Quality and quantity of paediatric research: An analysis of the OTseeker database

Aim:  This study aimed to analyse the quantity and quality of paediatric research evidence contained in the OTseeker database and to compare the findings with surveys of paediatric occupational therapy practice.
Methods:  In June 2005, systematic reviews and randomised controlled trials contained in OTseeker were analysed according to year of publication and the client diagnostic groups and interventions addressed. The internal validity scores of the trials were determined (according to the PEDro scale (partitioned)) and the outcome measures used extracted.
Results:  Of 3294 papers contained in OTseeker, 372 (11.3%) were related to paediatrics. The mean internal validity score of the trials was 2.5/8. The five most frequently studied diagnostic groups were mental health/psychosocial issues, neurology, learning disabilities, developmental delay and 'other'. There was much variation in the outcome measures used, with a large number of outcome measures used in only one or a few studies. The five most frequently studied interventions were behavioural interventions, consumer education, psychosocial techniques, interventions for carers/parents and developmental therapy.
Conclusion:  OTseeker contains a considerable amount of research relevant to paediatric occupational therapy practice. There was some congruence between the papers and practice surveys regarding client diagnostic groups and interventions, but little between the outcome measures used in research and those used in clinical practice.     

Evaluating family-centred service in paediatric oncology with the measure of processes of care (MPOC-20)

Background   In order to evaluate the family-centeredness of paediatric oncology services, a psychometrically sound measure of family-centred services is needed. We performed a comprehensive evaluation of the psychometric properties of the 20-item Measure of Processes of Care (MPOC-20) in parents of children undergoing treatment for cancer at five paediatric oncology centres in Canada.
Methods   The sample included 411 parents (80% response rate). Exploratory factor analysis was used to determine the best way to group the items into scales. Psychometric tests were used to examine data quality, targeting, internal consistency reliability, within-scale construct validity and known-groups validity.
Results   Exploratory factor analysis identified two factors: a summary measure of family-centred services and a scale measuring activities that meet parents' general informational needs. Scores spanned the entire scale range, floor and ceiling effects were low, and the sample distribution was not unduly skewed. Scales showed acceptable internal consistency reliability (Cronbach's alphas ≥0.93). Known-group hypotheses supported the scales' ability to differentiate between groups hypothesized to differ. Moderate effect sizes were found when MPOC-20 scale scores for parents and for children with good quality of life were compared with those with poor quality of life.
Conclusions   The MPOC-20 is the only evaluated instrument currently available to measure family-centred services in paediatric oncology. Paediatric cancer programmes can now use this tool to determine parental perception of the extent to which services are family-centred.     

Validation of Gastrointestinal Quality of Life Index in Swedish for Assessing the Impact of Gallstones on Health-Related Quality of Life

Objective:  The aim of the present study was to validate a Swedish translation of the Gastrointestinal Quality of Life Index (GIQLI) questionnaire in patients with gallstone disease.
Methods:  Sensitivity to change, internal consistency, and test–retest stability were tested in 187 consecutive patients who underwent planned cholecystectomy. Construct validity was assessed by comparing the GIQLI score with the bodily pain scale of SF-36 and four single-item questions in a separate group of 104 patients.
Results:  A significant increase in all five domains as well as in the overall GIQLI score 6 months after surgery (all P  < 0.05) was seen. All five domains correlated significantly with other measures of gallstone-related symptoms except one single-item question. Intraclass correlations ranged from 0.62 to 0.87. Cronbach's alpha ranged from 0.77 to 0.89.
Conclusion:  The Swedish translation of GIQLI has a high validity and reliability for assessing the impact of gallstones on quality of life.     

Development of a New Questionnaire to Assess Patient Perceptions of Cancer-Related Fatigue: Item Generation and Item Reduction

Objectives:  Existing instruments that measure the impact of cancer-related fatigue on health-related quality of life do not usually incorporate the attitudes, beliefs and perspectives of patients. This study aimed to develop an instrument to measure the impact of cancer-related fatigue on the health-related quality of life of cancer patients.
Methods:  Items were generated from a literature review, focus groups of cancer patients and meetings with oncologists. Potential items were administered to cancer patients to facilitate item reduction, which was based on clinimetric and psychometric analyses and qualitative criteria. A preliminary assessment of feasibility, reliability and validity of the retained items was performed.
Results:  An initial pool of 75 items was administered to 238 cancer patients. Fifty items were eliminated after statistical analysis and 13 in response to expert opinion, resulting in a provisional instrument with 12 items in 3 dimensions. These displayed acceptable internal consistency (Cronbach's alpha, 0.78–0.92) and their overall score was associated with fatigue intensity, extent of disease, intention of treatment and need of caregivers.
Conclusion:  The newly developed questionnaire, which measures the impact of cancer-related fatigue on oncology patients, has shown satisfactory feasibility, reliability and validity.     

Psychometric Evaluation of the Diabetes Symptom Checklist-Revised (DSC-R)—A Measure of Symptom Distress

Objective:  To assess the psychometric validity, reliability, responsiveness, and minimal important differences of the Diabetes Symptoms Checklist-Revised (DSC-R), a widely used patient-reported outcome measure of diabetes symptom distress.
Research Design and Methods:  Psychometric validity of the DSC-R was assessed using blinded data from a large-scale trial of approximately 4000 type 2 diabetes patients. Confirmatory factorial analysis (CFA) and multitrait analysis were used to examine the construct validity of the structure of DSC-R. DSC-R internal consistency, discriminative validity, and responsiveness were also assessed. Distribution and anchor-based methods were used to estimate minimal important differences for DSC-R domains.
Results:  Mean age of the sample was 56 years, 42% were female, 88% were Caucasian. Patients had a mean body mass index (BMI) of 32.2 and mean glucose-fasting level of 151.7 md/dl. CFA and multitrait analysis indicated that the scoring of the DSC-R has acceptable construct validity. Item-scale correlations ranged from 0.44 to 0.78. Cronbach's alpha coefficients ranged from 0.69 to 0.87. At baseline, DSC-R scores were higher among patients with higher BMI scores ( P  < 0.0001), supporting the discriminative validity of the DSC-R. Minimal important difference estimates ranged from 0.39 to 0.60 points when using distribution methods and from 0.00 to 0.33 when estimated using anchor-based methods.
Conclusions:  The DSC-R demonstrated excellent psychometric properties when tested in a large-scale diabetes clinical trial. Responsiveness and test–retest reliability of the DSC-R warrant further evaluation.     

Reliability of the Perceive, Recall, Plan and Perform System of Task Analysis: A criterion-referenced assessment

Objective:  To conduct preliminary examination of the rater and test-reliability of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, an ecological measure designed to assess task-embedded information processing capacity during occupational therapy assessment of confused and agitated adults following traumatic brain injury.
Methods:  Occupational therapists observed and scored client performance using the PRPP System of Task Analysis. Correlational analysis and measures of agreement were performed to determine interrater and intrarater reliability. Test procedures were examined for reliability and internal consistency.
Results:  Interrater and test reliability considered three factors: therapists, clients and tasks. A moderate level of interrater reliability was achieved between trained therapists (intraclass correlation coefficient (ICC) = 0.60). Test procedures were highly reliable (ICC = 0.88). Across two measurement occasions, therapists showed a tendency towards harder rating on the second test occasion (      –4.5%; 95% confidence interval for     : –10.67%→ 3.17%).
Conclusion:  The findings of this study support the use of criterion-referenced tests in the area of occupational performance measurement. Occupational therapists achieved moderate interrater reliability when measuring the performance of adults with brain injury on various activities of daily living. Test procedures were found to be highly reliable in measuring the occupational performance of adults demonstrating confusion and agitation typical to the stage of post-traumatic amnesia following head injury.     

Understanding where we come from: Occupational therapy with urban Indigenous Australians

Background:  This article outlines issues of service provision for Indigenous families in Brisbane, Australia. It presents guidelines for the development of a socially and culturally appropriate occupational therapy service for urban Indigenous children.
Methods:  A mixed methodology was used in two independent components of the research. Part 1 comprised a survey of paediatric occupational therapists in Brisbane. Part 2 consisted of focus groups and interviews with recipients of a newly established occupational therapy service for Indigenous children.
Results:  Survey findings indicated that very few Indigenous families access mainstream occupational therapy services. Issues and strategies for developing culturally appropriate practice emerged around five main themes. These were the need to develop effective relationships, develop particular personal qualities, understand the background of both the client and the therapist, both gain and give knowledge, and address logistical issues of service delivery.
Conclusions:  Service providers need to understand the social and cultural context of both their Indigenous clients and themselves. Recommendations for future education and practice are provided.     

Development and Validation of a Markov Microsimulation Model for the Economic Evaluation of Treatments in Osteoporosis

Objective:  Markov models are increasingly used in economic evaluations of treatments for osteoporosis. Most of the existing evaluations are cohort-based Markov models missing comprehensive memory management and versatility. In this article, we describe and validate an original Markov microsimulation model to accurately assess the cost-effectiveness of prevention and treatment of osteoporosis.
Methods:  We developed a Markov microsimulation model with a lifetime horizon and a direct health-care cost perspective. The patient history was recorded and was used in calculations of transition probabilities, utilities, and costs. To test the internal consistency of the model, we carried out an example calculation for alendronate therapy. Then, external consistency was investigated by comparing absolute lifetime risk of fracture estimates with epidemiologic data.
Results:  For women at age 70 years, with a twofold increase in the fracture risk of the average population, the costs per quality-adjusted life-year gained for alendronate therapy versus no treatment were estimated at €9105 and €15,325, respectively, under full and realistic adherence assumptions. All the sensitivity analyses in terms of model parameters and modeling assumptions were coherent with expected conclusions and absolute lifetime risk of fracture estimates were within the range of previous estimates, which confirmed both internal and external consistency of the model.
Conclusion:  Microsimulation models present some major advantages over cohort-based models, increasing the reliability of the results and being largely compatible with the existing state of the art, evidence-based literature. The developed model appears to be a valid model for use in economic evaluations in osteoporosis.     

Profile of paediatric occupational therapy practice in Australia

Background:  The purpose of the present study was to describe a profile of Australian paediatric occupational therapy practice in terms of theories, assessments and interventions used with the most frequently seen client groups.
Methods:  An ex post facto survey design was utilised. A purpose-designed survey was mailed to 600 occupational therapists identified by OT Australia as working in paediatrics.
Results:  The response rate was 55% ( n =  330). Respondents in the sample worked chiefly with children with developmental delays, learning disabilities, neurological impairments, and infants/toddlers. Theoretical models used by paediatric clinicians that were common to the most frequently seen client groups focused on sensory integration/multisensory approaches, occupational performance, and client-centred practice. Assessment tools most frequently used were the Test of Visual Motor Integration, Sensory Profile, Bruininks-Oseretsky Test of Motor Proficiency, Handwriting Speed Test, and Motor-Free Visual Perception Test. The most often used treatment methods across the four most frequently seen client groups were parent/caregiver education, sensory integration/stimulation techniques, and managing activities of daily living.
Conclusions:  Paediatric occupational therapists appeared to draw on a range of theoretical models. With the exception of the Sensory Profile, the assessment and treatment methods most frequently used are not congruent with the most commonly used theoretical models. It is critical that the assessment and treatment methods used are conceptually consistent with the theoretical models that guide practice. Occupational therapists need to examine the evidence and determine whether their clinical practice is grounded in the best contemporary theoretical models, assessments and interventions.     

Development of EMPRO: A Tool for the Standardized Assessment of Patient-Reported Outcome Measures

Objective:  This study was aimed to develop a tool for the standardized assessment of patient-reported outcomes (PROs) to assist the choice of instruments.
Methods:  An expert panel adapted the eight attributes proposed by the Medical Outcomes Trust as evaluation review criteria, created items to evaluate them, and included a response scale for each item. A pilot test was designed to test the new tool's feasibility and to obtain preliminary information concerning its psychometric properties. The Spanish versions of five measures were selected for assessment: the SF-36 Health Survey, the Nottingham Health Profile, the COOP-WONCA charts, the EuroQol-5D, and the Quality of Life Questionnaire EORTC-QLQ-C30. We assessed the new tool's reliability (Cronbach's alpha and intraclass correlation coefficient [ICC]) and construct validity.
Results:  The new EMPRO (Evaluating the Measurement of Patient-Reported Outcomes) tool has 39 items covering eight key attributes: conceptual and measurement model, reliability, validity, responsiveness, interpretability, burden, alternative modes of administration, and cross-cultural and linguistic adaptations. Internal consistency was high (α = 0.95) as was interrater concordance (ICC: 0.87–0.94). Positive associations consistent with a priori hypotheses were observed between EMPRO attribute scores and the number of articles identified for the measures, the years elapsed since the publication of the first article, and the number of citations.
Conclusion:  A new tool for the standardized assessment of PRO measures is available. It has shown good preliminary reliability and validity and should be a useful aid to investigators who need to choose between alternative measures. Further assessment of the tool is necessary.     

Psychometric Properties of a German Version of the "Satisfaction with Information about Medicines Scale" (SIMS-D)

Objective:  The aim of this study was to translate the Satisfaction with Information about Medicines Scale (SIMS) into German and test its psychometric properties in a German primary care setting. The SIMS was developed to assess the extent to which patients feel they have received enough information about their medicines.
Methods:  Three hundred seventy chronically ill patients were included in the study. The SIMS was translated to SIMS-D (German version) and evaluated in terms of acceptability, internal consistency, test–retest reliability, discriminant, and criterion-related validity.
Results:  The SIMS-D showed good internal consistency (Cronbach's α 0.92) and adequate test–retest reliability (Pearson's r  > 0.7). Relationships to external criteria regarding medication management were acceptable (Spearman's ρ > 0.4). The SIMS-D was reasonably well accepted (return rate of 71%); however, older people produced more missing values when filling in the questionnaire.
Conclusions:  Preliminary evidence was given that the SIMS-D is a suitable instrument for measuring patient satisfaction with information about medicines in German primary care settings.     

A framework for systematically improving occupational therapy expert opinions on work capacity

Aim:  To present an evidence-based framework to improve the quality of occupational therapy expert opinions on work capacity for litigation, compensation and insurance purposes.
Methods:  Grounded theory methodology was used to collect and analyse data from a sample of 31 participants, comprising 19 occupational therapists, 6 medical specialists and 6 lawyers. A focused semistructured interview was completed with each participant. In addition, 20 participants verified the key findings.
Results:  The framework is contextualised within a medicolegal system requiring increasing expertise. The framework consists of (i) broad professional development strategies and principles, and (ii) specific strategies and principles for improving opinions through reporting and assessment practices.
Conclusions:  The synthesis of the participants' recommendations provides systematic guidelines for improving occupational therapy expert opinion on work capacity.     

Enhancing the dietary management of general practice patients through collaborative care: perspectives of general practitioners and dietitians

Aim:  To describe how general practitioners and dietitians view their role in the dietary management of cardiac patients and to provide insights on how to facilitate collaborative care.
Methods:  Two studies were conducted in Victoria (Australia) 2005–2006. Study One: semi-structured interviews with general practitioners. Study Two: cross-sectional quantitative surveys of general practitioners and dietitians. Study One: texts were analysed using the grounded theory approach. Study Two: frequency analysis was conducted and chi-squared test for independence was used to explore the impact of age, sex and consultation time on the role and reporting scales.
Results:  Study One: Themes arising from the interviews with 30 general practitioners showed their involvement in dietary management fell into three broad roles: 'Influencing', 'Coordinator' of referrals and dietary 'Educator'. They described dietetic education as a process that included dietary assessment, education, application of behavioural change techniques and reporting back to general practitioners. Study Two: Respondents were 248 general practitioners (30% response) and 180 dietitians (60% response). General practitioners' counselling consisted mostly of advocating for dietary change, coordinating dietetic referrals and reinforcing dietitians' recommendations. General practitioners considered dietary education as the role of dietitians. Dietitians reported a much broader role in the management of patients with some overlap with general practitioners' roles.
Conclusions:  The findings indicate the need: (i) for more structured reporting to ensure general practitioners receive appropriate information to enable them to reinforce dietetic counselling and recommendations; and (ii) to streamline the communication process in order to expedite dietitians' reports to general practitioners.     

Satisfaction with Daily Occupations: Construct validity and test–retest reliability of a screening tool for people with mental health disorders

Background/Aim:  In occupational therapy research and in clinical practice there is a need for valid, reliable and easily administered measures. For research and screening purposes, the Satisfaction with Daily Occupations (SDO) instrument was developed. It addresses work, leisure, domestic tasks and self-care and generates a satisfaction and an activity level score. This study investigated its construct validity, internal consistency and test–retest reliability in 55 clients visiting occupational therapists in outpatient mental health care.
Methods:  The SDO was administered on two occasions with a 1-week interval, and data on the Canadian Occupational Performance Measure (COPM), psychosocial functioning and self-rated health were collected on the first of these occasions.
Results:  In contrast to what was expected, the relationships between the SDO scores and the COPM scores were low. The strongest relationship between the SDO satisfaction score and any other variable was to psychosocial functioning. These variables shared 23% of the variance. Internal consistency for the satisfaction score was acceptable, alpha = 0.75 on the second occasion, and the test–retest reliability was good; r _s   = 0.84 for the satisfaction score and r _s   = 0.92 for the activity level.
Conclusions:  The results indicated that the SDO has satisfactory reliability. The instrument targets a specific construct, as compared to the COPM and the measurements of self-rated health and psychosocial functioning. Thus, the SDO and the COPM satisfaction scale seem to assess different phenomena, probably because the SDO has predefined items, not specifically targeting a certain client's problematic occupations, whereas the COPM is based on self-defined problems. The instruments may therefore supplement each other.     

Reliability of a composite measure of social inclusion for people with psychiatric disabilities

Aim:  To assess the reliability of the components of a proposed composite measure of social inclusion for people with psychiatric disabilities.
Method:  The interview covered sociodemographics, domain-specific socially valued role functioning, social support, stigma experiences, integration within the immediate psychosocial rehabilitation community, and integration within the wider neighbourhood community. Participants (n ₁  = 28; n₂  = 26) were recruited from a psychosocial rehabilitation setting. The candidate measures were assessed for short-cycle test–retest reliability and internal consistency.
Results:  Several items were identified for removal from the stigma experiences and community integration subscales because of low test–retest reliability or for having not sufficiently contributed to internal consistency.
Conclusions:  The promising test–retest and internal consistency results warrant continuing the psychometric development of the composite measures of social inclusion and its applicability to community residents with psychiatric disabilities.     

Constructing an occupational therapy role in situ using Organisational Role Analysis: A case study

Background and Aims:  A developing international literature on population-based occupational intervention provides limited evidence of the ways in which the associated occupational therapy roles are developed among entry-level practitioners. This paper aims to explore the development of an occupational therapy role in a fieldwork placement from the perspective of a student and the off-site supervisor and to explore the use of Organisational Role Analysis in this process.
Methods:  Systems psychodynamics and an occupational perspective of health provided the theoretical framework for this participant observation case study. Data from the reflective diaries of a fourth-year student and her supervisor were analysed with respect to role development in an organisation where occupational therapy was welcome, but not completely understood.
Results:  This study provides insight into the challenges for students and supervisors in the development of an occupationally oriented role where the client is an organisation. Organisational Role Analysis was perceived to be helpful in focusing attention on the organisational context of role development.
Conclusions:  The application of the Organisational Role Analysis as an approach to student supervision in other settings, with more than one student and to facilitate professionally development warrants further investigation.     

Attitudes of entry level occupational therapy doctoral students towards inclusion for students with disabilities

Background/Aims:  The increasing popularity of inclusive education for students with disabilities and the attitudes towards it inevitably affect school-based occupational therapy practice. This survey study investigated the attitudes of entry-level occupational therapy doctoral (EOTD) students towards inclusive education and the effect of professional education on their perception.
Methods:  A total of 62 EOTD students responded to a self-developed questionnaire, Attitudes and Inclusive Education Survey , yielding a response rate of 91.2%.
Results:  Results of the study revealed that entry level occupational therapy doctoral students have positive attitudes towards inclusive education and believe that the inclusion movement has an inevitable impact on school-based occupational therapy practice. Professional education in occupational therapy might positively affect students' attitudes.
Conclusion:  Given the close association between one's attitude and behaviour, the findings of the study are particularly encouraging. Future research needs to further examine school-based occupational therapy practice in inclusive environments.