²=0.461), occupational competence (F=70.59, p<0.001, Partial ȵ²=0.716), and parent satisfaction (F=17.03, p<0.001, Partial ȵ²=0.378) compared to the control group. Notably, no significant differences emerged between the TR and in-person groups, emphasizing their comparable effectiveness in improving outcomes. Conclusion: In conclusion, the study demonstrated the efficacy of TR and in-person interventions in school-based OT for children with SLD. The cohesive outcomes in academic self-efficacy, occupational competence, and parental satisfaction highlight TR as a versatile modality. This research, grounded in robust methodology, encourages further exploration of TR's transformative role in enhancing the holistic well-being of children with SLDs.

Occupational Therapy Outcome Measures in Preschool Children With Autism Spectrum Disorders: A Scoping Review.

With the rising prevalence of autism spectrum disorder (ASD), early assessment of preschool children is vital for occupational therapists. This scoping review aimed to provide detailed information about outcome measures used in occupational therapy interventions in preschool children with ASD and map the focus of the outcome measures based on the International Classification of Functioning, Disability, and Health (ICF) components. A thorough search from 2000 to 2022 was conducted that employed ICF linking rules to categorize the outcome measures. Seventy-four outcome measures were identified. They predominantly targeted body function and activity/participation, with less emphasis on environmental factors, and none assessed body structure. The most common measures were Vineland Adaptive Behavior Scale (VABS-2), Canadian Occupational Performance Measure (COPM), and Parenting Stress Index-Short Form (PSI-SF). This study offers a diverse array of outcome measures and underscores the potential of the ICF framework in enhancing evaluations, particularly concerning broader environmental components as one of the primary facilitating/hindering factors in the participation of children with ASD.

METHOD: We did a scoping review following steps by Arksey and O'Malley. Scoping reviews help us to find important information. We wanted to see what works in occupational therapy for young children with ASD, using the ICF. We looked at studies from 2000 to 2022 and also checked different sources for studies. We made a summary of what we found. RESULTS: We found 802 articles but only used 46 after checking. Most kids in the studies were 4 years or older. We found 74 different tools to see whether treatments worked. The most common tools were COPM, Vineland-II, and PSI-SF. These tools looked at how children move, do things, and feel. Some ways looked at how children play, talk, and connect with others. Others focused on how parents feel. Two ways, Pediatric Evaluation of Disability Inventory (PEDI) and Functional Emotional Assessment Scale (FEAS), looked at everything. Some general ways were used too. Over time, people looked more at how the environment affects children with ASD. CONCLUSION: We gathered many ways to see whether treatments work for children with ASD. The most common ones were COPM, Vineland-II, and PSI-SF. Each tool looked at different parts of how children do things. We did not see big changes in how people looked at treatments over time. Children with ASD need better ways to see whether treatments help them. We should look more at how the environment affects children.

Mapping the Available Tools for Occupational Therapy Effectiveness in Young Children With ASD Based on the ICF StructureIntroduction: Autism spectrum disorders (ASD) affect how people communicate and behave, with about one in 44 children having it. Early help for ASD, such as occupational therapy, is really important. Occupational therapy helps with everyday skills and makes life better. Not many studies use good ways and tools to see whether occupational therapy works for young children with ASD. The International Classification of Functioning, Disability, and Health (ICF) is a reference that helps to see how well treatments work.

Cost-utility analysis of multiple sclerosis rehabilitation in Iran.

BACKGROUND: Rehabilitation of Multiple Sclerosis (MS) is associated with various clinical, social and economic outcomes. We aimed to evaluate the cost-utility of MS multidisciplinary rehabilitation in Iran. RESEARCH DESIGN AND METHODS: An economic evaluation was conducted using a Markov model designed to reflect the natural course of the disease and interventions. Parameters and variables were extracted from available evidence, and costs and outcomes were calculated from the social perspective. The base-case analysis considered a 5-year time horizon. Costs were estimated based on approved national standards for MS rehabilitation. Sensitivity analyses were also performed. RESULTS: The average cost of the rehabilitation strategy was higher compared to the non-rehabilitation strategy, but it resulted in higher quality-adjusted life years (QALYs) values. The incremental cost-effectiveness ratio (ICER) was found to be $2,845.8 per QALY, indicating that the rehabilitation strategy is cost-effective. In the deterministic sensitivity analysis, extending the time horizon to 10 years made the rehabilitation strategy a dominant choice. Probabilistic sensitivity analysis results were consistent with the base-case findings. CONCLUSIONS: The MS multidisciplinary rehabilitation proved to be a cost-effective strategy; however, the results were sensitive to the input values of the model. Increasing the time horizon increased the probability of rehabilitation being cost-effective.

Cost-benefit analysis of stroke rehabilitation in Iran.

BACKGROUND: The economic evaluation of medication interventions for stroke has been the subject of much economic research. This study aimed to examine the cost-benefit of multidisciplinary rehabilitation services for stroke survivors in Iran. METHODS: This economic evaluation was conducted from the payer's perspective with a lifetime horizon in Iran. A Markov model was designed and Quality-adjusted life years (QALYs) were the final outcomes. First, to evaluate the cost-effectiveness, the incremental cost-effectiveness ratio (ICER) was calculated. Then, using the average net monetary benefit (NMB) of rehabilitation, the average Incremental Net Monetary Benefit (INMB) per patient was calculated. The analyses were carried out separately for public and private sector tariffs. RESULTS: While considering public tariffs, the rehabilitation strategy had lower costs (US$5320 vs. US$ 6047) and higher QALYs (2.78 vs. 2.61) compared to non-rehabilitation. Regarding the private tariffs, the rehabilitation strategy had slightly higher costs (US$6,698 vs. US$6,182) but higher QALYs (2.78 vs. 2.61) compared to no rehabilitation. The average INMB of rehabilitation vs non-rehabilitation for each patient was estimated at US$1518 and US$275 based on Public and private tariffs, respectively. CONCLUSION: Providing multidisciplinary rehabilitation services to stroke patients was cost-effective and has positive INMBs in public and private tariffs.

Neurofeedback Training Versus Perceptual-motor Exercises Interventions in Visual Attention for Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders characterized by poor attention and subsequently lower learning abilities than normal children. This study aimed to compare the effectiveness of neurofeedback and perceptual-motor exercises as two common nonpharmacological treatments for visual attention. Methods: A total of 40 combined medicated ADHD children (aged 5-12 years) were randomly allocated into two groups: neurofeedback training and perceptual-motor exercises. Visual attention and motor proficiency were assessed before and after the treatment by continuous performance test (CPT) and Bruininks-Oseretsky Test (BOT), respectively. Results: According to repeated measures analysis of variance (ANOVA), both groups showed significant improvement in three attention-related areas of CPT, including reaction time, omission, and commission errors (P<0.001), while the difference between the two groups was not significant (P>0.05). However, in the perceptual-motor exercises group, motor proficiency improved significantly (P<0.01). Conclusion: Neurofeedback training intervention, as well as perceptual-motor exercises, are effective in improving ADHD symptoms, and given the similar effect of both interventions and their lack of side effects, perceptual-motor exercises appear to be the more appropriate option for reducing symptoms of ADHD, because of its additional effect on motor proficiency, rich content of purposeful activities, and social interactions. Highlights: Neurofeedback training intervention promote attention in ADHD;Perceptual-motor exercises improve ADHD symptoms;Perceptual-motor exercises has an additional effect on motor proficiency. Plain Language Summary: The effectiveness and cost of interventions is an important issue. The result of this study revealed although neuro-feedback training intervention as well as perceptual-motor exercises are effective in improving ADHD symptoms, perceptual-motor exercises seem more appropriate option for reducing symptoms of ADHD, due to its additional effect on motor proficiency.

Availability of Physical Rehabilitation Facilities for People with Disabilities in Iran: A Comparative Study on Universal Health Coverage.

BACKGROUND: Iran, like many other countries, has committed to providing universal and equal access to health care and rehabilitation for people with disabilities by joining the Convention on the Rights of People with Disabilities. Thus, this study aimed to examine the availability of rehabilitation facilities on national and sub-national levels. METHODS: This cross-sectional study was conducted between May and December 2019. The data of rehabilitation facilities including infrastructure and rehabilitation workforce in health system settings were obtained using rehabilitation master list. The data were collected from the Vice-Chancellor for the Treatment Ministry of Health and Medical Education, the Rehabilitation of the State Welfare Organization, and Licensing and Planning the Medical Council in the 32 provinces of Iran and analyzed using Excel version 2016. RESULTS: On the national level, the following situation was found: in inpatient settings: 1.1 beds per million population; in outpatient settings: physiotherapy 42.6, optometry 16.4, audiology 10.5,occupational therapy 8.2, speech therapy 8.1, orthotic & prosthetic 4.5, physical medicine & rehabilitation 3.8 centers; day-care centers 11.7 and rehabilitation centers 1.3 centers, community-based rehabilitation (CBR): 15.9 units, rehabilitation home care 2 centers, rehabilitation nursing home care 1.6 centers and medical rehabilitation home care 0.3; Long-term care centers: residential care 4.1 centers per million population. Regarding rehabilitation work force: physiotherapists 84, speech therapists 34.8, occupational therapists 32.5, optometrists 31.2, audiologists 27.9, prosthetists and orthotists 10.3 therapists and physical medicine & rehabilitation 5.1 specialists per million populations. On the sub-national level, there were no outpatient rehabilitation centers in 12 of the provinces and the distribution of day rehabilitation centers in the rich provinces was 10 times higher. The number of CBR units, rehabilitation home care and rehabilitation nursing home were 40, 22, and 23 times higher in rich provinces than in poor provinces, respectively and there were no medical rehabilitation home care centers in 21 provinces. Regarding long-term care, the residential care centers in the richest province were 8 times higher. CONCLUSION: According to the WHO report and the rehabilitation expert panel, it was concluded that the number of rehabilitation facilities including rehabilitation centers and workforce was limited in Iran and that the available centers were also poorly distributed in the provinces of the country. This made it difficult for people to have fair access to rehabilitation services. It appears that health policymakers should pay special attention to further developing rehabilitation facilities.

Internal Consistency and Item Analysis of the Persian Version of the Child Sensory Profile 2 in Vulnerable Populations.

Objective: The purpose of the present study was to establish the item analysis and internal consistency of the Persian version of the Child Sensory Profile 2 in 2 groups of typical and atypical children (autism spectrum disorder and learning disabilities) aged 3 to 14 years. Method : The sample of this study included 120 typical and atypical children aged 3 to 14 years who referred to schools and rehabilitation centers in Tehran were selected using multistage sampling method. To collect data, the Child Sensory Profile 2 questionnaire was used, which is a set of questionnaires of the Sensory Profile 2. To analyze the data, the discrimination index was used to determine the discriminant validity of the Child Sensory Profile 2, and the Cronbach's alpha coefficient was used to determine the reliability in terms of internal consistency. Results: Discrimination index was satisfactory for all the items of the Child Sensory Profile 2. The values of Cronbach's alpha ranged from 0.795-0.919 in typical children and 0.617-0.901 in autistic children, and 0.792-0.920 in children with learning disabilities. Conclusion: The Persian version of the child sensory profile 2 is a valid (discrimination with vulnerable populations) and reliable (internal consistency) tool for assessing sensory processing.

The Relationship of School Participation with Motor Proficiency and Executive Function in Children with Autism Spectrum Disorder.

OBJECTIVES: Participation in meaningful activities is an important aspect of development in children with developmental disorders such as autism spectrum disorder (ASD). The purpose of this study was to assess the correlation of school participation with motor proficiency and executive function in children with ASD. MATERIALS & METHODS: In this cross-sectional (descriptive-analytic) study, 52 students aged 6 to 12 years old with ASD were selected through the convenience sampling method. The GARS-2 scale was used to confirm ASD diagnosis. Other psychiatric comorbidities such as ADHA were studied by the CSI-4 tool, and students with comorbidities were excluded. Data were collected using SFA, BOTMP-2, and BRIEF questionnaires. It should be noted that in the BRIEF questionnaire, a higher score indicates a more severe disability. RESULTS: Our findings showed that motor proficiency and its components had a significant direct correlation with school participation in children with ASD (P ≤0.001). On the other hand, school participation was inversely and significantly correlated with the behavioral regulation and metacognition monitoring indices of the executive function dimension (P <0.05). CONCLUSION: Based on the findings of this research, the development of motor proficiency and improvements in the behavioral regulation and metacognition monitoring of students with ASD will boost their participation in school activities. Motor proficiency was significantly correlated with school participation in children with ASD. More attention should be paid to perceptual motor interventions and cognitive rehabilitation programs (with a focus on monitoring metacognition and shifting behavioral regulation) to increase the participation of children with ASD in school activities.

The Development and Validation of a Scale for the Activities of Daily Living in Iranian Children.

Introduction: Activities of Daily Living (ADL), as an ultimate goal of rehabilitation, rely on cultural and environmental factors. This study aimed to develop a questionnaire based on the occupational therapy practice frame to accurately evaluate Iranian children's occupational performance. Methods: This scale was developed in two phases of planning and construction. The planning phase involved a literature review and a collection of the available evaluation tools in the area. The advice of two expert panels was used to develop a preliminary 87-item questionnaire. In the construction phase, 40 parents were surveyed to assess the popularity of the activities in Iran. After a face to content validation, the final version of the questionnaire was prepared with 93 items. Results: The final 93-item questionnaire was used to assess the ADL of 3-6-year-old children. The 93 items, selected according to criteria found in the literature and the panel of experts, were categorized into six ranges of occupational therapy practice framework (bathing/washing/personal hygiene, toileting, dressing, eating/feeding, functional mobility, and others). Conclusion: The ADL in Iranian children is a practical and culturally relevant tool for measuring the occupational performance of Iranian children. It can be used in clinical and population-based research. Highlights: ADLs are essential and routine tasks required to independent and healthy living.The active participation of the child in ADL during development has a positive effect on the development of sensory and cognitive functions of the brain.ADLs are highly dependent on contextual and ecological factors, such as parenting style, the environment and given context.The ADLIC tool is a standard, culturally adapted tool that can be used by occupational therapists to assess ADLS in Iranian children. Plain Language Summary: The ADLs referred to Self Care Skills, which play a major role in a child overall functional growth, confidence and independence. The healthy individuals can perform these life skills without assistance. The inability to accomplish essential ADLs may lead to unsafe conditions and poor quality of life. Due to the importance of these activities during the development of the child, it is necessary for Iranian children to be evaluated in terms of independence in these activities so that in case of disorder, the necessary counseling and education can be provided by occupational therapists.