The Use of Tele-Occupational Therapy for Children and Adolescents with Different Disabilities: Systematic Review of RCT Articles.

Background: Due to the limited access of clients in non-urban areas to rehabilitation and the difficulty of specialized counseling in such conditions, the need for telehealth services has increased. The purpose of this study is to evaluate the effectiveness of Tele occupational therapy in common disorders of children and adolescents. Methods: In this systematic review study, a research method published from 2010 to 2022 focusing on the effectiveness of tele-rehabilitation and its impact on children and adolescents with different physical disabilities was done in Google Scholar, PubMed, Scopus and EMBASE databases. 467 articles were obtained in the review, and finally, 18 articles were reviewed. Results: In children with CP, Tele occupational therapy will be effective on gross motor function and balance skills, but the impact on the executive function needs more studies. In children with ASD, it will be effective on behavioral problems, but the effect on pro-social behavior needs further studies. In children and adolescents with other movement disorders, it will have an impact on the progress of their physical activity and in children and adolescents with Traumatic Brain Injury (TBI), it will be effective, but the effectiveness of MitiiTM programs needs further studies. Conclusion: The findings of this study showed that tele-occupational therapy could be performed in line with face-to-face occupational therapy, and it can lead to the satisfaction of families, but there is still a need to assess the effectiveness of various interventions and tools on different disorders, outcomes and settings.

Psychometric properties of Autism Spectrum Disorders Screening Assessment Tools: Systematic Review.

Background: Due to the prevalence of autism spectrum disorder (ASD), these children must be screened as soon as possible and receive the necessary and appropriate treatment. The purpose of this study was to examine all the ASD screening tools and examine their psychometric properties in available languages. Methods: This was a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to review the articles published between 2000 and 2023 and were published in PubMed, EMBASE, ProQuest, and Scopus databases. English keywords were as follows: autism spectrum disorders (ASD), screening/screen, tools, psychometric properties, validity, reliability, translations, pervasive developmental disorders (PDD), and children. The COnsensus -based Standards for the selection of health Measurement Instruments (COSMIN) checklist were used to investigate the psychometric properties of the studies. Results: Among the 476 primary studies, 35 ASD screening tools (132 articles related to the psychometric properties of 35 ASD screening tools in different languages) were identified based on our criteria, and their psychometric properties were examined. Various tools, including performance-based, direct observation, interactive play, and parent and teacher reports tools, were included in the list of tools. Conclusion: Considering that each of these tools has advantages and limitations, they need to be selected and used according to the goals of the researchers and the therapists. Another important point is that many of these tools still need more extensive studies in relation to their psychometric properties.

Developing The Spiritual Health Curriculum Approach Based on Tyler's Model in Iran.

Background: Spiritual health education is known as an important element in its implementation in the health system, which has different approaches to its implementation. Spiritual health has a positive effect on health, longevity, and recovery from physical ailments. Without spirituality education, education cannot function properly in biological, psychological, spiritual, and social dimensions or reach its maximum capacity. The present study aimed to develop the spiritual health curriculum approach based on Tyler's model in Iran between 2020 and 2021. Methods: In this qualitative study, by using a directed content analysis method and using validated curriculum models (Tyler's model), we developed a new spiritual health curriculum approach for Iranian society. This study was done between April 2021 and February 2022. Results: Because the spiritual health curriculum in Iran should be based on the philosophical and social principles of Iran, a new approach to spiritual health education based on Tyler's model was developed. Conclusion: Tyler's Iranian-Islamic model, which is suitable for our Iranian-Islamic culture and is valid for developing spirituality, was introduced.

Strategies to Promote the Quality of Occupational Therapy Fieldwork Education: A Qualitative Study.

Background: Clinical education is a bridge between theory and practice. The purpose of this study was to develop strategies to promote the quality of occupational therapy fieldwork education. Methods: The qualitative content analysis was used to identify the promoting strategies of fieldwork quality in occupational therapy from students' and fieldwork educators' perspectives during the 2019-2020 academic sessions. Participants were 12 fieldwork educators (mean age=39.33 yr, Male=5, female 7) and 14 students (mean age=23.28 yr, Male=7, female 7) in the code extraction phase and 16 fieldwork educators (12 of them were in code extraction phase too) in actions of strategies scoring phase. Results: Following the content analysis of the data, the prompting strategies categorized into 4 major categories and 10 subcategories: factors related to Fieldwork educators (Improving clinical teaching skills, Enhancing fieldwork management skills, Motivating fieldwork educators, and Fostering coordination between fieldwork educators), related to Educational Planning (Modifying clinical fieldwork planning, Revising curriculums), related to Students (Empowering students, Motivating students) and related to Fieldwork settings ( Improving the social environment, Improving physical environment ). Based on the qualitative content analysis and 3 expert panels. Finally, the 23 promoting actions were identified. Conclusion: Improving the quality of fieldwork education in occupational therapy needs a systematic collaboration between educators, students, and educational planners. Doing the promoting actions on fieldwork education process in occupational therapy may improve the quality of fieldwork education process.

Factors Affecting Participation of Children with Cerebral Palsy in Meaningful Activities: Systematic Review.

This is a systematic review using PRISMA guidelines to review the factors affecting participation of children with cerebral palsy (CP), the most common childhood motor disability. Inclusion criteria consisted of publications in a peer-reviewed journal between 2000 and 2018, and at I, II, III, and IV levels of AOTA Evidence. After the title, abstract, and a full text screening, 31 articles met eligibility to be included. The studies examined ADLs (12), IADLs (9), play and leisure (19), and social participation (14), but only 3 in rest/sleep, 1 in work, and 8 in education. Gross motor and manual function, CP type, home, and community physical environment, were the most common factors affecting individuals' participation with CP. Results imply occupational therapists must evaluate clients on all factors shown to facilitate or inhibit participation to ensure an adequate intervention plan. However, evaluating every individual case in the occupational therapy process is time-consuming and difficult. Based on this study's findings, we suggest occupational therapists prioritize evaluating motor skills (gross and fine), the most influential of the factors in all areas of participation. Occupational therapists also could advocate for policy around community environmental barrier removal.

Development of social participation classification system for children with cerebral palsy.

Background: Some classification systems have been designed to measure domains of function of children with cerebral palsy (CP), including the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Eating and Drinking Ability Classification System (EDACS), and Communication Function Classification System (CFCS). The purpose of the present study was to develop a Social Participation Classification System for children with cerebral palsy (SPCS) with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) and assess its reliability. Methods: In this cross-sectional analytic study, 274 parents of 6 to 12 year-old children with CP were asked to complete the questionnaires (CPAS-P, MACS, GMFCS, and CFCS) for their child. The expert review consisting of 10 occupational therapists with at least 5 years of experience working with children with CP was asked to rate the level of social participation with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) of these children according to the variables (intelligent quotient [IQ], CP type, walking ability, GMFCS, CFCS, and MACS). Then, these data were analyzed using the polynomial discriminant function. After performing discriminant function, a flowchart model was determined for the level of children's social participation. To calculate the reliability of the model, 53 new samples were collected and their level of social participation was determined based on the flowchart model. The experts were then asked to determine the social participation level of these 53 new samples in the same manner as before, and then to calculate reliability, intraclass correlation coefficient (ICC) and Cronbach alpha. The SPSS Version 22 (SPSS Inc) and discriminant function model analysis was used for statistical analysis. Results: Based on the discriminant function model, the results between the predicted classification and expert review are over 88% consistent. The ICC and Cronbach alpha values were 0.952 and 0.975, respectively, with absolute agreement and multivariate mixed effects. Conclusion: Based on the results of the present study, the SPCS was developed in 5 levels (very low, low, moderate, high, and very high) and to determine it, the GMFCS, MACS, and CFCS scores, CP type, and IQ level should be calculated.

Assessment tools to evaluate Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older adults: A systematic review.

Background: Given the increasing population of older adults in different societies, it is important to take into account the needs of them. In this regard, the most important things that are closely related to their quality of life are their ability in evaluating Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) performances. The aims of the present study were to identify the outcome measures specific to the ADL and IADL for older adults and to investigate the psychometric properties of these measures. Methods: This is a systematic review done on the articles published between June 2019 and February 2019. Articles in English language from these database included: Medline, PubMed, Google Scholar, CINAHL, OVID Medline, Cochrane, ProQuest, Up to Date, Web of Science, OT search, OT direct, Pedro, SID, Magiran, Iran Medex, MEDLIB and Iran doc. English keywords included: "Activity of Daily Living (ADL)", "Instrumental Activity of Daily Living (IADL)", "assessment", "evaluation", "aging", "ageing", "older adults", "elders", "Basic Activity of Daily Living (BADL)", "Advanced Activity of Daily Living (AADL)", "basic functions", "self-care", "mobility", "independency", "dependency", "occupational therapy", "physical therapy", "rehabilitation". The Consensusbased Standards for the selection of health Measurement Instruments (COSMIN) checklist were employed to investigate the psychometric properties of the studies. Results: Of the initial 482 studies considered, 13 studies met the inclusion criteria that assess the ADL and IADL performance of older adults. In this regard, 8 outcome measures were found especially for ADL assessment and 5 for IADL assessment. Conclusion: Most of the assessment tools are performance-based and have been developed in especial contexts and especial groups of older adults. Some have been used frequently in different contexts but some were used less than others. None of these measures has been developed in Iran. So, for better assessment and having better intervention plans for older adults in Iran, it is suggested to develop an instrument that is especially designed for Iranian context.

Which models can be used as a clinical education model in occupational therapy? Introduction of the models: A scoping review study.

Background: Clinical education is a vital part of occupational therapy education process. High clinical education quality in fieldwork settings leads to higher clinical competency and occupational proficiency. One of the most effective clinical education methods in equalizing the conditions of clinical education to students is the correct use of educational models related to each field of medical sciences. In the field of clinical education, various models have been designed with a specific subject. However, limited research has been done on the introduction of the usability of these models in occupational therapy settings. This study was conducted to determine which models have the potential to be used as clinical education models in occupational therapy. Methods: A scoping review was conducted and studies published in English between 2000 and 2018 that examined clinical education models were selected. Results: A total of 8 articles were entered in the review, and a central theme of implementing clinical education models in occupational therapy was determined by thematic analysis. This central theme consisted of 3 categories: (1) evaluative models, (2) acting models, and (3) evaluative/acting models. Conclusion: Occupational therapists, especially who work as educators should be aware of the different types of clinical education models and try to use these models in clinical education process and minimize the variation of teaching methods in fieldwork settings to promote the clinical education quality. However, more research should be done to improve evidence-based occupational therapy practice in clinical education.

Reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version for children with physical disabilities.

INTRODUCTION: Occupational therapy supports individuals to participate in meaningful activities. Participation in activities should be assessed with appropriate tools. The aim of the present study was to establish the reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version (CPAS-P) for children with physical disabilities. METHODS: The participants were 304 parents of 6- to 12-year-old children with physical disabilities. Confirmatory factor analysis (CFA), internal consistency, convergent validity of the CPAS-P with the Vineland Adaptive Behavior Scale (VABS), and test-retest reliability were measured. RESULTS: Confirmatory factor analysis showed acceptable values for all indices of fit, namely goodness of fit index (GFI), adjusted GFI, normal fix index, comparative fit index, incremental fit index (i.e., greater than 0.90), and the value of root mean square error of approximation was 0.07, which was acceptable. High Cronbach's alpha coefficients (above 0.9) were reported for the total score of each scale (diversity = 0.94, frequency = 0.94, with whom = 0.92, enjoyment = 0.95, and parent satisfaction = 0.95). The convergent validity of the CPAS-P with the VABS was moderate to good and the test-retest reliability (ICC) for the total scores ranged from 0.90 to 0.96. CONCLUSION: The CPAS-P had good psychometric properties for parents reporting the activities of their 6- to 12-year-old children with physical disabilities and can be utilized in clinical practice.

Factors affecting social participation of Iranian children with cerebral palsy.

The purpose of this study was to identify the factors affecting the social participation of Iranian children with cerebral palsy (CP). Participants were 274 (male = 62%; female = 38%) children with CP, 6- to 12-years old (mean = 1.64) and their parents. Several standardized measures were used to assess social participation, gather environmental factors, and demographic questionnaires. The results of stepwise linear regression analysis indicated that the type of CP, Manual ability level and cognitive level (IQ) appear to be strong predictors of social participation between personal and environmental factors.

Factors affecting the clinical education of rehabilitation students in Iran: A systematic review.

Background: Clinical education is one of the main parts in medical education, and rehabilitation sciences are not exception. Through clinical education programs, students gain required qualifications to enter professional life. Several factors impact on students' clinical education, and identifying these factors could help in the improvement of clinical education and could improve knowledge transferring to clinical practice especially in rehabilitation sciences in Iran. The purpose of present review study is identifying the factors potentially affecting the clinical education of rehabilitation students in Iran. Methods: A systematic review study conducted based on the evidence-based method on published articles from 2000 to 2017. The search process was carried out on MEDLINE, CINAHL, PsycINFO, and EMBASE databases. Results: A total of 167 papers were selected. Given identical findings and considering eligibility criteria, 12 articles in the fields of clinical education, clinical competence, professional ethics education, and clinical reasoning were ultimately chosen. Conclusion: The results indicate that many factors might influence the clinical education of rehabilitation science students. Environmental factors (including ministry policies, educational curriculums, clinical education environments, and educational facilities/equipment) and individual factors (the knowledge and skills of students and characteristics of clinical trainers) were identified as the most influential factors in clinical education.

Combined effect of botulinum toxin and splinting on motor components and function of people suffering a stroke.

BACKGROUND: Spasticity is one of the problems after a stroke. Due to this increase in muscle tone, patients are confronted with problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of the simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period. METHODS: In this study a comparison was done between three groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about three months and the evaluations were done monthly. Goniometry was the method to measure the range of motion, and Modified Ashworth Scale was used to examine the spasticity and the upper extremity function was scored based on Fugl- Meyer Assessment. Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times. Significance was set at 0.05. RESULTS: All outcome measures were improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during the 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month) (p>0.05). The results also showed that the changes in elbow`s spasticity (p=0.05) and wrist`s spasticity (p=0.007) and upper extremity function (p=0.04) were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin, and the splint was more than other groups. CONCLUSION: In this study, the effects of botulinum toxin injection and Volar-Dorsal Wrist/Hand Immobilization splint and the combined use of botulinum injection and splint were obvious in all groups but was not significantly different between the interventions in a 3-month follow-up.

Barriers to Occupational Therapy Fieldwork Education in Iran: The Perspectives of Fieldwork Educators and Students.

BACKGROUND: Clinical education is a vital factor in the process of learning in medical sciences universities. The aim of the present study was to explore the perspectives of fieldwork educators and students concerning barriers to occupational therapy fieldwork education in Iran. MATERIALS AND METHODS: A qualitative research was conducted from May 2019 to April 2020 to address the study objectives. The data analysis was performed using conventional content analysis based on Graneheim and Lundman's approach. Purposive sampling was used to enroll 12 educators and 14 students of various backgrounds (physical disabilities-adult, physical disabilities-pediatrics, psychosocial-adult, and psychosocial-pediatrics) in the study. RESULTS: The findings indicated that the main themes were related to fieldwork educators, fieldwork settings, educational planning, students, and educational regulation. CONCLUSIONS: It can be concluded that the perspectives of students and occupational therapy educators regarding the field of clinical education are not only important but also useful for the attainment of effective clinical education and the development of knowledge related to rehabilitation nursing education. Therefore, educational planners should develop effective programs based on these themes.

The Impact of Manual Ability Level on Participation of Children with Cerebral Palsy in Life Areas: A Cross-Sectional Study.

OBJECTIVES: Participation is a complex and context-dependent concept, which several factors can influence it. The aim of this study was assessing the relationship between the upper extremity function level of children with cerebral palsy (all type of cerebral palsy and severity) and their participation in different life areas. MATERIALS & METHODS: This cross-sectional study assessed the relationship between the level of upper extremity function of cerebral palsy children and their participation in different life areas. Participants were 274 parents of children with cerebral palsy of the schools of children with special needs and occupational therapy clinics in Tehran, Iran in 2018. They completed the Manual Ability Classification System (MACS) to determine the level of upper extremity function of children with cerebral palsy and Children Participation Assessment Scale-Parent version (CPAS-P) (to determine the participation level of children with cerebral palsy) questionnaires separately. RESULTS: The mean age of children was 8 yr and 8 months old (at least 6 yr and maximum 12 yr). The correlation between the level of upper extremity function and the overall score of each dimension of participation is significant (P<0.05) and moderate. CONCLUSION: The upper extremity function of children with cerebral palsy has a moderate and significant relationship with the participation of children with cerebral palsy in different life areas and with different dimensions of participation especially parental satisfaction dimension. Therefore, there is a correlation between upper extremity function and participation in occupations, but this relationship is moderate and is not very strong.

Participation of Iranian Cerebral Palsy Children in Life Areas: A Systematic Review Article.

OBJECTIVE: Cerebral palsy (CP) is the most common cause of chronic disability that restricts participation in areas of occupations for children. The main aim of rehabilitation is enhancement of their clients for participation in occupations. The aim of this study was to overview of the factors influencing the participations of children with CP in Iran. MATERIALS & METHODS: A systematic, evidence-based process (Duffy 2005) was used. For data gathering electronic databases including Google scholar and Iranian and foreigner famous journals in the fields of pediatrics, were used. The main key words for search were Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL), play, leisure, work, rest/sleep, social participation, and education. All the papers of this study were about the factors influencing the participation of Iranian CP children during 2000-2016. Totally, 156 articles were found eligible as for Iranian CP children study, of which 100 articles were discarded. Because of repetitive and duplicability of some articles, 17 articles were removed as well. RESULTS: The most studies about Iranian CP children participations in life areas were in the ADL area of participation (N=12), and the lowest articles were in the area in the field of: Work (N=2), play (N=2), and sleep/rest (N=2). Most of the occupational therapists do not focus on the all life areas. CONCLUSION: In Iran, many researchers do not pay attention to the participation of CP children. Many articles just paid attention to the sensory, motor or cognitive components of their clients.

Does Parent Report Gross Motor Function Level of Cerebral Palsy Children Impact on the Quality of Life in these Children?

OBJECTIVE: The aim of this study was to assess the effect of parent report gross motor function level of cerebral palsy (CP) children on the parent report quality of life of CP children. MATERIALS & METHODS: Sampling of this cross-sectional study was done in occupational therapy clinics and CP children's schools in 2016 in Zanjan, Iran. Samples size was 60 CP children aged 6-12 yr and for sampling method, a non-probability convenience was used. For assessing the quality of life of CP children the cerebral palsy quality of life (CP QOL) questionnaire and for assessing the level of gross motor function of CP children the Gross Motor Function Classification System Family Report Questionnaire (GMFCSFRQ) were used. RESULTS: The average age of children (22 males and 30 females) was 8.92 yr old (minimum 6 yr and maximum 12 yr). The relationship between the level of gross motor function and participation and physical health was direct and significant (r=0.65). The relationship between functioning, access to services and family health with the level of gross motor function was direct but was not significant (P>0.05) and the relationship between pain and impact of disability and emotional well-being with the level of gross motor function was significant (P<0.05). CONCLUSION: There was no strong correlation between the level of gross motor function and quality of life of children with cerebral palsy. It means that the level of gross motor function cannot be used as a predictor of quality of life for children with cerebral palsy alone.

The effect of Son-Rise and Floor-Time programs on social interaction skills and stereotyped behaviors of children with Autism Spectrum Disorders: a clinical trial / O efeito dos programas Son-Rise e Floor-Time nas habilidades de interação social e comportamentos estereotipados de crianças com Transtornos do Espectro do Autismo: um ensaio clínico

Abstract Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder in which difficulty in social interaction skills and performing limited and stereotyped activities are among its symptoms. This study aims to determine the effect of Son-Rise and Floor Time programs on social interaction skills and stereotyped behaviors in children with ASD. The present study was a Clinical Trial. The participant were 60 children with ASD who were selected by convenience sampling method and randomly assigned to three groups (Son-Rise intervention, Floor-Time intervention, and control group with routine occupational therapy interventions). For data gathering, Autism Spectrum Screening Questionnaire, Gilliam Autism Rating Scale, and Autism Social Skills Profile were used, respectively. For data analysis, repeated measures and analysis of variance were used (two-way between and within- subjects). The results of data analysis showed that Son-Rise and Floor Time programs had a positive effect on social interaction skills of children with ASD, and reduced stereotyped behaviors of these children; Also, there is a significant difference between the effectiveness of Son-Rise and Floor-Time programs on social interaction skills and stereotyped behavior in the post-test, which is more effective in the Floor Time compared to Son-Rise program.

Resumo O Transtorno do Espectro do Autismo (TEA) é um transtorno do neurodesenvolvimento que tem entre seus sintomas a dificuldade nas habilidades de interação social e a realização de atividades limitadas e estereotipadas. O objetivo deste estudo foi determinar o efeito dos programas Son-Rise e Floor Time nas habilidades de interação social e comportamentos estereotipados em crianças com TEA. O presente estudo foi um Ensaio Clínico. Os participantes foram 60 crianças com TEA que foram selecionadas pelo método de amostragem de conveniência e distribuídas aleatoriamente em três grupos (intervenção Son-Rise, intervenção Floor-Time e grupo controle com intervenções de terapia ocupacional de rotina). Para a coleta de dados, foram utilizados o Autism Spectrum Screening Questionnaire, a Gilliam Autism Rating Scale e o Autism Social Skills Profile, respectivamente. Para a análise dos dados foi utilizada a análise de variância de medidas repetidas (bidirecional entre e dentro dos sujeitos). Os resultados da análise dos dados mostraram que os programas Son-Rise e Floor Time tiveram um efeito positivo nas habilidades de interação social das crianças com TEA e reduziram os comportamentos estereotipados dessas crianças; Além disso, há uma diferença significativa entre a eficácia dos programas Son-Rise e Floor-Time nas habilidades de interação social e comportamento estereotipado no pós-teste, que é mais eficaz no Floor Time comparado ao programa Son-Rise.