Can a Community of Practice Improve Physical Therapists’ Self-Perceived Practice in Developmental Coordination Disorder?

Abstract : Background. Communities of practice (CoPs) are useful knowledge translation (KT) strategies, but little is known about their impact on physical therapists’ self-perceived practice. Purpose. The impact of a CoP on physical therapists’ self-perceived practice was evaluated, and factors influencing changes in self-perceived knowledge, skills, and practice related to developmental coordination disorder (DCD) were explored. Design. An explanatory sequential mixed-methods design was used, guided by the Theory of Reasoned Action and Theory of Planned Behavior. Methods. Physical therapists participated in a DCD physical therapist CoP, which included 2 full-day, face-to-face workshops, with access to a 5-month online forum between the workshops, and completed questionnaires at 3 time-points: before the first workshop, before accessing the online forum, and following the second workshop. Measures completed before and after the CoP included closed-ended questions providing global scores on therapists’ self-perceived knowledge, skills, and practice. Physical therapists’ sociodemographic characteristics, information-seeking style, use of the online forum, and behavioral change goals were also collected. Paired t-tests, ANCOVAs, and linear regression models were used to analyze the data. Results. Forty-one physical therapists completed all questionnaires. Their self-perceived knowledge, skills, and practice change scores were significantly higher (+0.47, +1.23, and +2.61, respectively; P < .001) at the end of the CoP compared with the beginning. Few of the factors explored significantly influenced therapists’ self-reported change scores. Limitations. No observational data on practice change was collected. The small sample may have limited the ability to identify factors influencing self-perceived practice changes. Conclusions. The CoP increased physical therapists’ self-perceived knowledge, skills, and practice. More research is needed to explore CoP impact on physical therapist practices and how behavioral changes influence patient outcomes

Evaluation of a web platform aiming to support parents having a child with developmental coordination disorder: Brief report

Abstract: Objective To explore the effects of a web platform, aiming to support parents of children with developmental coordination disorder (DCD), on parental knowledge and skills. Method A randomized pilot trial was undertaken (Clinical trial XX). Parents of children 5-12 years old with suspected or diagnosed DCD were recruited. The intervention group (n=15) had access to a web platform (including resources, forum and virtual interactions) for three months. The control group (n=13) only had access to resources. The primary outcome was measured pre- and postintervention with the Parent Knowledge and Skills Questionnaire. Pre- post-questionnaires evaluated secondary outcomes (parents’ sense of competence, children’s strenghts and difficulties, and children’s occupational performance). Results and discussion All outcome measures improved over time for families of the intervention group. However, those improvements were not statistically significant. Conclusion Web platforms supporting parents of children with DCD are promising and need further evaluation

Diversity of practices in telerehabilitation for children with disabilities and effective intervention characteristics: results from a systematic review

Abstract : Purpose: To describe the characteristics and effectiveness of pediatric telerehabilitation interventions offered to children 0–12 years old or to their families. Methods: A systematic review was conducted on randomized control trials published between 2007 and 2018 involving at least one rehabilitation professional who provided services remotely. Information was extracted about key study, participants and intervention characteristics. The percentage of outcomes that improved were computed per study, and per intervention characteristic. Results: Out of 4472 screened articles, 23 were included. Most studies were published after 2016 and evaluated outcomes related to the child’s behavior (n = 12, 52.2%) or to the parent (n = 10, 43.5%), such as parental skills or stress. Overall, 56.1% (SD: 38.5%) of evaluated outcomes improved following telerehabilitation. A great diversity of population and teleintervention characteristics was observed. Effective interventions tended to target parents, centered around an exercise program, used a coaching approach, focused on improving children’s behavioral functioning, lasted >8 weeks and were offered at least once a week. Conclusions: Intervention characteristics that appear to yield better outcomes should inform the development of future telerehabilitation studies, especially in populations for whom telerehabilitation is currently understudied (e.g., children’s with physical functioning difficulties). Future trials should compare telerehabilitation interventions to well-described evidence-based face-to-face interventions, and document their cost-effectiveness

A Preliminary Study to Develop a Collaborative Tiered School-Based Physical Therapy Service Delivery Model: Results from an International Delphi Consultation

Background: Physical therapy (PT) is increasingly provided at schools to help students participate in educational activities. Recent rehabilitation models emphasized the benefits of using collaborative tiered services for service provision, yet no model is available to guide how these services should be delivered. Therefore, this study aims to determine the core attributes and PT interventions of a collaborative tiered school-based PT model that could guide how PT services are delivered in schools worldwide. Methods: A modified Delphi method was used to identify the core attributes and the PT interventions that would be part of the model. An introductory webinar followed by three Delphi rounds with 24 international experts was conducted. Similar ideas generated in Round 1 were combined into statements; the statements reaching the predetermined consensus level in Rounds 2 or 3 were retained. Categories were created to present core attributes and Tiered interventions that were retained. Results: 41 core attributes were identified and grouped under seven categories. Tiered interventions were grouped under 15 categories which included 37 interventions for Tier 1, 24 interventions for Tier 2, and 60 interventions for Tier 3. Conclusion: The recommended core attributes and interventions will support the development of an international framework for school-based PT services, fostering health promotion for all children, and supporting those with disabilities

Recruitment, use, and satisfaction with a web platform supporting families of children with suspected or diagnosed developmental coordination disorder: A randomized feasibility trial

Objectives. To determine the feasibility of recruiting families of children with suspected or diagnosed developmental coordination disorder (sdDCD) and explore their satisfaction with a web-based intervention Design. A feasibility randomized trial was conducted. Participants were the parents of 5-12-year-old children with sdDCD. The intervention group had access to online resources, group and private forums, and videoconferencing with a therapist. Main outcomes were recruitement and retention rates. Satisfaction was documented through a post-intervention survey and interview. Results. The recruitment rate was seven participants per month (n = 28 participants) and retention rate was 68%. Satisfaction was moderate. No differences in use and satisfaction were observed between groups. Participants formulated recommendations for improving the intervention, including targeting families earlier in the diagnosis process, and pre-scheduling meetings with therapists. Conclusions. This study demonstrated the feasibility of future trials, and highlighted avenues for improvement. Parent involvement during the development of the intervention is discussed at length. Abbreviations: DCD: Developmental Coordination Disorder; sdDCD: suspected or diagnosed Developmental Coordination Disorder; RCT: randomized-controled trial

Using an evidence-based online module to improve parents’ ability to manage their child with Developmental Coordination Disorder

Background : Developmental coordination disorder (DCD) is a prevalent neurodevelopmental disorder. Best practices include raising parents’ awareness and building capacity but few interventions incorporating these best practices are documented. Objective : To examine whether an evidence-based online module can increase the perceived knowledge and skills of parents of children with DCD, and lead to behavioral changes when managing their child’s health condition. Methods : A mixed-methods, before-after design guided by the theory of planned behavior was employed. Data about the knowledge, skills and behaviors of parents of children with DCD were collected using questionnaires prior to completing the module, immediately after, and three months later. Paired T-tests, sensitivity analyses and thematic analyses were performed on data as appropriate. Results: One hundred-sixteen, 81 and 58 participants respectively completed the three questionnaires. For knowledge and skills, post- and follow-up scores were significantly higher than baseline scores (p<0.01). Fifty-two (64%) participants reported an intention to change behavior post-intervention and 29 (50%) participants had tried recommended strategies at follow-up. Three themes emerged to describe parents’ behavioral change: sharing information, trialing strategies and changing attitudes. Factors influencing parents’ ability to implement these behavioral changes included clear recommendations, time, and ‘right’ attitude. Perceived outcomes associated with the parental behavioral changes involved improvement in well-being for the children at school, at home, and for the family as a whole. Conclusions : The online module increased parents’ self-reported knowledge and skills in DCD management. Future research should explore its impacts on children’s long-term outcomes

Implementing partnering for change in Québec: Occupational therapy activities and stakeholders’ perceptions

Abstract: Background. The occupational therapy school-based Partnering for Change (P4C) model has mostly been documented in Ontario. Purpose. This implementation study describes the implementation of P4C in two Québec elementary schools (P4C-Q), as well as therapy practices, their impacts, factors perceived to influence implementation, and recommendations. Method. A sequential mixed-methods design was applied. Therapists (n=2) completed daily journals, describing activities by P4C-Q level. Therapists and other school-stakeholders (n=11) participated in semi-structured interviews, analyzed through a content analysis framework. Findings. Daily journals illustrated that the majority of therapy time was spent on activities targeting the entire classroom, and on collaboration with educators. Interviews illustrated how coaching was used across different practices, the impact of these practices for schools (e.g., capacity-building) and children (e.g., increased functioning), and highlighted how relationship-building is key to facilitating the implementation of this model. Implications. Lessons learned may be helpful for others implementing P4C in their own contexts

Web-based early intervention for children with motor difficulties aged 3–8 years old using multimodal rehabilitation (WECARE): protocol of a patient-centred pragmatic randomised trial of paediatric telerehabilitation to support families

Introduction Mild motor difficulties in children are underdiagnosed despite being highly prevalent, leaving such children often underserved and at higher risk for secondary consequences such as cardiovascular disease and anxiety. Evidence suggests that early patient-oriented interventions, coaching parents and providing children with early stimulation should be provided, even in the absence of a diagnosis. Such interventions may be effectively delivered via telerehabilitation.Methods and analysis A family-centred, pragmatic randomised controlled trial will be carried out to evaluate the real-world effectiveness of a Web-based Early intervention for Children using multimodAl REhabilitation (WECARE). Families of children with motor difficulties, 3–8 years of age, living in Quebec, Canada, and receiving no public rehabilitation services (n=118) will be asked to determine up to 12 performance goals, evaluated using the Canadian Occupational Performance Measure (COPM, the primary outcome). Families will be randomised to receive either usual care or the WECARE intervention. The WECARE intervention will be delivered for 1 year via a web-based platform. Families will have access to videoconferences with an assigned rehabilitation therapist using a collaborative coaching approach, a private chat function, a forum open to all intervention arm participants and online resources pertaining to child development. Participants will be asked to re-evaluate the child’s COPM performance goals every 3 months up to 1 year post allocation. The COPM results will be analysed using a mixed Poisson regression model. Secondary outcomes include measures of the child’s functional ability, parental knowledge and skills and health-related quality of life, as well as qualitative outcomes pertaining to parental satisfaction and service delivery trajectories. Investigators and quantitative data analysts will be blinded to group allocation.Ethics and dissemination The CIUSSS de l’Estrie—CHUS ethics committee approved this trial (2020-3429). Study results will be communicated via peer-reviewed journal publications, conference presentations and stakeholder-specific knowledge transfer activities.Trial registration number NCT04254302