Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

Incomplete reporting of components of interventions limits uptake of evidence into clinical practice

A systematic review of the psychometric properties of Quality of Life measures for school aged children with cerebral palsy

Background: This systematic review aimed to evaluate the psychometric properties and clinical utility of all condition specific outcome measures used to assess quality of life (QOL) in school aged children with cerebral palsy (CP)

Goal-directed occupational therapy for children with unilateral cerebral palsy: categorising and quantifying session content

Introduction: There is strong evidence that goal-directed occupational therapy achieves improvements in motor and self-care outcomes for children with unilateral cerebral palsy. This pilot study aimed to describe collaborative goals set in occupational therapy sessions, develop categories to describe session content and determine the percentage of in-session time spent addressing goal practice for children with unilateral cerebral palsy. Method: Videos of 10 therapy sessions with 10 unique child–therapist dyads were analysed. Session content was categorised into goal practice (goal-directed therapy, meaningful goal-supporting activity) and other activity (non-goal-related, child engagement and behavioural support, parent engagement, transition). Descriptive statistics determined the percentage of in-session time spent in goal practice. Results: Forty-three goals were set and 41 (95%) were activity focused. Mean percentage of time spent in-session on goal practice was 47.5% (SD 31.1%, range 0%–88.1%). Child behavioural support (4.9%), engaging parents (3.2%), transitioning between activities (6.7%) and non-goal-related activity (45.3%) comprised the remaining session time. Conclusion: Less than half of session time was spent in goal practice, despite being conducted under a goal-directed framework. Non-goal-related activities comprised nearly half of in-session time. Therapists need to consider how to maximise time spent in goal practice during therapy sessions

Development of a parent‐reported questionnaire evaluating upper limb activity limitation in children with cerebral palsy

Background and purpose: Upper limb activity measures for children with cerebral palsy have a number of limitations, for example, lack of validity and poor responsiveness. To overcome these limitations, we developed the Children's Arm Rehabilitation Measure (ChARM), a parent‐reported questionnaire validated for children with cerebral palsy aged 5–16 years. This paper describes both the development of the ChARM items and response categories and its psychometric testing and further refinement using the Rasch measurement model. Methods: To generate valid items for the ChARM, we collected goals of therapy specifically developed by therapists, children with cerebral palsy, and their parents for improving activity limitation of the upper limb. The activities, which were the focus of these goals, formed the basis for the items. Therapists typically break an activity into natural stages for the purpose of improving activity performance, and these natural orders of achievement formed each item's response options. Items underwent face validity testing with health care professionals, parents of children with cerebral palsy, academics, and lay persons. A Rasch analysis was performed on ChARM questionnaires completed by the parents of 170 children with cerebral palsy from 12 hospital paediatric services. The ChARM was amended, and the procedure repeated on 148 ChARMs (from children's mean age: 10 years and 1 month; range: 4 years and 8 months to 16 years and 11 months; 85 males; Manual Ability Classification System Levels I = 9, II = 26, III = 48, IV = 45, and V = 18). Results: The final 19‐item unidimensional questionnaire displayed fit to the Rasch model (chi‐square p = .18), excellent reliability (person separation index = 0.95, α = 0.95), and no floor or ceiling effects. Items showed no response bias for gender, distribution of impairment, age, or learning disability. Discussion: The ChARM is a psychometrically sound measure of upper limb activity validated for children with cerebral palsy aged 5–16 years. The ChARM is freely available for use to clinicians and nonprofit organisations

Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.phpBACKGROUND: The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. PURPOSE: This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. METHODS: Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. RESULTS: Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. CONCLUSION: The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF

Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

Background: The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose: This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods: Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results: Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion: The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF

Improving Participation Outcomes and Interventions in Neurodisability: Co-designing Future Research

There is an urgent, agreed need to improve participation outcomes and interventions for children and young people with neurodisability. We worked together with service users and providers to design research into participation outcomes and interventions in neurodisability. We built on existing evidence about participation outcomes and interventions, and the WHO International Classification of Functioning, Disability and Health. We: (1) specified seven participation outcome categories for measurement; (2) prioritised these for improvement: self-care, friends and social, and physical activity ranked the highest; (3) identified eleven potential intervention categories for targeting the top priority, self-care, through eight hypothesised change mechanisms; and agreed for the interventions to be delivered as a ‘Menu of Interventions’ for personalised self-care support; and (4) designed a before-and-after mixed methods feasibility study to evaluate the Menu with children and young people (0-12 years), and their parents and therapists

INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia

Background: Congenital hemiplegia is the most common form of cerebral palsy (CP) accounting for 1 in 1300 live births. These children have limitations in capacity to use the impaired upper limb and bimanual coordination deficits which impact on daily activities and participation in home, school and community life. There are currently two diverse intensive therapy approaches. Traditional therapy has adopted a bimanual approach (BIM training) and recently, constraint induced movement therapy (CIMT) has emerged as a promising unimanual approach. Uncertainty remains about the efficacy of these interventions and characteristics of best responders. This study aims to compare the efficacy of CIMT to BIM training to improve outcomes across the ICF for school children with congenital hemiplegia

The role of ergonomic saddle seats and magnification loupes in the prevention of musculoskeletal disorders. A systematic review.

OBJECTIVES: Musculoskeletal disorders affect a high percentage of dentists, dental hygienists and therapists. Static and awkward working postures are considered as major risk factors. Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits. The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on (i) correction of poor posture and (ii) reduction in musculoskeletal pain. METHODS: The review was conducted according to the PRISMA guidelines. The review protocol was registered with PROSPERO (CRD42017058580). The Medline via Ovid, CINHAL via EBSCO, Web of Science, OpenGrey and EThOS electronic databases were searched. Prospective experimental studies were considered for inclusion. The Effective Public Health Practice Project Quality Assessment Tool (EPHPP) was used to assess the methodological quality of the included studies. RESULTS: Eight studies were included in the review. Four investigated the effect of loupes on posture and musculoskeletal pain, 4 the effect of the saddle seats on posture and one of the latter explored the combined effect of magnification and use of saddle seats on posture. CONCLUSIONS: Based on a limited number of studies, the use of ergonomic saddle seats and dental loupes leads to improved working postures. The use of loupes appears to relieve shoulder, arm and hand pain. However, their effect on neck pain is scarce. None of the studies reported on the effect of the saddle seats on musculoskeletal pain. Future well-powered prospective longitudinal studies are deemed necessary to confirm the conclusions of this review