69 research outputs found
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
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
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)
Study protocol for Running for health (Run4Health CP) : a multicentre, assessor-blinded randomised controlled trial of 12 weeks of two times weekly Frame Running training versus usual care to improve cardiovascular health risk factors in children and youth with cerebral palsy
Introduction: Children and youth with moderate-severe (Gross Motor Function Classification System (GMFCS) levels II–V) cerebral palsy (CP) participate less frequently in physical activities compared with peers without CP and have elevated risk of cardiorespiratory morbidity and mortality in adulthood. Frame Running (RaceRunning) is a new athletics discipline that is an accessible option for physical activity participation for people with moderate-severe CP. There is no high-quality evidence for the effect of Frame Running on cardiovascular disease in children and young people with CP. The primary aim of this study is to conduct a randomised controlled trial of the effect of 12 weeks of Frame Running training on risk factors for cardiovascular disease.
Methods and analysis: Sixty-two children and youth with CP (age 8–20 years) in GMFCS levels II–V will be recruited across four sites and randomised to receive either 12 weeks of Frame Running training two times weekly for 60 min, or usual care. Outcomes will be measured at baseline, immediately postintervention (primary endpoint) and 12 weeks later for retention of training effects. The primary outcome is cardiorespiratory fitness as measured by distance covered on Six Minute RaceRunner Test with 1 min heart rate recovery. Other outcomes include blood pressure, objectively measured physical activity, body mass index, waist circumference, percentage body fat, gross motor function capacity, community participation, feasibility, tolerability and safety. Adverse events will be monitored, and participants and their caregivers will be interviewed to discern their experiences of participation in Frame Running.
Ethics and dissemination: The Children’s Health Queensland Hospital and Health Service and the University of Queensland Human Research Ethics Committees have approved this study. Results will be disseminated in peer-reviewed journals and scientific conferences; through professional and athletic organisations; and to people with CP and their families.
Trial registration number: ACTRN12621000317897; Australian New Zealand Clinical Trials Registry number
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
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
Factors affecting length of hospital stay for children with acquired brain injuries: A review of the literature
Acquired brain injury (ABI) is a significant cause of morbidity and mortality for children within the industrialized world. Either in acute care or long-term management settings, occupational therapists are concerned with children who have sustained an ABI. Children with ABI often require a prolonged period of hospitalization and intensive rehabilitation with significant costs to the hospital, community and family. This literature review addresses the factors affecting length of hospital stay (LOS) for children with severe ABI. Broadly speaking these factors are: (i) injury severity; (ii) complicating factors; and (iii) the effects of intervention procedures. While these factors have been highlighted in the literature, little research has been done to examine their relative contribution to the LOS for children with ABI. Occupational therapists are primarily interested in the impact of rehabilitation and the timing of its introduction; however the impact of this cannot be understood without consideration of the other known factors that influence LOS
Impact of early discharge planning and case management on length of hospital stay for children with acquired brain injury
The aim of this study was to determine the impact of co-ordinated management and early discharge planning as an intervention strategy to reduce hospital length of stay for children with acquired brain injury. Data for children admitted to the Royal Children's Hospital, Brisbane, between 1987 and 1993 were compared with data collected for children receiving the intervention programme from August 1993 to August 1994. In total, 99 children were included in the study, of whom 84 were retrospective and 15 were prospective patients. Age, sex, Glasgow Coma Score, mechanism of injury (traumatic vs non-traumatic), and treatment intervention were predictor variables and total length of hospital stay and associated hospital costs were the outcome variables. Univariate analyses were performed to determine differences between the retrospective and intervention groups and showed a highly significant difference between the two groups in relation to length of stay and total hospital costs (P < 0.001). Multiple regression analyses were carried out to determine what factors could predict length of stay. Along with the Glasgow Coma Score (P < 0.01), the intervention programme was found to be a statistically significant predictor of total hospital days (P < 0.01). A couple of issues, nevertheless remain unanswered. These pertain to the functional status of the patient at discharge and the nature of community supports required. This study opens up an area of investigation not before undertaken in occupational therapy and points towards future studies
A randomised trial of novel upper limb rehabilitation in children with congenital hemiplegia.
Abstract Background Congenital hemiplegia is the most common form of cerebral palsy accounting for 1 in 1300 live births. Children usually present with greater upper limb than lower limb involvement. Impaired unimanual capacity of the involved upper limb and deficits in bimanual performance contribute to difficulties with day to day activities and participation in home, school and community life. Interventions to address these deficits in upper limb unimanual capacity and bimanual performance have recently shifted focus to address limitations in activity performance rather than underlying impairments. One intensive intervention approach is constraint induced movement therapy, which entails placing a constraint on the unimpaired upper limb to focus intense and repetitive training of the impaired upper limb. To date, it is unclear whether constraint induced movement therapy is superior to a more traditional bimanual therapy to improve activity performance and participation outcomes for children with congenital hemiplegia, as there has been no direct comparison of the two approaches. Aim The primary aim of this research was to determine whether constraint induced movement therapy was more effective than bimanual training to improve activity performance and participation for children with congenital hemiplegia. The specific aims were to: i) determine the efficacy of therapeutic upper limb interventions on activity and participation outcomes for children with congenital hemiplegia, ii) systematically review the clinimetric properties (psychometric properties and clinical utility) of participation assessment tools for children with congenital hemiplegia, iii) examine the relationship between impairments, unimanual capacity and bimanual performance in children with congenital hemiplegia and, iv) determine whether constraint induced movement therapy is more effective than bimanual training to improve activity and participation outcomes for children with congenital hemiplegia. Research Design A matched pairs randomised design was chosen with children matched for age, gender, side of hemiplegia and upper limb function. Children were randomised within pairs to receive either constraint induced movement therapy or bimanual training in equal dosages. Both interventions used a day camp model, with groups receiving the same dosage and content of intervention delivered in the same environment. A novel circus theme was used in the camps to enhance children’s engagement and motivation. Children in the constraint induced movement therapy group wore a tailor made glove on their unimpaired hand during the intervention camp. Outcomes were measured across all domains of the International Classification of Functioning, Disability and Health at baseline, 3 and 26 weeks post intervention. The primary outcome measure for unimanual capacity of the impaired upper limb was the Melbourne Assessment of Unilateral Upper Limb Function, and bimanual performance was the Assisting Hand Assessment. A secondary outcome measure for unimanual capacity was the Jebsen Taylor Test of Hand Function. The Canadian Occupational Performance Measure was used as the primary outcome for participation and three measures, the Assessment of Life Habits, Children’s Assessment of Participation and Enjoyment and the School Function Assessment were included to explore their research utility and responsiveness to change. Results Two systematic reviews were performed prior to the commencement of the randomised trial. The first systematic review and meta-analysis of all upper limb interventions for children with congenital hemiplegia identified four treatment approaches with varying evidence to support their efficacy. Interventions included the use of intramuscular Botulinum toxin A injections to the upper limb augmenting upper limb training, neurodevelopmental treatment, constraint induced movement therapy and hand arm intensive bimanual training. Data were pooled for upper limb, self care and individualised outcomes. Results indicated a small to medium treatment effect favouring all four interventions on upper limb outcomes. Large treatment effects favoured intramuscular Botulinum toxin A injections combined with upper limb training for individualised outcomes. Overall, the systematic review and meta-analysis found no upper limb training approach to be superior although Botulinum toxin A injections appeared to provide a consistent supplementary benefit to a variety of upper limb training approaches. However it was unclear which type of upper limb training was optimal. Findings suggested that the two intensive intervention approaches that are the focus of this randomised controlled trial, constraint induced movement therapy and bimanual intensive training, required further research to support their efficacy. The second systematic review was performed to inform choice of participation measures for the randomised comparison trial. The review identified five specific measures of participation suitable for school aged children with congenital hemiplegia (Assessment of Life Habits, Children’s Assessment of Participation and Enjoyment, School Function Assessment (participation domain), Children Helping Out: Responsibilities and Expectations, School Outcome Measure) and two measures of individualised outcomes that could include specific participation goals (Goal Attainment Scaling and Canadian Occupational Performance Measure). Results suggested that no one measure adequately captured all aspects of participation as outlined in the International Classification of Functioning, Disability and Health, and a combination of assessments would be required to broadly assess children’s participation in home, school and community life. The Canadian Occupational Performance Measure was selected as the primary outcome measure in the randomised trial as it had strong evidence for validity and reliability, had been used in paediatric clinical trials and was responsive to change. Three measures of participation, the Assessment of Life Habits which was completed by the parent/caregiver, the Children’s Assessment of Participation and Enjoyment which was completed by the child, and the School Function Assessment, which was completed by the child’s teacher, were selected to explore the research utility of the measures and their responsiveness to change. Analysis of cross-sectional data collected during screening and baseline assessments for the randomised trial found a strong relationship between bimanual performance and unimanual capacity. Scores on the Melbourne Assessment of Unilateral Upper Limb Function and stereognosis accounted for a significant amount of variance in scores on the Assisting Hand Assessment. There were only moderate associations between impairments (eg. sensory deficits and reduced grip strength) and bimanual performance and unimanual capacity. Age, gender, grip strength and two-point discrimination did not significantly influence bimanual performance. Results of the randomised controlled trial found no differences between groups on any baseline measure. A significant difference between groups favouring the constraint induced movement therapy group was found at 26 weeks on the Melbourne Assessment of Unilateral Upper Limb Function. There were no differences between groups on any other measure at either immediately post intervention at 3 weeks or in the medium term at 26 weeks. The constraint induced movement therapy group made significant gains in unimanual capacity (Melbourne Assessment of Unilateral Upper Limb Function and Jebsen Taylor Test of Hand Function) from baseline to 3 and 26 weeks. The bimanual group demonstrated significant improvement in movement efficiency (Jebsen Taylor Test of Hand Function) by 26 weeks. Significant gains in bimanual performance (Assisting Hand Assessment) were evidenced for both groups from baseline to 3 weeks. These gains were maintained at 26 weeks by the bimanual group only. There were no differences between groups on any participation measures. Both constraint induced movement therapy and bimanual training groups made statistically and clinically significant changes in perceived performance and satisfaction of identified functional goals from baseline to 3 and 26 weeks. Significant gains were made by both groups in personal care on the Assessment of Life Habits from baseline to 26 weeks. There were no changes for either group on the School Function Assessment and Children’s Assessment of Participation and Enjoyment. Conclusions This study found minimal differences between the two training approaches. Outcomes achieved by children reflected the mode of upper limb training, that is, improved and sustained gains in unimanual capacity were achieved with a unimanual approach (constraint induced movement therapy), and significant change in bimanual performance was achieved following bimanual training. The constraint induced movement therapy group made initial improvements in bimanual performance that were not sustained at 26 weeks, suggesting that intensive unimanual training may need to be followed by bimanual training in order to retain effects. Both interventions resulted in significant improvements in the achievement of individualised outcomes. Small gains in participation appeared to correspond with specific goal areas identified by children and their caregivers and highlighted the importance of goal directed training and measuring individualised outcomes. Regardless of the type of approach, intervention needs to be goal-directed, focusing on areas of central importance for children and their families
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