Date Presented 04/04/19
This study demonstrates the effectiveness of a novel, client-centered OT intervention, named PREP, for improving the participation of youth with disabilities. By removing environmental barriers, OTs enabled 28 youth to successfully take part in the activities they identified, such as shopping with friends, riding a bike, and joining a glee club. These findings support a shift toward community-based ecological practices that occur in real-life situations.
Primary Author and Speaker: Dana Anaby
Additional Authors and Speakers: Rachel Teplicky, Laura Turner
Contributing Authors: Mary Law, Lisa Avery, Annette Majnemer, Debbie Feldman
PURPOSE: While participation in occupation is key to youth health (Law, 2002), little is known about effective intervention strategies to improve participation in community activities for those with physical disabilities (Adair et al., 2015). Developed by CanChild, the PREP (Pathways and Resources for Engagement and Participation) approach aims to enhance participation by removing environmental barriers and coaching youth/parents (Law et al., 2016). The purpose of this study was to examine the effectiveness of the PREP intervention among youth with physical disabilities.
METHODS: Youth whose mobility is restricted (e.g., due to cerebral palsy, spina bifida, musculoskeletal disorders) were recruited from five major rehabilitation centers and two high-schools in Montreal, Canada. Twenty-eight youth (50% female) aged 12 to 19 years (mean=14.6, SD=1.8) with moderate physical disabilities, as measured by the Activities Scale for Kids, participated in a 12-week PREP intervention. The PREP intervention follows a 5-step approach, including Make Goals, Map Out a Plan, Make it Happen, Measure Processes and Outcomes and Move Forward.
DESIGN: An Interrupted Time Series design with multiple baselines was employed, replicating the intervention effect across 3 chosen goals/occupations and across participants. An occupational therapist worked individually with youth/parents to identify and implement strategies to remove environmental barriers that impede participation in selected activities within each youth’s local context. Activity performance was repeatedly measured using the Canadian Occupational Performance Measure (COPM) at baseline, intervention and follow-up (20-weeks). For each goal/activity, a trajectory representing change in performance was analyzed using visual inspection. To estimate the overall effectiveness of the intervention across all 79 activities, segmented regression combined with mixed-effects modeling approach was used.
RESULTS: A clinically and statistically significant improvement (B=2.08, p<0.001) of more than 2 points on the COPM scale was observed across activities. Levels of performance were maintained during follow-up. Examples of effective environmental strategies include: improving physical accessibility, adapting activity equipment, finding available programs, providing information about transportation, informing community agencies about how they could adapt their programs and provide accessible services, and improving attitudes of others through education. The intervention was most effective for boys and those with a higher number of functional issues. Aspects of cost-effectiveness were also observed, with an average of 6.5 hours needed to accomplish each goal/activity.
CONCLUSION: The PREP intervention is an effective, efficient approach for improving participation in a diverse array of occupations. These findings are of high importance to occupational therapists who strive to enhance their clients’ participation in everyday occupations. Using this approach shows that changes in participation can be accomplished by changing the environment only, and that youth and their families can be empowered to apply these strategies to future occupation goals. These findings support a shift in the way service is delivered and packaged, towards community-based ecological practices that occur in real life situations.
References
Adair B, Ullenhag A, Keen D, et al. (2015) The effect of interventions aimed at improving participation outcomes for children with disabilities: a systematic review. Developmental Medicine and Child Neurology 57: 1093-1104. doi:10.1111/dmcn.12809
Law M. (2002) Participation in the occupations of everyday life. American Journal of Occupational Therapy 56: 640-649. doi:10.5014/ajot.56.6.640
Law M, Anaby D, Teplicky R, et al. (2016) Pathways and Resources for Engagement and Participation (PREP): A Practice Model for Occupational Therapists. Available at: https://www.canchild.ca/en/shop/25-prep.
