Occupational Therapy Management Research Articles

Designing an occupation-based group intervention for adult inpatient rehabilitation: Partnering with clinicians and patients using a nominal group technique design.

Occupation-based interventions use engagement in a person's daily activities to achieve change. There is growing research into the use of occupation-based group interventions in the inpatient rehabilitation setting. It remains unclear whether occupation-based groups offer comparable outcomes to occupation-based interventions delivered individually; this research will precede a clinical trial aimed at comparing these two approaches for improving occupational performance outcomes. This study details the process of co-designing the intervention. Partnering with clinicians and patients in the design of healthcare interventions can promote patient-centred care, enhance uptake, and improve applicability and sustainability of the intervention to that setting. A modified nominal group technique (NGT) design was applied to facilitate two meetings and an electronic survey with an expert panel of clinicians and patients. Twelve participants (n = 4 occupational therapists, n = 1 registered nurse, n = 1 physiotherapist, n = 1 occupational therapy assistant, n = 1 occupational therapy manager, and n = 4 patients) were purposively recruited. A modified approach to the technique's four stages was used: silent generation, round robin, clarification, and voting. Consensus was set at >50%. Qualitative data from group discussions were analysed thematically. All participants agreed the intervention should include patient-centred, goal-directed, practice of daily activities, including breakfast and lunch preparation, domestic tasks, and laundry. Other components that were agreed included where the groups could run, group size, eligibility criteria, and frequency. Key themes from clinicians included needing a goal-directed intervention, focused on progressing towards hospital discharge; time and resource requirements were also discussed. Patients emphasised the importance of building social connections, opportunity to engage in meaningful activity, and the importance of linking participation to patient goals. Through collaboration with clinicians and patients, an occupation-based group intervention considering the available evidence, alongside clinical, experiential, and contextual sources of knowledge was developed; this resulted in an evidence-based, patient-centred, and contextually relevant intervention.

Effectiveness of Occupational Therapy Based Sleep Intervention on Sleep Quality and Its Impact on Quality of Life in Patients with Parkinson’s Disease

Parkinson’s disease is a degenerative disease which has motor as well as non-motor symptoms. Most of the times non-motor symptoms are neglected in traditional management by the healthcare professionals. But these symptoms add up to the suffering of the person. Sleep disturbances are one of the commonest non-motor symptoms seen in Parkinson’s disease. These symptoms affect daily life of an individual. Thus, Occupational therapy management is essential in improving sleep quality along with management of other symptoms. The aim of this study is to evaluate the effectiveness of occupational therapy based sleep intervention in improving sleep quality in Parkinson’s disease. Also, this study aimed at evaluating its impact on quality of life. The study included 37 patients. The intervention program of four weeks was provided to all which was tailored made as per patients’ evaluation. The results showed statistically significant result in Pittsburgh sleep quality index and WHO Quality of Life BREF scale. This study highlighted the need for customized sleep program and demonstrated the effectiveness of occupational therapy based sleep intervention. Keywords: sleep, sleep quality, occupational therapy, Parkinson’s disease, neurorehabilitation, quality of life.

Promoting Participation-Focused Practices in Inclusive Educational Settings: Stakeholders' Perspectives Following a Knowledge Translation Initiative.

Available participation-focused interventions (e.g., the Pathways and Resources for Engagement and Participation intervention [PREP]), are not well integrated into practice, indicating a knowledge-to-practice gap. To explore the perspectives of school-based (SB) occupational therapists and occupational therapy managers following knowledge translation (KT) programs for facilitating participation-based practices in inclusive education. This was an implementation qualitative study. After taking part in KT programs for implementing PREP, which were tailored to the needs and contexts of each stakeholder group, occupational therapists participated in focus groups, and occupational therapy managers responded to open-ended survey questions. A content analysis was done separately for each group, then integrated and organized according to the Participation-focused KT (P-KT) framework. Inclusive educational setting. Seven occupational therapists working in inclusive schools and 39 occupational therapy managers. We identified 10 themes addressing the micro, meso, and macro levels of the P-KT framework across the two groups. Five themes, common to all participants, addressed micro (e.g., setting participation-focused goals) and meso (e.g., school-PREP fit) levels. Macro-level themes were addressed by managers only (e.g., anchoring PREP to existing policy of the Israeli Ministry of Education). Targeting different stakeholders at the micro and meso levels of the educational system can initiate a shift in practice toward a focus on participation. KT intersectoral initiatives at the macro level (e.g., targeting community services and local policies), and engaging other stakeholders (e.g., students, families, and educators), are required to ensure the sustainability of participation-based practices. What This Article Adds: The authors present two knowledge translation programs that target both occupational therapists and managers in the educational system. The programs promote a shift in school-based occupational therapy services toward a focus on participation and environment.

International consensus on occupational therapy interventions for people with palliative care needs: A European Association for Palliative Care Group Concept Mapping study

Background: While evidence shows that occupational therapists can play a key role in the care of people with palliative care needs, more knowledge about effective occupational therapy interventions for this group is needed. Aim: To identify, organise and prioritise intervention components considered to be effective within occupational therapy for people with palliative care needs from the perspective of occupational therapy clinicians, managers and researchers. Design: Group Concept Mapping utilising a mixed methods participatory approach. Using a focus prompt, participants brainstormed, sorted, labelled and rated generated statements about effective occupational therapy intervention components. Multidimensional scaling analysis and cluster analysis were conducted. Setting/Participants: Snowball recruitment was used to recruit participants. Participants included occupational therapists worldwide who were able to read and write in English and were working as clinicians, managers and/or researchers with occupational therapy interventions for people with palliative care needs. Results: Seventy-two occupational therapists from 15 countries participated in the study representing Asia (n = 3, 20%), Europe (n = 8, 53%), Oceania (n = 2, 13%) and North America (n = 2, 13%). A total of 117 statements were identified and organised into five clusters: (1) being client-centred, (2) promoting occupational engagement to optimise quality of life, (3) involving the social and relational environment, (4) enabling occupations and (5) facilitating occupational adaptation. Conclusions: Five clusters of core occupational therapy intervention components were considered to be effective when supporting people with palliative care needs. Research should use this knowledge to inform future occupational therapy interventions for this group of people.

The 30th Occupational Therapy Australia National Conference and Exhibition 2023: An opportunity to acknowledge, celebrate and ignite our occupational achievements

The 30th Occupational Therapy Australia National Conference and Exhibition 2023: An opportunity to acknowledge, celebrate and <i>ignite</i> our occupational achievements

Efficacy on Non-motor and Motor symptoms and Quality of Life using a multidisciplinary telemedicine program in high-risk fall patients with Parkinson’s disease. (S32.003)

<h3>Objective:</h3> This study aims to evaluate the efficacy of a multidisciplinary telemedicine (TM) program to improve lifestyles, the burden of motor and non-motor symptoms (NMS), and quality of life (QoL) in fall patients with Parkinson’s disease (PD) and high risk of fall. <h3>Background:</h3> Falls in PD are very frequent, with devastating consequences, worse QoL, increasing comorbidity, and social isolation. Telerehabilitation has shown promising effects on motor symptoms, but the effectiveness of a multidisciplinary TM intervention in addition to standard clinical care on NMS, QoL and lifestyle remains unclear <h3>Design/Methods:</h3> Longitudinal, randomized study. PD Patients with high risk of falling and restricted access to multidisciplinary care were included (NCT04694443). A multidisciplinary TM program plus standard care was allocated to the study group for 4 months and compared to controls (in-office visits, standard care). TM included occupational therapy, nutrition, and PD clinical management. After discontinuing TM, both groups were compared at 8 months. Gait and PD motor severity were assessed using wearable sensors, MDS-UPDRS, Mini-Best and Freezing of gait questionnaire (FOGQ); quality of life (EuroHis-QoL8) and NMS (NMSS), Apathy Severity (LARS) and Depression/Anxiety Scale (BDI-II). Clinical information at baseline vs. 4 and 8-months visits were compared using parametric/non-parametric tests as needed. <h3>Results:</h3> 51 PD patients, 48.6 % males, median Hoehn Yhar stage 2 (1;3), mean age 68.6 ± 9.7 years were included. At 4 months, compared to controls, patients on TM had an improvement in the MDS-UPDRS II (p=0.01), Mini-Best (p&lt;0.0001) FOGQ (p=0.01); EuroHis-QoL8 (p=0.004); LARS (p&lt;0.0001) and BDI-II scores (p=0.004). After discontinuing TM at 8 months, FOG (p=0.01), and Mini-Best (p=0.001) scores were better in the TM group compared to controls. <h3>Conclusions:</h3> A multidisciplinary TM intervention alongside with standard care improves gait, QoL and NMS in PD patients with a high risk of falling. Long-term benefits on gait were observed more likely attributed to lifestyle modifications <b>Disclosure:</b> Dr. Cubo Delgado has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Cubo Delgado has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Zambon. Dr. Cubo Delgado has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Cubo Delgado has received research support from Spanish health ministry. The institution of Dr. Cubo Delgado has received research support from European union grant. Alvaro Garcia Bustillo has nothing to disclose. Dr. Arnaiz-Gonzalez has nothing to disclose. Florita Valiñas has nothing to disclose. Marta Allende Del Río has nothing to disclose. José Miguel Ramírez Sanz has nothing to disclose. Jose Luis Garrido_Labrador has nothing to disclose. Mrs. Olivares Gil has nothing to disclose. Dr. Diez Pastor has nothing to disclose. Jose Maria Trejo has nothing to disclose. Jeronimo González-Bernal has nothing to disclose. Josefa Gonzalez-Santos has nothing to disclose.

Predictors of extended length of stay related to craniotomy for tumor resection

BackgroundHospital length of stay (LOS) related to craniotomy for tumor resection (CTR) is a marker of neurosurgical quality of care. Limiting LOS benefits both patients and hospitals. This study examined which factors contribute to extended LOS (eLOS) at our academic center. MethodsRetrospective medical record review of 139 consecutive CTRs performed between July 2020 and July 2021. Univariate and multivariable analyses determined which factors were associated with an eLOS (≥8 days). ResultsMedian LOS was 6 days (IQR 3–9 days). Fifty-one subjects (36.7%) experienced an eLOS. Upon univariate analysis, potentially modifiable factors associated with eLOS included days to occupational therapy (OT), physical therapy (PT), and case management clearance (p < .001); and discharge disposition (p < .001). Multivariable analysis revealed that pre-operative anti-coagulant use (OR 10.74, 95% CI 2.64–43.63, p = .001), Medicare (OR 4.80, 95% CI 1.07–21.52, p = .04), ED admission (OR 26.21, 95% CI 5.17–132.99, p < .001), transfer to another service post-surgery (OR 30.00, 95% CI 1.56–577.35, p = .02), and time to post-operative imaging (OR 2.91, 95% CI 1.27–6.65, p = .01) were associated with eLOS. Extended LOS was not significantly associated with ED visits (p = .45) or unplanned readmissions within 30 days of surgery (p = .35), and both (p = .04; p = .04) were less likely following a short LOS (<5 days). ConclusionWhile some factors driving LOS related to CTR are uncontrollable, expedient pre- and post-operative management may reduce LOS without compromising care.

Physical therapy and occupational therapy management of a person with bilateral transradial amputations: a case report

Objective This longitudinal case study describes the physical and occupational therapy interventions and recommendations for treatment of a person with bilateral transradial amputations during subacute rehabilitation, as there are currently few recommendations. Materials and methods A 53-year-old female with subacute bilateral transradial amputations received inpatient rehabilitation. Impairments include decreased balance, global weakness, and need for assistance with ADLs and transfers. Physical therapy, occupational therapy, nursing, a peer mentor, and a prosthetist collaborated. Interventions included task-specific and generalized strengthening, standing balance re-education, assistive device prescription, education using body-powered prostheses, home adaption recommendations, and activities of daily living practice. Results Patient progressed to independent functional mobility but required assist for activities of daily living and stairs negotiation due to limited caregiver support and poor prosthetic dexterity. She discharged to a skilled nursing facility. Conclusion Rehabilitation of a person with bilateral transradial amputations requires clinicians experienced with prostheses; excellent interdisciplinary coordination; early discernment of the available social support system; task-specific strengthening and coordination exercises to prepare the patient for prostheses; significant task-practice with prostheses; and a working knowledge of home modifications and adaptive equipment. This article describes recommendations, successful interventions, and lessons learned for future therapists when rehabilitating someone with bilateral transradial amputations. IMPLICATIONS FOR REHABILITATION Bilateral transradial amputations (BTAs) are a life-altering, but rare condition, meaning that literature surrounding this population is sparse and that guidelines for rehabilitation are unclear. This article provides recommendations so that clinicians can be better informed when treating BTA patients in the subacute phase and more quickly progress patients toward functional independence and discharge to the community.

Neurological, Psychiatric, and Multisystemic Involvement of Fragile X Syndrome Along With Its Pathophysiology, Methods of Screening, and Current Treatment Modalities.

Fragile X syndrome (FXS) is a hereditary disease that predominantly leads to intellectual disability (ID) in boys. It is the second prominent cause of ID, which manifests as a result of the atypical development of the cytosine-guanine-guanine (CGG) region. This irregular extension of the CGG region gives rise to methylation and silencing of the fragile X mental retardation 1 (FMR1) gene, causing a loss of the fragile X mental retardation 1 protein (FMRP). This reduction or loss of FMRP is the main cause of ID. It has a multisystemic involvement showing neuropsychiatric features such as ID, speech and language delay, autism spectrum disorder, sensory hyperarousal, social anxiety, abnormal eye contact, shyness, and aggressive behaviour. It is also known to cause musculoskeletal symptoms, ocular symptoms, cardiac abnormalities, and gastrointestinal symptoms. The management is challenging, and there is no known cure for the disease; hence an early diagnosis of the condition is needed through prenatal screening offered to couples with familial history of ID before conception. The management rests on non-pharmacological modalities, including applied behaviour analysis, physical therapy, occupational therapy, speech-language therapy, and pharmacologic management through symptomatic treatment of comorbid behaviours and psychiatric problems and some forms of targeted therapy.

Occupational therapy rehabilitation managers' perspectives on community integration of persons with spinal cord injuries in Nairobi, Kenya

INTRODUCTION: Spinal cord injuries (SCI) present complex clinical challenges requiring comprehensive rehabilitation management to facilitate adequate community reintegration. Rehabilitation managers are suitably positioned to enforce and enact policy related to holistic rehabilitation intervention, including preparing patients for community integration. However, due to discrepancies within the chain of care systems, they are unable to ensure individuals with SCI in Kenya are discharged to their respective communities fully prepared for effective community integration. Exploring their perspectives may therefore highlight potential barriers or enablers to ensuring more effective community integration for survivors of SCIs METHODS: A qualitative, descriptive study was conducted via individual interviews with 12 purposively sampled rehabilitation managers. Data were audio-recorded and transcribed and underwent content analysis FINDINGS: The study findings revealed inadequacies in the process of spear-heading and facilitating community integration of individuals that sustained a spinal cord injury. On the other hand, the study suggested possible strategies to reinforce community integration for individuals with spinal cord injuries by involving all stakeholders in decision making, addressing training gaps, facilitating research programmes and equipping rehabilitation centres with specialised spinal cord units CONCLUSIONS: Implementing disability policies to minimise barriers to community integration and access to essential services is required. This includes developing clear guidelines on comprehensively managing individuals with spinal cord injuries in the community within the Kenyan context Implications for practice • Occupational therapy managers have a role to play in the facilitation of empowerment strategies aimed at influencing community (re) integration of survivors of SCIs. • There is the need for the enactment of an effective rehabilitation framework to enforce the role of occupational therapists as a key role player in facilitating community (re) integration. • Goodwill is required from the governmental political systems and organisations to spearhead the enforcement of the existing disability legislation if the welfare of survivors of SCIs are to be achieved.

Adaption of a Behaviour Change Intervention to Support Constraint-Induced Movement Therapy (CIMT) Delivery Via Telehealth

<h3>Research Objectives</h3> To explore therapists' perceived barriers and enablers to the delivery of CIMT programs via telehealth (TeleCIMT) and understand experiences and use of online resources to support TeleCIMT implementation. <h3>Design</h3> Prospective single group pre and post-test implementation study using mixed methods. <h3>Setting</h3> Ambulatory rehabilitation services within metropolitan Sydney, Australia. <h3>Participants</h3> Occupational Therapists and Occupational Therapy Managers delivering outpatient upper limb rehabilitation services post-stroke were recruited from three rehabilitation services. <h3>Interventions</h3> Relevant literature and the key barriers and facilitators to providing standard CIMT (identified in a previous study of face to face CIMT delivery (ACTIveARM)) were synthesised in phase 1. Key facilitators and barriers to the adoption of CIMT in the new context of telehealth were then identified and a behaviour change intervention developed using implementation mapping. Focus groups with therapists, managers and implementation researchers were then used to refine the behaviour change intervention prior to delivery. <h3>Main Outcome Measures</h3> The proportion of eligible stroke survivors who were offered and received a TeleCIMT program following delivery of the behaviour change intervention. <h3>Results</h3> Barriers to telehealth delivery included lack of therapist knowledge and skills, and lack of resources to delivery CIMT. This result was consistent with previous studies. Additional barriers identified included challenges for participants with accessing telehealth and an increased need for family member/carer engagement to support program delivery. The developed behaviour change intervention included online therapist training modules and an online community of practice. Preliminary outcomes associated with therapist adoption and delivery of TeleCIMT will be presented. <h3>Conclusions</h3> We describe the process of adapting an effective, theoretically-informed behaviour change intervention to a new context to support the delivery of evidence based upper limb rehabilitation via telehealth. <h3>Author(s) Disclosures</h3> LC declares she received funding support through a Stroke Foundation (Australia) Early Career Researcher grant and St Vincent's Clinic Foundation (Australia) Multidisciplinary Research grant to conduct this study. NL declares she received Heart Foundation (Australia) funding (GNT102055).

Developing interactive oral assessments to foster graduate attributes in higher education

Interactive oral assessments demonstrate potential to develop graduate attributes such as critical thinking, professional communication and collaborative skills in students through authentic simulation of workplace scenarios. This study captured the design, delivery and evaluation of interactive oral assessments across three programmes – occupational therapy, nursing and air transport management – in one university. A four-step Model to Build Authentic Assessment was used to design the assessments. Quantitative and qualitative data collected from 158 students, five assessors and three module leaders were analysed for a basic evaluation of the fidelity of interactive oral assessment implementation across different contexts and to explore the experiences of faculty and students undertaking the assessments. Fidelity was considered in terms of: (i) whether students could express their individualised responses, (ii) if they perceived the assessment to be authentic, and (iii) if it helped them gain professional knowledge and skills. In all the developed assessments, each of the three aspects were somewhat evident, evident or clearly evident. Qualitative findings suggested the interactive oral assessments reflected real-world expectations, promoted deep learning and offered a quality learning experience. From these results, practical suggestions for how faculty can self-assess their readiness for implementing interactive oral assessments are offered.

Exploring the meaning of value-based occupational therapy services from the perspectives of managers, therapists and clients

Introduction There is a worldwide trend towards value-based health care, which strives to control healthcare costs while maximising value for clients. The main concept of value has been defined as health outcomes achieved per US dollar spent. This research explored how clients of occupational therapy services, managers and occupational therapists perceived value in occupational therapy services. Method A qualitative design was used to explore the perspectives of clients ( n = 11), occupational therapists ( n = 7) and occupational therapy managers ( n = 7). Appreciative inquiry guided the two phases of semi-structured interviews ( n = 5) and focus groups ( n = 6). Inductive and deductive coding were used to establish themes. Findings Three themes encompassed the participants’ perceived value of occupational therapy services: (1) outcomes which are meaningful to daily life, (2) a constructive client–therapist relationship and (3) affordable, coordinated and understandable therapy. Conclusion Participants attributed value to occupational therapy services when they encountered personalised goal setting, focused on meaningful outcomes, managed personal costs and experienced positive therapeutic relationships. Enhancing services could focus on (1) developing skills in collaborative goal setting, (2) determining suitable outcome measures which are meaningful at personal- and service-level reporting, (3) encouraging self-management strategies, and (4) emphasising therapeutic relationships and supporting therapeutic communication skill development.

Occupational Therapy Management of a Moderate COVID-19 Disease Process in a Skilled Nursing Facility: A Case Report

Abstract Older adults living in skilled nursing facilities (SNFs) and long-term care facilities are particularly susceptible to the coronavirus disease 2019 virus and face unique challenges during their rehabilitation process. This case report highlights the disease and rehabilitation course of an older adult who received all of his medical and rehabilitative treatment while residing in a SNF. The occupational therapy evaluation and intervention processes, as well as the client’s response to intervention, are described. The client’s positive outcomes are linked directly to occupational therapy’s ability to incorporate medical, physical, and psychosocial aspects into part of the interdisciplinary model of care in a SNF.

Patient functional independence and occupational therapist time-use in inpatient services: Patient demographic and clinical correlates.

IntroductionHealth care expenditure has rapidly increased in Australia. Effective management of occupational therapy services is required to meet clinical demand. Improving our understanding of factors which influence occupational therapy service delivery is a vital step to manage workload distribution and optimise service efficiency. This study aims to examine the influence of patient sociodemographic characteristics, diagnosis and functional independence on the utilisation of occupational therapy resources in hospital inpatients over 18 years old.MethodsProspective, cross-sectional, observational cohort study of 4549 inpatients from three hospital sites in Melbourne, Australia. Data extracted from organisational databases and included in this study were: patient demographics, diagnosis, functional level assessed using the SMAF (Functional Autonomy Measurement System) and occupational therapy time-use. Data were analysed using univariable and multivariable modelling.ResultsOccupational therapy time-use was significantly associated with all variables included in analysis (p < 0.05). For each variable the amount and direction of effect differed between hospital sites. The SMAF was the only variable consistently associated with occupational therapy time-use. Higher occupational therapy time-use was associated with lower functional independence (leading to a 3.5 min increase in median occupational therapy time for every unit decrease in SMAF score).ConclusionsManagement of resources within busy hospitals require knowledge of factors associated with occupational therapist time-use. This study identified that time-use could in part be predicted by functional independence, diagnosis and sociodemographic characteristics. Occupational therapy managers can use this information to support decision making while acknowledging other patient and therapist level factors also influence time-use.

Perspectives on the Professional Communication Profile and Needs of Emerging Occupational Therapists of the Millennial Generation: A Comparison Study

Background: Millennials, born between 1982­ and 2000, became the largest share of the American workforce in 2015. As of 2014, 23.9% of American occupational therapists were under the age of 30. Positive traits ascribed to millennials include: highly educated, ambitious, confident, and optimistic. However, indicators of challenges for managing millennials emerge from media and anecdotal evidence, including stereotypes of disloyalty, entitlement, dependency, and casualness. Relevant for supporting professional development is a call to understand and enhance professional communication. Method: This study analyzed how emerging millennial occupational therapists self-describe their professional communication profile and needs, compared to the perspective of managers, while aiming to describe the accuracy of communication stereotypes. Occupational therapy managers and emerging occupational therapists of the millennial generation completed an online researcher-created survey. Results: Comparison of means revealed statistically significant differences, with the most significance noted on items reflecting professional communication skills of millennial occupational therapists. Conclusion: Analysis of results suggested support for some stereotypes and inaccuracy of others, painting a unique picture of the professional communication profile of millennial occupational therapists. Results from this small-population survey study may inform professional development opportunities for academic and fieldwork educators and occupational therapy managers related to the communication profile and needs of emerging occupational therapists through the lens of generational theory.

Disaster Management and Working with Displaced Persons (Methodological Paper)

This methodological paper explains the process of occupational therapy management of displaced persons due to disaster influence. It is yet to be part of the occupational therapy practice domain even in recent decades with the advancement in occupational therapy research evidence and development. It is based on the current knowledge and developments in occupational therapy client centered practice. This methodological and conceptual based study describes and illustrates the occupational therapy practice model of rehabilitating displaced persons due to disaster influence. The present paper explores the occupational therapy role in rehabilitating displaced persons through People’s Environmental Occupation, Ecology of Human Performance (EHP), and Occupational Therapy Practice Framework. These are integrated as a single conceptual model to describe how and process of occupational therapy practice area during the rehabilitation process of a displaced person(s). The paper finally presented a sequenced framework to guide occupational therapists practice in this new emerging practice area of rehabilitation. This study was developed based on three different theories to support the occupational therapy treatment process of a displaced person due to disaster of any nature. Its concept based without any statistical analysis.

Development and Validation of Jegadeesan and Maimoona Impulsivity Parent Rating Scale (Jam-Iprs) for Adhd Children

Aim: The aim of this study is to develop and validate the Jegadeesan and Maimoona Impulsivity ParentRating Scale (JAM-IPRS) among ADHD Children.ObjectivesO To generate the scale items through focus group discussion.O To identify the appropriateness and relevance of the items through subject matter Expert Rating.O To establish the psychometric properties of developed scale.O To develop norms for developed scale.O To translate the scale items in a two vernacular languages Tamil and MalayalamMethodology: Formulation of 42 statements was done with focus group discussion. The statements are sentto 50 experts in the field of Occupational Therapy, Speech Therapy, Psychologist and Special Educator forvalidating the items. Total of 42 items are validated by the experts. A total of 60 samples (30 normal subjectsand 30 impulsive subjects) were selected for the field trial/ main study those who were under occupationaltherapy management at the age range between 5 – 13 years residing Kerala (Malappuram and Thrissur) andTamilnadu (Erode and Komarapalayam). Samples were selected by using convenient sampling method.Socio-demographic data sheet prepared by investigators were used for collecting information regarding thename of the child, number of siblings, birth order, type of family, parental occupation and parental education.Conclusion: From the statistical analysis the assessment’s Cronbach alpha value is ? = 0.68 to 0.72 whichshows the assessment tool has good internal consistency, reliability. The expert validation was done andgot good relevance or content validity for all the scale items. The Test-Retest Reliability of developed scaleis 0.725. Hence Jegadeesan and Maimoona Impulsivity Parent Rating Scale(JAM-IPRS) can be used toidentify the level of impulsivity for ADHD children.

Psychometric Properties of the Multidimensional Impression of Change in a Cohort of Pediatric Patients With Pain

ObjectivesThis study assessed the utility of the Multidimensional Patient Impression of Change (MPIC) questionnaire in a pediatric pain population after interdisciplinary treatment. DesignObservational study with retrospective chart review. The observed treatment program included psychological counseling, relaxation training, physical therapy, occupational therapy, and physician management. SettingOutpatient pain management center affiliated with an academic rehabilitation hospital. ParticipantsA heterogeneous group of pediatric patients with chronic pain (N=202) who completed an interdisciplinary pain management program. InterventionsNot applicable. Main Outcome MeasuresMeasures assessing pain, mood, development, social functioning, physical functioning, and family functioning were administered pre- and posttreatment, and the MPIC was administered posttreatment. ResultsStatistically significant improvements were observed in all outcomes (P<.05). The majority of patients perceived themselves to be improved (minimally to very much) in all clinical domains of the MPIC, ranging from 60% (medication efficacy) to 96% (coping with pain). The MPIC ratings were significantly correlated with improvements in most of the outcome measures. The MPIC domains accounted for more than half of the unique variance in predictive models when added to the Patient Global Impression of Change, and most of the variance when added to the models first. ConclusionsThe MPIC was found to be an effective screening tool for assessing patient perceived progress in a pediatric chronic pain population.

Structural MRI Analysis of Chronic Pain Patients Following Interdisciplinary Treatment Shows Changes in Brain Volume and Opiate-Dependent Reorganization of the Amygdala and Hippocampus.

The present study examined pre- to post-treatment changes in volumes for brain structures known to be associated with pain processing (thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and accumbens) following an interdisciplinary pain management program. Twenty-one patients participating in a four-week interdisciplinary pain management program completed the study. The program consisted of individual and group therapies with the following disciplines: physical therapy, occupational therapy, pain psychology, biofeedback/relaxation training, nursing lectures, and medical management. All patients underwent functional magnetic resonance imaging of the brain before the start and at completion of the program. They also completed standard outcome measures assessing pain, symptoms of central sensitization, disability, mood, coping, pain acceptance, and impressions of change. Our results showed a significant increase in total brain volume, as well as increased volumes in the thalamus, hippocampus, and amygdala. As expected, we also found significant improvements in our standard outcome measures. The majority of patients rated themselves as much or very much improved. The increase in volume in the hippocampus was significantly associated with patient perceptions of change. However, the correlations were in the unexpected direction, such that greater increases in hippocampal volume were associated with perceptions of less improvement. Further exploratory analyses comparing patients by their opioid use status (use vs no use) showed differential program effects on volume increases in the hippocampus and amygdala. These findings show that a four-week interdisciplinary pain management program resulted in changes in the brain, which adds objective findings further demonstrating program efficacy.