Development and psychometric evaluation of a new measure for children's participation in hand-use life situations

Objective To describe the development of the Children's Assessment of Participation with Hands, a parent-report questionnaire that assesses children's participation in life situations requiring hand use specifically, and to investigate its construct validity (using Rasch analysis and known-group comparison) and reliability (test-retest reliability and internal consistency). Design Cross-sectional, validation, and test-retest studies. Setting Schools. Participants Parents/caregivers (N=202) reported on their children aged 2 to 12 years with (n=97) and without disabilities (n=105). Interventions Not applicable. Main Outcome Measure The Children's Assessment of Participation with Hands was developed based on a content review of existing children's participation measures and literature, expert review, and pilot testing. The Children's Assessment of Participation with Hands included 37 items measuring participation diversity, frequency, independence, and desire for change in specific hand-use life situations across 4 domains of self-care, recreation, education, and domestic life and community. Results Evidence for construct validity of the Children's Assessment of Participation with Hands domains was established through Rasch analysis (after removing 2 misfitting items from the recreational domain and 1 item from the domestic life and community domain). Differences in summary scores of each domain between children with and without disabilities were also significant (

Supervising role emerging placements: a CPD opportunity that supports innovation in practice

Supervision of occupational therapy students on placements is a challenging, but rewarding experience. There is a growing body of literature related to role emerging placements but the experiences of the occupational therapists who undertake the role of off-site supervisors are underrepresented. These placements are based in settings where there is no defined occupational therapy role and the professional supervisor is not based at the placement site. Drawing from research in two European countries with off-site supervisors the enablers and barriers of this role are presented. Supervising students with innovative occupational therapy interventions positively influenced the off-site supervisors’ professional practice. Practical guidance for those interested in this role is shared to encourage occupational therapists to pursue this rewarding role including the need for peer support while undertaking this valuable role

Neurorehabilitation of the upper limb across the lifespan: managing hypertonicity for optimal function

A comprehensive guide to managing spastic hypertonia after brain injury and the first full overview of this area. The ideal reference for therapeutic interventions that optimise arm and hand function to support goal achievement. An extensive clinical manual for neurological practice, a key reference for students and qualified practitioners, and a valuable resource for all occupational therapists and physiotherapists working with brain-injured clients

Casting for upper limb hypertonia: A retrospective study to determine the factors associated with intervention decisions

Aim: To determine if a Clinical Reasoning Protocol assisted occupational therapists to consistently choose casting as an intervention in the context of moderate/severe upper limb hypertonia and possible contracture. Methods: Sixty-four intervention decisions (including strength/movement training, splinting and/or casting) were drawn retrospectively from initial reports at a community clinic. Associations between identified upper limb characteristics, stated clinical aims and intervention decisions were analysed using logistic regression. Results: Casting was statistically significantly likely to be chosen in the presence of moderate (CI 1.88-39.80, p=0.01) or severe hypertonicity (CI 1.34-135.98, p=0.03), and if the stated clinical aim was to reduce hypertonicity (CI 2.01-18.10, p=0.001) or contracture (CI 1.31-12.73, p=0.02). When reports included both these clinical aims, there was a highly significant association with the decision to cast (CI 5.67-9.13, p=0.001). Where casting was indicated as appropriate, but not chosen as an intervention, mitigating factors included older age (70-95 years), limited personal support and a clinical aim of comfort/hygiene maintenance. Conclusion: Occupational therapists using the Protocol consistently chose casting as an upper limb intervention for adults who demonstrated moderate/severe hypertonicity, contracture or limited functional ability. Prospective research is required to determine intervention outcomes following use of the Protocol

Development and evaluation of interprofessional patient simulation activity for physiotherapy and occupational therapy students to assess and manage patients with chronic pain

Background/aims Opportunities for interprofessional learning are a priority to prepare health professionals for the effective interprofessional assessment and management of patients with chronic pain, yet finding effective and sustainable approaches are a challenge for health professional programmes. The aim of this study was to develop and evaluate an ‘interprofessional management of pain’ learning activity using simulation for physiotherapy and occupational therapy students. Methods A total of 40 physiotherapy and 20 occupational therapy students undertook the interprofessional management of pain learning activity. Chronic pain attitudes and beliefs (HC-PAIRS) and perception of interprofessional practice (SPICE-R) were assessed before and following the intervention. A survey relating to content and format of the activity was completed following the intervention. Results There was a significant improvement in total HC-PAIRS and SPICE-R scores for both student groups. Both groups demonstrated satisfaction with the activity. Conclusions These findings support the use of an interprofessional simulated learning activity with facilitated planning and debriefing to enhance students’ attitudes to chronic pain and interprofessional practice

Explanatory case study design: Applications in paediatric burns health services research

Background: Explanatory case study design offers a way to address complex research issues; however its application in health arenas has been limited. Contents: This article describes the application of explanatory case study design when investigating complex, multifactorial phenomena in a clinical setting. To provide an example, this article shows a case where it was applied to the investigation of functional outcome following burn injury in children, within the real-life contexts of hospital, home, and school. Conclusions: Strategies implemented to maintain quality and rigour of the research design, whilst responding to the inherent difficulties of working in a clinical setting, are outlined. A summary model of the implementation of explanatory case design is presented to provide a benchmark against which this methodology, as applied in health research, can be appraised