Resources to facilitate evidence-based practice in paediatric rehabilitation

This article discusses the need for knowledge transfer/translation in paediatric rehabilitation. The scientific knowledge production and publication process is presented to invite readers to become critical analysts of the literature and websites. Journals, book editors and websites presenting good resources in childhood disability are presented. More specifically, CanChild’s website is described and some resources available in Spanish are presented. Readers are invited to collaborate to the development of evidence-based practice in Colombia, contributing in translating resources into Spanish and participating to the development of a network on individuals interested in evidence-based practice in paediatric rehabilitation

Facial validity of the measuring instrument of habits of life (MHAVIDA) in disability persons between 5-13 years

Resumen : Introducción : La Clasificación Internacional del Funcionamiento (CIF) ha definido la discapacidad como un término que incluye deficiencias, limitaciones en la actividad y restricciones en la participación. Objetivo: Establecer la validez facial del instrumento de medición de hábitos de vida (MHAVIDA), que evalúa la participación social en niños y niñas de entre 5 y 13 años de edad que se encuentran en Condición de Discapacidad (CD). Materiales y métodos: Se realizó un estudio de evaluación de pruebas diagnósticas, así como la adaptación cultural de los instrumentos con 6 madres de niños y niñas sin condición de discapacidad (CD). A su vez, la validez facial fue evaluada por 19 madres de niños y niñas en CD, a quienes se les aplicó el instrumento mediante entrevista, realizada por dos estudiantes de último año de Fisioterapia. Resultados: El instrumento MHAVIDA para el rango de 5 a 13 años de edad, que evalúala participación social fue traducido oficialmente, y adaptado al lenguaje local con preguntas comprensibles, claras y fáciles de responder. Se encontraron palabras o preguntas confusas principalmente en las categorías educación y nutrición del instrumento que fueron modificadas y, finalmente, se obtuvo un instrumento con validez facial y adaptabilidad cultural pertinente al contexto. Conclusión: Se obtuvo un instrumento útil para evaluar la participación social a partir de los hábitos de vida de la población de 5 a 13 años con discapacidad, lo cual proporciona una base sólida para mejorar las intervenciones en rehabilitación.Abstract : Introduction : The International Classification of Functioning (ICF) has defined disability as a term that includes impairments, activity limitations and restrictions. Objective: To establish the facial validity of the instruments Assessment of Life Habits (LIFE-H) for disabled children between 5 and13 years old. Materials and methods: a study was carried out on the assesment of diagnostic tests, as well as the cultural adaptation of the instruments using 6 mothers of children without disabilities (CD) as a reference. At the same time, the validity was assessed by 19 mothers of boys and girls in CD who were assessed through an interview done by two last year physiotherapy students. Results: The LIFE-H for age 5-13 years old, in order to assess social participation were officially translated, adapted to local language with comprehensible, clear, and easy to answer questions. We obtained an instrument with facial validity and relevant cultural adaptability to the context. We found confusing words or questions in education and nutrition categories in the LIFE-H for 5-13 years old that were modified. Conclusion: We obtained a useful tool to measure social participation from the habits of children with disabilities, which provides a sound basis for improving interventions in rehabilitation. It is suggested to continue the evaluating the reliability of this instrument

Increasing the use of group interventions in a pediatric rehabilitation program: perceptions of administrators, therapists, and parents

Objectives. To explore perceptions related to increased utilization of group interventions as a part of the service reorganization within a pediatric rehabilitation program. Methods. Individual interviews with program administrators (n=13) and focus groups with therapists (n=19) and parents of children with disabilities (n=5) were conducted. Data were analyzed using a coding grid inspired by the organized action systems theory. Results. Administrators and therapists identified several issues including the need to improve the referral process for groups and the coordination across services. Groups considerably modified practice and required substantial efforts from therapists. Administrators felt groups contributed to increased service accessibility. Although therapists had some doubts about service quality in groups, especially in regard to the reduced attention to individual needs, they reported positive benefits on children’s social participation. Generally, parents were satisfied with group interventions. Conclusion. Groups appear to be a promising method of service delivery, but organizational-related issues should be considered

Knowledge to Practice in Developmental Coordination Disorder: Impact of an Evidence-Based Online Module on Physical Therapists’ Self-Reported Knowledge, Skills, and Practice

Aims : This study evaluates the impact of a Developmental Coordination Disorder (DCD) evidence-based online module including synthesized resources, practical strategies, and interactive component on self-reported physical therapist (PT) knowledge, skills, and practice. Methods : PTs from across Canada completed questionnaires before, immediately after, and 2 months following completion of the module. Questionnaires used 7-point Likert scale items and short open-ended questions; analyzes used paired t-tests and a thematic approach. Results : Fifty PTs completed both pre- and post-questionnaires; 41 of these completed the follow-up questionnaire. Most items (79%) evaluating self-reported knowledge and skills increased significantly following module completion and this increase was maintained two months later. Most participants (92%) reported an increase in their confidence to provide DCD evidence-based services. Participants plan to modify their evaluative practices (e.g., involving children in goal setting) and their management of DCD (e.g., using best practice principles, providing resources to families and physicians). At the 2- month follow-up, 46% of participants had returned to the module to review information (e.g., video, resources) or to download handouts. Conclusion : An online module developed collaboratively with PTs has the potential not only to increase PTs’ knowledge, but also to support them in implementing evidence-based services for children with DCD

Let’s not go back to ‘normal’! lessons from COVID-19 for professionals working in childhood disability

Purpose: The worldwide COVID-19 pandemic has changed almost all aspects of our lives, and the field of childhood disability is no exception. Methods: This article is based on an invited lecture by the first author at a conference–the eHealth Summit (“Pediatric Rehabilitation in a Digital Space”)–organized by the other authors and their colleagues in May 2020. Results: The first author offers his own experiences and perspectives, supplemented by comments and observations contributed by many of the 9000þ attendees at this talk, as curated by the second and third authors. The basic messages are that while life for families of children with developmental disabilities, and for service providers who work with them, is significantly altered, many important lessons are being learned. Conclusions: The comments from participants support the currency of the ideas that were presented, and encourage childhood disability professionals to reflect on what we are learning, so that we can seize the opportunities they afford to do things differently–and we believe better–moving forward

A Discrete Choice Experiment on Women’s Preferences for Water Immersion During Labor and Birth: Identification, Refinement and Selection of Attributes and Levels

Abstract : Objectives: To identify attributes (i.e., characteristics describing a scenario) and levels (i.e., each characteristic may be defined by a di erent level) that would be included in a discrete choice experiment (DCE) questionnaire to evaluate women’s preferences for water immersion during labor and birth. Methods: A mixed-method approach, combining systematic reviews of the literature and patient focus groups to identify attributes and levels explaining women’s preferences. After the focus groups, preference exercises were conducted and led to the creation of the questionnaire, including the DCE. A qualitative validation of the questionnaire was conducted with women from the focus groups and with medical experts. Results: The literature reviews provided 26 attributes to be considered for childbirth in water, and focus groups identified 14 additional attributes. From these 40 attributes, preference exercises allowed us to select four for the DCE, in addition to the birth mode. Labor duration was also included, even if it was not well ranked, as it is the main clinical outcome in the literature. Validation with experts and women did not change the choice of attributes but slightly changed the levels selected. The final six attributes were: birth mode, duration of the labor phase, pain sensation, risk of severe tears in the perineum during the expulsion of the newborn, risk of death of the newborn, and general condition of the newborn (Apgar) score at 5 minutes. Conclusion: This study allowed us to detail all the stages for the design of a DCE questionnaire. To date, this is the first study of this kind in the context of women’s preferences for water immersion during labor and birth

Recommended practices to organize and deliver school-based services for children with disabilities: A scoping review

Abstract: Background: Inclusive educational environments can have a positive effect on the general health and well-being of children with disabilities. However, their level of academic success and participation remains limited. Considering scarce resources and high needs, identifying efficient methods for providing interdisciplinary services is critical. This scoping review, therefore, aims to 1) synthesize current evidence about principles for organizing and delivering interdisciplinary school-based support services for students with disabilities and 2) ascertain useful strategies for implementation of principles in the school setting. Methods: Scholarly and grey literature in rehabilitation and education were reviewed collaboratively with school-based stakeholders. A search of five databases identified 13,141 references and resulted in 56 relevant articles published from 1998 to 2017. Information (e.g., principles to organize services, strategies for implementation) was extracted and thematic analysis was used to summarize findings. Results: Within the documents retained, 65% were scientific and 35% were grey. Services primarily targeted students with behavioural issues, followed by those with cognitive and learning disabilities with a focus on improving social-emotional functioning and academic performance. Thematic analysis revealed 10 common principles to guide service organization (e.g., collaborative interventions, support for teachers) and seven implementation strategies (e.g., training, coordination) for employing these principles. Conclusions: Findings can guide rehabilitation professionals, educators, and policy makers in restructuring well-coordinated collaborative services involving training and capacity-building of school-based service providers. Such knowledge can contribute to the improved provision of care and, consequently, promote children’s school participation and inclusion

Best Practice Recommendations for the Development, Implementation, and Evaluation of Online Knowledge Translation Resources in Rehabilitation

Abstract : The knowledge-to-practice gap in rehabilitation has spurred knowledge translation (KT) initiatives aimed at promoting clinician behavior change and improving patient care. Online KT resources for physical therapists and other rehabilitation clinicians are appealing because of their potential to reach large numbers of individuals through self-paced, self-directed learning. This article proposes best practice recommendations for developing online KT resources that are designed to translate evidence into practice. Four recommendations are proposed with specific steps in the development, implementation, and evaluation process: (1) develop evidence-based, usercentered content; (2) tailor content to online format; (3) evaluate impact; and (4) share results and disseminate knowledge. Based on KT evidence and instructional design principles, concrete examples are provided along with insights gained from experiences in creating and evaluating online KT resources for physical therapists. In proposing these recommendations, the next steps for research are suggested, and others are invited to contribute to the discussion

How are Canadian universities training and supporting undergraduate medical, physiotherapy and occupational students for global health experiences in international low-resource settings?

Abstract : OBJECTIVES : Canadian medical (MD), physiotherapy (PT) and occupational therapy (OT) students increasingly show an interest in global health experiences (GHEs). As certain moral hazards can occur as a result of student GHEs, a growing consensus exists that universities must have an established selection process, in-depth pre-departure training (PDT), adequate onsite supervision and formal debriefing for their students. This study aimed at identifying current practices in Canadian MD, PT and OT programs and discussing areas for improvement by comparing them with recommendations found in the literature. METHODS : Canadian MD, PT and OT programs (n = 45) were invited to answer an online survey about their current practices for GHE support and training. The survey included 24 close-ended questions and 18 open-ended questions. Descriptive statistics and a thematic analysis were performed on the data and results were discussed with recommendations found in the literature. RESULTS : Twenty-three programs responded to the survey. Student selection processes varied across universities; examples included using academic performance, interviews and motivation letters. All but 1 MD program had mandatory PDT; content and teaching formats varied, as did training duration (2-38 hours). All but 1 MD program had onsite supervision; local clinicians were frequently involved. Debriefing, although not systematic, covered similar content; debriefing was variable in duration (1-8 hours). CONCLUSIONS : Many current practices are encouraging but areas for improvement exist. Integrating global health content into the regular curriculum with advanced study option in global health for students participating in GHEs could help universities standardize support and training.Résumé : OBJECTIFS : Un intérêt croissant est observé parmi les étudiants canadiens de médecine (MD), physiothérapie (PHT) et ergothérapie (ERG) pour les expériences en santé mondiale. Face aux enjeux moraux en lien avec ceux-ci, il est reconnu que les universités doivent se doter de processus de sélection, d’une formation prédépart (FPD) et d’un débreffage au retour, de même qu’assurer une supervision sur le terrain. Cette étude visait à identifier les pratiques actuelles dans les programmes canadiens de MD, PHT, ERG et de les comparer avec des recommandations retrouvées dans la littérature. MÉTHODES : Un sondage en ligne a été envoyé à tous les départements de MD, PHT et ERG (n = 45). Le sondage contenait 24 questions fermées et 18 questions ouvertes. Une analyse thématique ainsi que des statistiques descriptives ont été utilisées sur les données recensées, et les résultats ont été comparés avec des recommandations identifiées dans la littérature. RÉSULTATS : Au total, 23 programmes ont répondu au sondage. Le processus de sélection varie d’une université à l’autre ; quelques exemples incluent l’utilisation des résultats académiques et d’entrevues de sélection. Tous les programmes sauf 1 en MD offrent une FPD ; les thèmes couverts, les méthodes d’enseignement, ainsi que la durée (2-38 heures) varient. Tous les programmes sauf 1 en MD assurent une supervision sur le terrain. Le débreffage n’est pas systématique, mais est similaire chez ceux qui l’offrent ; la durée de celui-ci est variable (1-8 heures). CONCLUSIONS : Si plusieurs des pratiques actuelles sont encourageantes, certaines pourraient être améliorées. Intégrer de la formation en santé mondiale dans le curriculum et avoir des cours d’option avancés en santé mondiale permettraient aux universités de mieux standardiser leurs pratiques

Philosophy for children and mindfulness during COVID-19: Results from a randomized cluster trial and impact on mental health in elementary school students

significant impacts throughout the lifespan, preventing the negative repercussions of COVID-19 on children’s mental health is essential. Philosophy for children (P4C) and mindfulness-based interventions (MBIs) show promise in this regard. Objective: The goal of the present study was to compare the impact of online MBI and P4C interventions on mental health, within the context of the COVID-19 pandemic. We used a randomized cluster trial to assess and compare the impact of both interventions on elementary school students’ (N = 37) anxiety and inattention symptoms as well as on their basic psychological need satisfaction (BPN). Results: ANCOVAs revealed a significant effect of the P4C intervention on mental health difficulties, controlling for baseline levels. Participants in the P4C group showed lower scores on the measured symptoms at post-test than participants in the MBI group. Significant effects of the MBI on levels of BPN were also found. Participants in the MBI intervention reported greater BPN satisfaction at post-test than participants in the P4C intervention. Conclusion: Results from this study suggest that, in the current context of the COVID-19 pandemic, a P4C intervention centered around COVID-19 related themes may be helpful to reduce mental health difficulties, that a MBI may be useful to satisfy BPN, and that both interventions were easy to offer online to elementary school students. Future work including a larger sample size and follow-up measures is warranted. Public significance: Practice: Philosophy for children (P4C) and mindfulness-based interventions (MBIs) can be used to foster mental health in elementary school students, in the current COVID-19 context. Policy: As we do not anticipate that facilitators will be allowed in schools during the 2020–2021 school year and that children will, most likely, be attending school in the current COVID-19 context, policymakers who want to implement psychological support measures in elementary schools should consider an online modality, which has shown in this study to work well, be feasible, and yield positive results on youth mental health