Background: Use of Botulinum toxin-A (BoNT-A) for treatment of upper limb spasticity in children with cerebral palsy has become routine clinical practice in many paediatric treatment centres worldwide. There is now high-level evidence that upper limb BoNT-A injection, in combination with occupational therapy, improves outcomes in children with cerebral palsy at both the body function/structure and activity level domains of the International Classification of Functioning, Disability and Health. Investigation is now required to establish what amount and specific type of occupational therapy will further enhance functional outcomes and prolong the beneficial effects of BoNT-A.Methods/Design: A randomised, controlled, evaluator blinded, prospective parallel-group trial. Eligible participants were children aged 18 months to 6 years, diagnosed with spastic hemiplegic cerebral palsy and who were able to demonstrate selective motor control of the affected upper limb. Both groups received upper limb injections of BoNT-A. Children were randomised to either the modified constraint-induced movement therapy group (experimental) or bimanual occupational therapy group (control). Outcome assessments were undertaken at pre-injection and 1, 3 and 6 months following injection of BoNT-A. The primary outcome measure was the Assisting Hand Assessment. Secondary outcomes included: the Quality of Upper Extremity Skills Test; Pediatric Evaluation of Disability Inventory; Canadian Occupational Performance Measure; Goal Attainment Scaling; Pediatric Motor Activity Log; modified Ashworth Scale and; the modified Tardieu Scale.Discussion: The aim of this paper is to describe the methodology of a randomised controlled trial comparing the effects of modified constraint-induced movement therapy (a uni-manual therapy) versus bimanual occupational therapy (a bimanual therapy) on improving bimanual upper limb performance of children with hemiplegic cerebral palsy following upper limb injection of BoNT-A. The paper outlines the background to the study, the study hypotheses, outcome measures and trial methodology. It also provides a comprehensive description of the interventions provided.Trial Registration: ACTRN12605000002684. © 2010 Hoare et al; licensee BioMed Central Ltd.

Date Presented 04/22/2023 Telehealth is rapidly expanding in OT practice; therefore, advanced technologies must also be incorporated into OT education. A telepresence robot was used for a remote faculty presence and to stimulate critical thinking skills during an OTD Level I fieldwork experience. Student satisfaction scores were significantly higher when the robot was incorporated into the learning than when it was not, and students reportedthat learning was enhanced with this technology. Primary Author and Speaker: Kirsten Davin Additional Authors and Speakers: Barbara M. Mollere Doucet

Background@#The pandemic brought permanent changes in education in terms of set-up and delivery. In the Philippines, most universities switched to online learning to provide educational continuity to their students. Without direct supervision from instructors, higher educational level learners bear greater responsibility for their learning behaviors, emphasizing the need to employ online self-regulated learning (OSRL) skills, which are goal setting, environment structuring, time management, help-seeking, self-evaluation, and metacognition.@*Objectives@#This study examined the OSRL skills of occupational therapy (OT) students enrolled in a full online curriculum at the University of Santo Tomas (UST) during the academic year (A.Y.) 2020-2021. It also describes the differences between students' OSRL skills and their demographic characteristics—sex, age, year level, and student status.@*Methods@#The study employed a cross-sectional records review of the 2021 Student Life Survey, which was deployed through Google Forms to a total of 205 respondents. Responses from the Online Self-Regulated Questionnaire were extracted and analyzed through descriptive and inferential statistics in SPSS version 27, using the Mann-Whitney U Test and Kruskal-Wallis Test with a significance level set at 0.050.@*Results@#Data analysis showed that UST OT students reported average to high levels of online self-regulated learning, with the highest SRL mean score in environmental structuring and goal setting. The students’ online self-regulated learning in goal setting is statistically significant to sex (p= 0.021) and age (p= 0.036). Additionally, year levels have a significant difference in task strategies (p= 0.042) and time management (p= 0.006).@*Conclusion@#OSRL skills vary depending on the students’ contexts and learning environment. They are independent of the students’ demographic characteristics. These findings could inform stakeholders and researchers about students’ OSRL levels, which can help in providing pedagogical strategies that will enhance students' self-regulated learning in online education.

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Background The OTTER (OsTeoarthritis Thumb ThERapy) trial is a two-year developmental study for a full randomised controlled trial (RCT) into the clinical and cost effectiveness of an occupational therapy and splint intervention for thumb base OA. To develop an optimal package of care for evaluation within a multi-centre RCT, the views of both clinicians and patients are crucial. Objectives To conduct a Delphi study to obtain agreement between both patients with thumb base OA and AHPs concerning the most appropriate optimal NHS OT programme, splint and placebo splint intervention to use in the RCT. Methods The Delphi panel consisted of 63 AHPs experienced in treating adults with thumb base OA, and 7 patients with thumb base OA. The panel were asked to rate how much they agreed or disagreed about what optimal NHS OT care for thumb base OA should include, and what method(s) of delivery (individual one-to-one, group, patient leaflets, or telephone advice) they deemed were more appropriate. The Delphi study comprised 3 rounds. A seven-point Likert-type scale was used. Pre-defined inclusion and exclusion criteria were applied in order to reach a final number of statements which, in turn, created the desired tool. Group differences were analysed using Mann-Whitney U tests. Results Between-groups analyses showed significant differences in the ratings of overall importance of items to be included in an optimal NHS OT consultation Conclusions AHPs and patients differed in their views about the importance of including 'Education for Family/Significant Others/Carers', 'NHS Clinic Procedures', 'Prognosis Advice', 'Referral to other Health Care Professional', 'Sleep Assessment and Management' and 'Treatment Options' in an optimal NHS OT consultation, and in the methods of delivery used in the consultation. AHPs placed significantly less importance than patients on 'One-to-One Contact', 'Leaflets' and 'Telephone Advice'. These findings demonstrate the importance of consultingwith patients at an early stage in developing an intervention. (Figure Presented).

RECORD STATUS:

This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database.

CITATION:

Breuer J, Piso B. Ergotherapie bei kindern und jugendlichen. Literaturübersicht zu indikationen, inanspruchnahme und empfehlungen. [Occupational therapy in children; Part 1 – Literature review on indications, utilisation and recommendations] Vienna: Ludwig Boltzmann Institut fuer Health Technology Assessment (LBIHTA). HTA Projektbericht Nr. 70. 2013

Objectives: Aim of this work is to assess the costs, outcomes and the cost-utility of the Community Occupational Therapy in Dementia (COTiD-UK) intervention compared to Treatment as usual (TAU), using the within-trial data from the VALID RCT. Methods: A cost-utility analysis of the COTiD-UK intervention compared to TAU was performed using within-trial costs and outcomes data adopting the NHS perspective. Costs were calculated in 2017UK£ and include the cost of the COTiD-UK training for occupational therapists, the COTiD-UK intervention to person with dementia and supporters, the cost of NHS resource use (e.g. A&E and hospital admissions, GP consultations, etc.), medications, adaptations and equipment costs and changes in accommodation. The effectiveness of the intervention, captured using EQ5D-5L and DEMQOL questionnaires in both arms, were converted into QALYs, both for the person with dementia and the supporters. Extensive sensitivity analysis has been performed to control for uncertainty in the parameter values used. Results: The preliminary results of the analysis show that at 26 weeks there is some evidence that NHS costs are significantly higher in the COTiD-UK arm for person with dementia alone and for the person with dementia and supporters combined: this is mainly due to the cost of the COTiD-UK intervention. There is some evidence that in the intervention arm QALYs are higher in the person with dementia, but the findings are not statistically significant. Further work is currently exploring the broader societal costs and also modelling the long-term results beyond the trial. Conclusions: The preliminary results of this analysis seem to suggest that COTiD-UK is effective for the person with dementia, but the ICER is exceeding the recommended threshold of £20,000 per QALY. However these results do not take into account the societal costs (private costs, transport costs, productivity losses) for person with dementia and supporters, that may provide better results.

Objective: This study is conducted to investigate the effects of occupational therapy (OT) with or without combined acupuncture for upper limb pain and hand functions among children with spastic hemiplegic cerebral palsy. Methods: A total of 90 patients who met the inclusion criteria were enrolled in a three‐arm randomized, placebo‐controlled trial, and were allocated to mono‐occupational therapy (OT) group (patients= 30), OT combined with real‐acupuncture (ORA) group (patients= 30), and OT combined with placebo‐acupuncture (OPA) group (patients= 30), respectively. In addition to receiving the conventional OT program as the basic treatment for total 8 weeks, patients in ORA and OPA group also received corresponding acupuncture treatment 5 days per week for the first two weeks, 3 days per week for the next two weeks, 2 days per week for another two weeks, and 1 day per week for the last two weeks. Non‐communicating children's pain checklist‐revised scale (NCCPC‐R) was used for assessing the upper limb pain among patients. Squeeze dynamometry, modified Ashworth scale (MAS), manual muscle testing (MMT), Jebsen‐Taylor hand function test (JTHFT) and box and block test (BBT) were used for assessing various aspects of upper limb and hand functions among patients. Meanwhile, adverse effects were monitored and recorded. Results: After 8‐week treatment, NCCPC‐R global scores witnessed a dramatic decline in ORA group (P < 0.05), but not in either OPA (P > 0.05) or OT group (P > 0.05). Dramatic increases were identified in both squeeze dynamometry scores and MMT scores in all three groups (all P < 0.05). Furthermore, the increases of ORA group were more significant than those of another two groups (both P < 0.05). There were no significant changes in MAS global scores in each group (all P > 0.05). The BBT global scores of all three groups significantly increased (all P < 0.05) after treatment. Among them, the increase of the ORA group was more than that of the other two groups (P < 0.05). The 8‐week treatment also had a significant impact on several sub‐tests of JTFHT in each group. No significant adverse event was reported. Conclusion: ORA is a potential and promising alternative therapy for mitigating upper limb pain as well as improving both upper limb and hand functions among children with spastic hemiplegic cerebral palsy.

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