Pediatric Occupational Therapy Research Articles

Spreading Standardized Documentation of Pediatric Occupational and Physical Therapy Dose: A Quality Improvement Initiative.

Clinicians and researchers can leverage clinical documentation of therapy services for quality improvement and research purposes. However, documentation is often institution specific and may not adequately capture the dose of therapy delivered, thus limiting collaboration. To implement documentation of pediatric occupational and physical therapy dose from one institution to another institution. Dose documentation includes the frequency, intensity, time, and type of interventions delivered (FITT Epic® Flowsheet) at each session. Prospective time-series quality improvement study. Two large urban pediatric hospitals. Occupational and physical therapy staff members. Staff training and feedback loops utilizing existing groups. The process measure (number of available staff trained and using the FITT Epic Flowsheet over time) and the outcome measure (percentage of FITT Epic Flowsheets used for treatment visits each month) were analyzed using a statistical process control chart. The balancing measure (percentage of notes closed before 7 p.m. on the same day as the encounter) was analyzed using mean per month across three time periods. Fifty-seven staff members (68%) attended formal training. On average, clinicians documented 90% of sessions using the FITT Epic Flowsheet after implementation. There was no change observed in the balancing measure. Documentation of dose was spread from one institution to another. Shared documentation will facilitate future collaboration for quality improvement and research purposes. Occupational therapy practitioners and leaders should consider implementing documentation with common dose elements. Plain-Language Summary: Occupational therapy documentation is often institution specific and may not adequately capture the dose of therapy (frequency, intensity, time) or types of interventions that were delivered, thus limiting opportunities for collaboration between institutions. This article adds to the literature on administrative supports for clinical and quality improvement research by illustrating a specific example of how documentation of dose can be shared from one institution to another. The data show that clinicians at one institution started using a new style of documentation using the FITT Epic® Flowsheet and shared discrete dose elements with another institution, creating new opportunities for collaboration. Shared documentation can facilitate future collaboration for quality improvement and research purposes.

OTs Should Be Using Video Modeling to Teach Self-Care to Children with NDDs

ABSTRACT An evidence-based project aimed at finding whether utilizing video modeling as an occupational therapy (OT) intervention increased basic self-care skills in school-aged children with neurodevelopmental disorders (NDDs). A total of 11 pediatric outpatient OT clients, 6–12 years old, with one or more NDDs, participated in this project. Pre- and post-intervention surveys completed by their parents garnered information regarding parental views on their children’s self-care skills, parental stress, and quality of life. Real-time data gathered during the intervention revealed the efficacy of video modeling, showing an overall increase in the completion of basic self-care skills from 16.1% at baseline to 96.4%. Meaningful gains were achieved in all eight self-care skills addressed and with all participants, elucidating a combined mean percentage of 79.3% improvement using video modeling. Post-intervention, qualitative data showed resultant perspectives of less parental stress, improved quality of life for the children and their parents, and improved independence with basic self-care skills. Considering the increasing diagnosis of NDDs, the call for evidence-based interventions from both payers and NDD-related organizations, and the future socioeconomic ramifications of not addressing basic self-care skills, this project reveals the efficacy of video modeling as a viable, accessible, cost-effective intervention which can be utilized across environments to address these concerns.

Profile of paediatric occupational therapy practice in Eastern Mediterranean countries

Background Paediatric occupational therapy (OT) is considered the largest practice area in OT in several regions, including the Eastern Mediterranean (EM) countries. Aims/objectives This study aimed to establish a profile of paediatric occupational therapists in EM countries to identify theoretical models, assessments and interventions employed. It also investigated the therapists’ usage of evidence-based practice in their practice. Material and methods We conducted a cross-sectional survey using a questionnaire which was distributed electronically to occupational therapists working with children. Results The participants included 118 therapists. Majority of the participants were working at rehabilitation centres. The primary client groups were pre- and school-age children with autism spectrum disorder and cerebral palsy. The most frequently used assessments were sensory-related tools. Activities of daily living and play were the most often targeted interventional area. Participants highlighted some of the challenges faced in implementing evidence in their practice. Conclusion Paediatric occupational therapists are usually exposed to specific age groups and conditions. However, a lack of knowledge practice in some areas and challenges in others exist. Significance Within the EM region, knowledge regarding therapists’ practices is lacking. Actions should be taken to improve current practice and meet the current needs of clients, and utilise evidence-based practices.

Evaluating the Experiences of Occupational Therapists and Children Using the SensoGrip Pressure-Sensitive Pen in a Handwriting Intervention: Multimethods Study.

The acquisition of handwriting skills is essential for a child's academic success, self-confidence, and general school performance. Nevertheless, an estimated 5% to 27% of children face handwriting challenges, where the ability to modulate pressure on the pencil and lead on the paper is a key motor component. We aimed to investigate the experience with and usability of the SensoGrip system, a pressure-measuring pen system with personalized real-time feedback about pressure modulation, in a clinical setting with children and occupational therapists (OTs). A multimethods study was conducted, incorporating qualitative interviews and questionnaires with children, user diaries, focus group discussions, and a usability questionnaire with OTs, along with a questionnaire for parents. The study involved OTs (n=8), children with handwriting difficulties (n=16), and their parents (n=16), each of whom used the SensoGrip system in up to 5 therapy sessions. OTs reported that the SensoGrip system helped to focus the child's awareness on handwriting pressure and to measure it objectively. The system received high acceptance and usability ratings from the OTs-usefulness: median score of 4 out of 7; ease of use and ease of learning: median score of 6 out of 7; and satisfaction: median score of 6 out of 7. Participants appreciated that it fosters pressure awareness and motivation to draw and write. The SensoGrip pressure-sensing system with real-time feedback is a promising tool for pediatric occupational therapy. It supports children with handwriting difficulties to adjust their pressure application during the task. In the future, controlled quantitative trials are warranted to further examine the system's impact.

Stress among Pediatric Occupational Therapists: A Study of Prevalence, Work and Demographic Factors

This study aimed to evaluate the self-reported stress levels of pediatric occupational therapists, examine specific work factors and determine if demographic factors predict occupational stress. A cross-sectional survey design study, using voluntary response sampling, was conducted. The survey included demographics, the Workplace Stress Scale, and the Stress Index. The sample included 289 pediatric occupational therapists. Using descriptive analysis, a one-sample t-test, and multiple linear regressions, results indicated that pediatric occupational therapists had significantly higher stress levels than the validating sample of the Workplace Stress Scale. Self-reported work factors included too much work to do in a limited time and lack of time to plan or evaluate treatments. No demographic factors predicted work stress, while several work factors did. Occupational stress exists in pediatric occupational therapy work settings, especially in settings where high productivity is self-reported.

Assessing physical literacy with school-aged children in occupational therapy practice: An exploratory qualitative study

Introduction: Physical literacy (the physical, psychological, social and cognitive capacities needed for movement and physical activity) is arguably important to occupational therapy yet is not explicit within current practice. This study aimed to understand how occupational therapists can engage with the physical literacy concept. Method: Eight paediatric occupational therapists were recruited by purposive sampling. Participants completed up to three semi-structured interviews to understand perspectives on physical literacy, introduce a novel pictorial assessment and to seek feedback on the assessment after trialling. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Results: Sixteen interviews were conducted. Four themes were identified: ‘Foreign tongue’ (occupational therapists have an understanding of physical literacy but used different terminology); ‘Sounds very OT oriented’ (illustrating the connection between physical literacy and occupational therapy); ‘We need the child’s voice’ (measure highlights the child’s perspective); and ‘Contemporary, useful BUT not for all’ (measure had utility for some children but was dependant on child’s condition). Conclusion: Occupational therapists can apply the physical literacy construct to traditional models and core concepts. The assessment can be used in paediatric occupational therapy practice supported by clinical reasoning, although future tool iterations may need to accommodate some children with disability.

Erratum to: Collaborative practices between parents and primary caregivers in pediatric occupational therapy: a scoping review protocol.

Erratum to: Collaborative practices between parents and primary caregivers in pediatric occupational therapy: a scoping review protocol.

Profile of Assessments in Pediatric Occupational Therapy Practice.

Occupational therapy practice is intended to reflect the core construct of occupation throughout all aspects of service delivery. In pediatric occupational therapy, the evidence examining regularly selected assessment tools and the occupational constructs of those assessment tools is insufficient. To examine the assessment tools regularly selected by practicing pediatric occupational therapists and the therapists' classification of assessment tools as occupation-based. A cross-sectional quantitative design through the dissemination of an anonymous, close-ended assessment tool inventory with completion of descriptive statistics. Pediatric occupational therapist practice specific to the assessments used. There were 337 pediatric occupational therapists recruited through targeted sampling via social media. The participants were included if they had provided direct client care to individuals ages of 0 to 21 yr during their career. The assessment tools most commonly used by pediatric occupational therapists are the Sensory Profile (86.4%) and the Beery-Buktenica Developmental Test of Visual-Motor Integration (85.2%). The primary assessment tools selected by pediatric occupational therapists were skill-based regardless of years of practice or practice setting. Therapists were unable to correctly classify assessment tools as occupation-based. The limited use of occupation-based assessments in conjunction with decreased recognition of the occupational nature of assessment tools hinders the integration of occupation-based assessment tools across pediatric clinical practice. Pediatric occupational therapists' integration of occupation-based assessment tools is needed to promote the occupational constructs of the profession. What This Article Adds: This article identifies the common assessment tools utilized by pediatric occupational therapists. Additionally, this article brings awareness to the inconsistent identification and integration of occupation-based assessment tools within pediatric clinical practice.

Occupation-Based Assessments in Pediatric Occupational Therapy Practice.

In pediatric occupational therapy, there is insufficient evidence examining assessment tool selection by occupational therapists and how assessment tools contribute to occupation-based practice. To examine the perceptions of occupation-based assessment tool selection by pediatric occupational therapists, a phenomenological research study was conducted with six pediatric occupational therapy practitioners. Three themes emerged from participants' perspectives: the centrality of occupation, selecting the just right tool, and practice implications. Participants recognized the need to integrate occupation-based assessments into practice but reported decreased opportunities secondary to training, available supplies, lack of awareness of foundational constructs, and organizational expectations. The use of occupation-based assessments positively enhances pediatric occupational therapists' clinical practice by upholding the core occupational beliefs of the profession throughout all phases of service delivery.

Evidence-Based Practice Through the Lens of Pediatric Occupational Therapy Clinic Managers in the Philippines

Evidence-Based Practice Through the Lens of Pediatric Occupational Therapy Clinic Managers in the Philippines

Exploring Therapeutic Relationships in Pediatric Occupational Therapy: A Meta-Ethnography.

Background. Developing strong therapeutic relationships with families is a crucial aspect of pediatric occupational therapy. However, building such relationships is complex as they involve multiple directions of interaction. Purpose. To provide a thorough interpretation of children's, caregivers', and occupational therapists' experience of the therapeutic relationship. Method. A meta-ethnography was realized to synthesize qualitative studies. A systematic search was carried out using five databases from 2005 to 2022. The CAPS checklist was used to appraise included studies' quality. The analysis was completed using a constant comparison of findings. Findings. Three themes emerged from the 14 studies synthesized. The first theme illustrates that the therapeutic relationship can have different meanings depending on the perspective of children, caregivers, or occupational therapists. The second theme explores the components impacting the experience of the relationship. These include the power dynamics, the communication, and respect for diversity. Finally, the third theme illustrates how the relationship can empower positive change. Implications. Children, caregivers, and occupational therapists each have a perspective that ought to be heard. Occupational therapists should actively ask for children's and caregivers' perspectives to encourage power sharing and effective communication. By doing so, occupational therapists can strengthen the therapeutic relationship, which, in turn, promotes positive change.

Metaphors of mindfulness in pediatric occupational therapy practice

Introduction: Metaphors are commonly used linguistic devices that can encourage deep reflection and offer new insight. Metaphors have been used within the both the occupational therapy and mindfulness literature to describe complex phenomena. The aim of this phenomenological study was to identify, analyze, and interpret metaphors used by pediatric occupational therapists to describe mindfulness in their clinical practices with children and youth. Method: Eight North American Occupational Therapists participated in semi-structured interviews which were transcribed verbatim. Transcripts were read to identify idiographic or naturally occurring metaphors used by participants. Metaphors of mindfulness were also elicited from participants as an interview question. Findings: Three themes were identified within participants’ idiographic metaphors of mindfulness: mindfulness as a tool, mindfulness as exploration, and mindfulness as a support. Two additional themes were identified within participants’ idiographic metaphors of themselves as facilitators of mindfulness: therapist as a guide, and therapist as a gardener. Elicited metaphors generally aligned with the themes identified for idiographic metaphors while some offered additional unique insights. Conclusion: The findings open conversations about therapists’ framing of the use of mindfulness within the context of pediatric occupational therapy.

Occupational therapists’ Perspectives of Using Telehealth for Youth with Autism Amidst the COVID-19 Pandemic in the UK: A Pilot Qualitative Study

ABSTRACT The COVID-19 national emergency led to a surging demand for telehealth expansion within pediatric occupational therapy. Despite the growing literature on telehealth as a response to COVID-19, few studies explore the use of telehealth for children and young people with autism spectrum disorder (ASD). This pilot study aimed to understand the experiences of occupational therapists adapting to a virtual delivery service model amidst COVID-19 to support youth with ASD. The researchers used a qualitative research design. Semi-structured, video-based interviews were used to collect data. Interviews were analyzed using thematic analysis. This study included 3 UK registered occupational therapists. Four themes emerged from the data: 1. “Telehealth is Reducing Social Anxiety” 2. “Parents End Up Becoming Your Therapy Assistants” 3. “Nothing Will Replace Face to Face for Assessments” 4. “You Definitely Have to Be More Creative.” The themes report that telehealth can reduce social anxiety, increase skill transferability, and improve family involvement. Participants indicated that shorter sessions, movement-based interventions, planning and adapting to home-based resources were strategies that overcame the limitations of virtual therapy. The findings contrast with some previous research that found that telehealth may inhibit engagement and may strain the therapeutic rapport. This study supports existing literature that telehealth can enhance engagement, family involvement and generalization of skills. Findings from this study support the use of telehealth to deliver occupational therapy services for children and young people with ASD, but it is recommended that telehealth should not be a one size fits all service delivery model. Further larger-scale research is needed to confirm the study findings and to explore the family and young person’s perspectives of using telehealth.

The Relationship Between School-Age Children’s Self-Reported Perceptions of Their Interoceptive Awareness and Emotional Regulation: An Exploratory Study

ABSTRACT Interoceptive awareness (IA) refers to one’s ability to perceive and recognize internal bodily signals. Our behavioral and emotional responses to interoceptive signals are determined by self-regulation. Therefore, IA and self-regulation have considerable impacts on children’s daily occupational engagement and performance. Nonetheless, the relationship between IA and self-regulation relevant to pediatric occupational therapy practice continues to lack empirical evidence. This study explores the association between school-age children’s self-reported IA, emotional regulation, and academic self-regulation. Twenty-five children completed the Cognitive Emotion Regulation Questionnaire for children (CERQ-k), the Multidimensional Assessment of Interoceptive Awareness – Youth adapted version (MAIA-y), and the Academic Self-Regulation Scale; parents/caregivers completed a demographics questionnaire (n = 25). Data were analyzed using Spearman’s rho (ρ) correlation and linear regression analyses with bootstrapping. Nineteen significant correlations were identified between MAIA-y and CERQ-k subscales (ρ = −.724 to .700, p < .05) and 14 between MAIA-y and ASRS subscales (ρ = .448 to .687, p < .05). Two MAIA-y subscales (“not-distracting” and “self-regulation”) were predictive of cognitive emotional regulatory strategies (total variance = 33%, 74.1%; p < .05); one MAIA-y subscale (“trusting”) was predictive of children’s autonomous academic self-regulation (total variance = 64.1%; p = .005). The result demonstrates significant correlations in children’s self-reported IA, emotional regulation, and academic self-regulation. Therapists should consider assessing children’s IA to inform self-regulation goal setting and treatment planning.

Mindfulness in paediatric occupational therapy practice: a phenomenological inquiry

Purpose While research into mindfulness practices is on the rise across populations, there is evidence to suggest that clinical practice has outpaced the literature with regard to mindfulness in pediatric rehabilitation. The aim of this study was to explore the perceptions of occupational therapists who opt to incorporate mindfulness into their clinical practices with children and youth. Methods Hermeneutic phenomenology was the methodology of the study. The theoretical framework employed a Heideggerian-informed phenomenology of practice. Eight occupational therapists practicing in Canada and the United States participated in 90–120 min semi-structured interviews that elicited first-hand accounts of mindfulness in pediatric occupational therapy practice. Interviews were transcribed verbatim and analyzed using Finlay’s four-step approach. Results Six salient themes were identified in the data: drawing from personal practice, enhancing participation, fostering healthy habits, adapting for children, keeping it playful, and doing with. Conclusion The findings of this study offer insights for therapists who are considering incorporating mindfulness into their practices with children and youth. Further, this research highlights a number of research priorities that require further inquiry.

Measuring Caregiver Outcomes in Pediatric Rehabilitation Telehealth Services: A Scoping Review.

Pediatric occupational therapy practitioners use telehealth to facilitate performance and participation in natural contexts. Optimal therapy outcomes occur when caregivers are integrated into telehealth sessions. This scoping review describes how caregiver outcomes are measured in the pediatric rehabilitation telehealth literature. We searched SCOPUS, MEDLINE, CINAHL, PsycINFO, and ERIC for articles on pediatric telehealth interventions published from January 2005 to June 2022. We excluded non-empirical articles and articles that measured children's underlying deficits only. Thirty-one articles met inclusion criteria. Studies measured caregiver outcomes with study-specific questionnaires, standardized measures, electronic tracking, and interviews. Caregiver outcomes improved after treatment, and caregivers reported high acceptability and satisfaction with telehealth. Ample evidence supports measurement of caregiver outcomes in pediatric rehabilitation telehealth services (PRTS). Future PRTS work should incorporate existing sound measures that comprehensively evaluate caregiver outcomes, including caregiver engagement and its components, to demonstrate the effect of occupational therapy telehealth services.

Therapist perceptions of barriers to telehealth uptake in children's occupational therapy.

The COVID-19 pandemic resulted in a rapid shift to telehealth implementation across paediatric occupational therapy services. Although telehealth can be an appealing option, access is conditional, and the delivery of a telehealth service differs from face-to-face. If telehealth is to be a viable and equitable option for families, insight is needed into why the service might be declined. The purpose of our study was to explore barriers to paediatric occupational therapy telehealth services from client and therapist perspectives in a Greater Sydney local health district. A mixed method approach was used, including (i) retrospective review of clinical records for 250 clients seeking occupational therapy who declined the service and (ii) a focus group with four therapists providing the service. Client demographic information was summarised using descriptive statistics. Open-text responses about reasons for declining telehealth were analysed using qualitative content analysis, whereas thematic analysis was used to explore focus group data. Key findings from the mixed methods analysis identified barriers and issues to consider when working to ensure equitable access to telehealth for children and families. These issues included child engagement, family complexity, the nature of assessments, interventions, and overarching service characteristics as well as the family's digital inclusion. Digital inclusion comprises affordable access to the internet, data, and devices and the capacity of a child and/or family to engage online. Our findings suggest that telehealth is not a panacea when face-to-face services are not available. Multiple barriers confounded uptake of telehealth prompting a call to action to ensure equitable access to occupational therapy services for all children.

Feasibility of Health Promoting Activity Coaching for Mothers of Children With Disabilities: Pilot Nonrandomized Controlled Trial.

Mothers of children with disabilities experience health disparity. Interventions targeting maternal mental health need to be developed. To determine the feasibility and preliminary effectiveness of the Healthy Mothers Healthy Families-Health Promoting Activities Coaching (HMHF-HPAC) intervention for mothers to improve participation in healthy activities and mental health and to evaluate outcome measures. Nonrandomized controlled pilot feasibility study with one group who received HMHF-HPAC and a control group. Pediatric occupational therapy service; on site or telehealth. Twenty-three mothers completed prequestionnaires; of those, 11 mothers participated in the intervention, and 5 did not (7 withdrew). Eleven pediatric occupational therapists were trained to deliver six 10-min sessions of HMHF-HPAC to mothers, integrated into their child's therapy session or separately via telehealth. Mixed-design analysis of variance explored changes in scores on the Depression Anxiety Stress Scale-21 Items and the Health Promoting Activities Scale. The intervention group reported, on average, significant reductions in depressive symptoms and stress symptoms and significant increases in participation in health-promoting activity. No significant main effect of time was found for these variables in the control group. The HMHF-HPAC program is a viable occupational therapy coaching intervention that can be embedded in existing services for families of children with disabilities. Future trials that evaluate the effectiveness of the HMHF-HPAC intervention for mothers of children with disabilities are warranted. What This Article Adds: This article provides support for the feasibility of appropriate and sensitive outcome measures and program content and delivery to implement the novel HMHF-HPAC intervention in further research. Mothers of children with disabilities benefited from integrated HMHF-HPAC delivered by pediatric occupational therapists within the family's existing services.

Including a relationship-focus in paediatric occupational therapy interventions: Introducing the PAIR Model

ABSTRACT The importance of parent-child relationships for child developmental outcomes suggests a need to incorporate a relationship focus into early intervention programs for children with developmental delays. Nevertheless, confusion exists about the definition and application of relationship-focussed interventions, and occupational therapists remain more developmentally- and child-focussed. There is a need to operationalize relationship-focussed interventions to make these approaches clinically accessible. This report defines, and provides a rationale for, including parent-child relationship-focussed interventions in early childhood occupational therapy interventions. A new conceptual model, the “Phased Approach to Incorporating a Relationship-focus” (PAIR), is detailed for consideration in pediatric therapy settings. The PAIR model can support professional education, inform practice, and guide future research regarding relationship-focussed interventions. Research is needed to test the usefulness of this model in occupational therapy practice.

Assessment Fidelity of Parents Implementing a Standardized Telehealth Infant Autism Screener.

Telehealth is effective for service delivery in pediatric occupational therapy across ages and diagnoses. Remote parent coaching provides unique benefits for both parents and infants. As a result of COVID-19, practitioners and researchers pivoted to remote assessment and intervention without much preparation or training. It is critical that we evaluate the quality of these telehealth services. One important component of remote evaluations is assessment fidelity. To examine assessment fidelity of a telehealth-delivered observational autism screening tool for infants. An assessment fidelity checklist was applied as the primary outcome measure. Parents conducted assessments with 82% adherence to the fidelity checklist. Implications: A parent coaching telehealth approach may be valid for assessment in pediatric telehealth. Continually monitoring the assessment fidelity of a tool is critical for the valid administration of remote services.