Abstract
ABSTRACTAims: To describe the focus of therapy practices in occupational and physical therapy for school-aged children with cerebral palsy, and better understand whether it is congruent with recommended practices. Methods: A Canada-wide Web-based survey was completed by 62 occupational and 61 physical therapists to identify problems, assessments, and treatment interventions for two case-based scenarios. Data were coded using the International Classification of Functioning, Disability and Health (ICF) definitions for “body functions and structure,” “activity and participation,” and “environment.” Results: Physical therapists, in comparison to occupational therapists, were more likely to select interventions classed in the “body functions and structure” category (34–42% and 18–20%, respectively). Both professions focused on “activity and participation” (34–61%) when identifying problems, assessing, and intervening; attention, however, was mainly directed towards task-oriented activities such as activities of daily living and mobility. Participation in leisure or community-based activities received less attention (2–15%). The environment received limited attention for problems and assessments (4–25%), though it was an important focus of intervention (19–37%). Conclusions: While body functions and structure are well-addressed, other ICF elements, specifically participation, are poorly integrated into practice. The emerging focus on the environment in therapy intervention, by modifying the context rather than changing aspects of the child, is consistent with current approaches and evidence. Knowledge translation implementation initiatives are recommended to bridge identified gaps.
Highlights
Knowledge translation implementation initiatives are recommended to bridge identified gaps
Considerable attention is directed towards the ICF category of body functions and structure involving a focus on quality and patterns of movement, when assessing and intervening, in particular among physical therapists (PTs)
Research indicates that practitioners including therapists, pediatric physicians, and neurologists value the outcome of social participation and consider it as a relevant area of functioning, and 60% of our sample indicated that a change in their clinical practice has occurred in the last year, gaps still exist and the shift has not been fully incorporated.[3,24]
Summary
This cross-sectional study was approved by the Institutional Review Board of McGill University. Eligible participants were registered OTs and PTs in Canada who have provided services for at least 4 months in the past year for school-age children (aged 5–10 years) with CP. The Canadian Association of Occupational Therapists (CAOT) and the Canadian Physiotherapy Association (CPA) Web sites provided the names and contact information of participating provincial and territorial licensing agencies or recognized professional associations of OTs and PTs in Canada. All possible agencies were approached, with nine of the 13 physical therapy organizations agreeing to participate as well as 10 out of the 12 provincial occupational therapy organizations (response rate between 69% and 83%), forwarding the online survey to their members. All members with electronic contact information listed on the CAOT Web site were forwarded the survey and encouraged to in turn forward it to colleagues who would potentially meet the eligibility criteria, promoting a snowball sampling effect.
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