Reliability reconsidered: Cronbach's alpha and paediatric assessment in occupational therapy

Background / aim: Using reliable outcome measures is a necessity for the occupational therapy profession in enabling valid assessments of clients. Although Cronbach’s alpha is the most widely applied index of internal consistency reliability, there are misconceptions about its use and interpretation. This paper aims to guide assessment developers in paediatric occupational therapy, as well as practitioners who are evaluating outcome measures in using and interpreting the Cronbach’s alpha estimates appropriately. This will enable them to decide on the tools’ clinical value and incorporate them into their practice with children. Method: Previously published papers reporting on internal consistency issues of outcome measures in paediatric occupational therapy were searched through the Allied and Complementary Medicine database. These papers were used as a basis to discuss possible reasons for reporting of low internal consistency. Results: The analysis demonstrates that Cronbach’s alpha reports are not always interpreted in a sound way. The paper emphasises that one should be cautious about judging estimates of internal consistency. Low size of the coefficient alpha might not always indicate problems with the construction of the tool; whereas large sizes do not always suggest adequate reliability. Instead, these reports might be related to the data characteristics of the construct. Conclusion: In judging an outcome measure’s internal consistency , researchers and practitioners in occupational therapy should report and consider the nature of data, the scale’s length and width, the linearity and the normality of response distribution, the central response tendency, the sample response variability and the sample size

Management of children with ADHD and LD: A survey of paediatric occupational therapists in the UK

Copyright @ 2009 The University of HuddersfieldAttention deficit/hyperactivity disorder (ADHD) is a common complex neuropsychiatric disorder frequently overlapping with learning disabilities (LD) in children with average and above intelligence (Biederman et al 1991). The complex needs of these children could be better addressed in a multidisciplinary context (Foy & Earls 2005) within which paediatric occupational therapists may have a significant role. The aim of this study was to identify the interventions used by occupational therapists in the United Kingdom with these children and explore the rationale for their use. The purpose was to provide baseline data to inform multidisciplinary team approaches for the management of these children. A survey, based on postal questionnaires, was conducted among 100 paediatric occupational therapists in the United Kingdom. The effective rate of response was 42%. Both qualitative and quantitative data were gathered and analysed. The findings suggested that therapists tended to use more than one method/ approach in the rehabilitation of these children. The sensory integration approach and the perceptual-motor training were more popular among therapists. A variety of other approaches, used on an individual needs basis, were reportedly used. Future studies to test the effectiveness of reported practices with children with both ADHD and LD are recommended

Preparing occupational therapy students for practice placements: Initial evidence

Practice placements are a crucial part of occupational therapy education, yet they can be a stressful experience for students, practice placement educators and the university. This may contribute to a shortage of placements. The effectiveness of a 4-week preparation with second-level full-time students at Brunel University, prior to a practice placement was evaluated by a two-part analysis. First, the students’ perspective on the effectiveness of the preparation is presented. This is followed by a comparison of placement grades between the current cohort of students (academic year 2006-2007), who attended the preparation and the previous cohort of students (academic year 2005-2006), who did not have this opportunity

Polio survivors’ perceptions of the meaning of quality of life and strategies used to promote participation in everyday activities

This article is made available through the Brunel Open Access Publishing Fund.Introduction: The term ‘post-polio syndrome’ (PPS) is used to describe new and late manifestations of poliomyelitis that occur later in life. Research in this area has focused upon health status rather than its effect on quality of life. Aim: To gain an in-depth understanding of the meaning of quality of life for polio survivors and to determine the type of strategies that are used by people with PPS and the support that they consider as important to facilitate participation in everyday life activities that have an impact on their quality of life. Method: Six focus groups were conducted with 51 participants from two regions in England. Data were audio-taped and analysed using thematic analysis. Results: Our research found that polio survivors used terms used to describe quality of life which could be associated with that of happiness. Our research has identified resolvable factors that influence quality of life namely inaccessible environments, attitudes of health-care professionals and societal attitudes. Polio survivors have tried alternative therapies, chiefly acupuncture and massage, and found them to be effective in enhancing their quality of life. Conclusion: It is suggested that health-care professionals should consider factors which influence happiness and implement a person-centred approach with the views of the polio survivor being listened to. The three factors that influenced quality of life could be resolved by health-care professionals and by society. With regard to strategies used, we suggest that polio survivors should have access to the treatments that they perceive as important, although further research is required to design optimal interventions for this client group

Using life cycle sustainability assessment to trade off sourcing strategies for humanitarian relief items

Purpose: While interest in supply chain sustainability has risen over the past few years in academic and business worlds, very little research has been conducted on sustainability in humanitarian supply chains, specifically. This study aims to contribute to the development of the field by conducting a life cycle sustainability analysis (LCSA) of sourcing scenarios for a core relief item in a humanitarian supply chain. Methods: This paper is structured according to the LCSA framework developed by Guinée et al. (Environ Sci Technol 45(1):90–96, 2011). The relief item analyzed is a kitchen set supplied by a UN agency. Environmental, social, and economic impacts of two sourcing scenarios for a kitchen set are mapped: one international and one local. Sources of data include interviews, company records, and online databases. Results are analyzed using the ReCiPe method to assess environmental impact and the United Nations Environmental Programme (UNEP)/Society of Environmental Toxicology and Chemistry (SETAC) guidelines to assess social impact. Results and discussion: We show how LCSA can be used to map the sustainability of two sourcing scenarios for kitchen sets in a humanitarian supply chain along triple bottom line dimensions. We report findings on sourcing scenarios for distribution to two refugee camps in Kenya: one from a supplier in India and one from a supplier in Kenya. We use an environmental life cycle analysis (LCA), a social LCA, and a life cycle costing (LCC) to analyze differences and similarities. We find that local sourcing is preferred over international sourcing on two out of the three sustainability dimensions-environmental and social impacts. Humanitarian organizations may further use this paper as a guideline to develop their own sustainability assessments of supply chain scenarios. Conclusions: The results of our study provide a fresh, sustainability-focused perspective on the debate over international vs. local procurement. This paper is the first to apply LCSA to a humanitarian context. It also addresses a void in the sourcing literature by determining the sustainability impacts of different sourcing strategies. The study evaluates only two sourcing options and also uses a limited number of data sources

The use of evidence-based guidance to enable reliable and accurate measurements of the home environment

Abstract Introduction: High quality guidance in home strategies is needed to enable older people to measure their home environment and become involved in the provision of assistive devices and to promote consistency among professionals. This study aims to investigate the reliability of such guidance and its ability to promote accuracy of results when measurements are taken by both older people and professionals. Method: Twenty-five health professionals and 26 older people participated in a within-group design to test the accuracy of measurements taken (that is, person’s popliteal height, baths, toilets, beds, stairs and chairs). Data were analysed with descriptive analysis and the Wilcoxon test. The intra-rater reliability was assessed by correlating measurements taken at two different times with guidance use. Results: The intra-rater reliability analysis revealed statistical significance (P<0.05) for all measurements except for the bath internal width. The guidance enabled participants to take 90% of measurements that they were not able to complete otherwise, 80.55% of which lay within the acceptable suggested margin of variation. Accuracy was supported by the significant reduction in the standard deviation of the actual measurements and accuracy scores. Conclusion: This evidence-based guidance can be used in its current format by older people and professionals to facilitate appropriate measurements. Yet, some users might need help from carers or specialists depending on their impairment