Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration intervention.

OBJECTIVE: We developed a reliable and valid fidelity measure for use in research on Ayres Sensory Integration (ASI) intervention. METHOD: We designed a fidelity instrument to measure structural and process aspects of ASI intervention. Because scoring of process involves subjectivity, we conducted a series of reliability and validity studies on the process section. Raters were trained to score therapist strategies observed in video recordings of adult-child dyads. We examined content validity through expert ratings. RESULTS: Reliability of the process section was strong for total fidelity score (ICC = .99, Cronbach\u27s alpha = .99) and acceptable for most items. Total score significantly differentiated ASI from four alternative interventions. Expert ratings indicated strong agreement that items in the structural and process sections represent ASI intervention. CONCLUSION. The Ayres Sensory Integration Fidelity Measure has strong content validity. The process section is reliable and valid when scored by trained raters with expertise in ASI

Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders.

Goal attainment scaling (GAS) is a methodology that shows promise for application to intervention effectiveness research and program evaluation in occupational therapy (Dreiling & Bundy, 2003; King et al., 1999; Lannin, 2003; Mitchell & Cusick, 1998). This article identifies the recent and current applications of GAS to occupational therapy for children with sensory integration dysfunction, as well as the process, usefulness, and problems of application of the GAS methodology to this population. The advantages and disadvantages of using GAS in single-site and multisite research with this population is explored, as well as the potential solutions and future programs that will strengthen the use of GAS as a measure of treatment effectiveness, both in current clinical practice and in much-needed larger, multisite research studies

Fidelity in sensory integration intervention research.

OBJECTIVE: We sought to assess validity of sensory integration outcomes research in relation to fidelity (faithfulness of intervention to underlying therapeutic principles). METHOD: We identified core sensory integration intervention elements through expert review and nominal group process. Elements were classified into structural (e.g., equipment used, therapist training) and therapeutic process categories. We analyzed 34 sensory integration intervention studies for consistency of intervention descriptions with these elements. RESULTS: Most studies described structural elements related to therapeutic equipment and interveners\u27 profession. Of the 10 process elements, only 1 (presentation of sensory opportunities) was addressed in all studies. Most studies described fewer than half of the process elements. Intervention descriptions in 35% of the studies were inconsistent with one process element, therapist-child collaboration. CONCLUSION: Validity of sensory integration outcomes studies is threatened by weak fidelity in regard to therapeutic process. Inferences regarding sensory integration effectiveness cannot be drawn with confidence until fidelity is adequately addressed in outcomes research

Asset price reactions to RPI announcements

This paper examines the same-day reaction of a variety of UK asset prices to monthly RPI inflation announcements over a sample period extending from the early 1980s until April 1997, the month before the Bank of England was given operational independence for setting interest rates. These announcements are decomposed into their expected and unexpected, or 'news', components using survey data on financial analysts' inflation expectations and, as a cross-check, prediction errors from a time-series model of inflation. It is found that markets are efficient, in that asset prices do not respond to the expected component of RPI announcements. Generally, only government bond prices are sensitive to inflation news, and this sensitivity appears particularly marked after late 1992, when the UK adopted an explicit inflation target. The responsiveness of implied medium and long-term forward inflation rates (calculated from conventional and index-linked bonds) during the post-1992 period is consistent with the expected inflation hypothesis, a result that suggests that the pre-independence inflation-targeting framework was not seen as fully credible by the financial markets. Nevertheless, the declining responsiveness of bond yields and implied forward inflation rates to inflation news over the period of operation of the framework suggests that its credibility improved over time.

A Survey of Pediatric Occupational Therapists’ Use of Play

Over a decade ago, researchers surveyed pediatric occupational therapists regarding their use of play and concluded that play was addressed inconsistently in the evaluation and treatment of preschool-age clients. Play was primarily used as a modality to achieve a desired performance in another skill area. In the intervening years, a significant body of literature has been published in occupational therapy promoting the use of play as a meaningful outcome of occupational therapy intervention; therefore, practice patterns may have changed. Five hundred pediatric occupational therapists were randomly selected from members of the school system and sensory integration special interest sections of the American Occupational Therapy Association (AOTA) to be surveyed regarding their current usage of play with children ages 3 to 7 years. They received a mailed survey, adapted from the original work of Couch, Dietz, and Kanny with the permission of the primary author. There were 198 surveys returned (40%). Similar to earlier findings, play was used primarily as a means of eliciting improvement in another area, such as fine-motor skill. Although some therapists assessed play, few focused on play as an outcome of importance, or included goals for play. Minimal changes have occurred in the role of play in pediatric occupational therapy. Despite the profession\u27s promotion of our role in play and the suggestion that play is one of the most important occupations of childhood, practitioners continue to report a limited focus on play as an occupation