| 1. |
- Baric, Vedrana B., et al.
(författare)
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Partnering for change (P4C) in Sweden : a study protocol of a collaborative school-based service delivery model to create inclusive learning environments
- 2023
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Ingår i: BMC Public Health. - : Springer Nature. - 1471-2458. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Inclusive learning environments are considered as crucial for children's engagement with learning and participation in school. Partnering for change (P4C) is a collaborative school-based service delivery model where services are provided at three levels of intensity based on children's needs (class, group-, individual interventions). Interventions in P4C are provided universally to support all children with learning, not only children with special education needs (SEN), and as such are expected to be health-promoting.Aim: The aim of the study is to evaluate the effectiveness and cost-effectiveness of P4C as well as school staff members' and children's experiences after P4C.Methods: In a parallel, non-randomised controlled intervention design, 400 children, aged 6-12 years, and their teachers, will be recruited to either intervention classes, working according to the P4C, or to control classes (allocation ratio 1:1). Data will be collected at baseline, post-intervention (4 months), and 11 months follow-up post baseline. The primary outcome is children's engagement with learning in school. Secondary outcomes include for example children's health-related quality of life and wellbeing, occupational performance in school, attendance, and special educational needs. The difference-in-differences method using regression modelling will be applied to evaluate any potential changes following P4C. Focus group interviews focusing on children, and professionals' experiences will be performed after P4C. A health economic evaluation of P4C will be performed, both in the short term (post intervention) and the long term (11-month follow-up). This study will provide knowledge about the effectiveness of P4C on children's engagement with learning, mental health, and wellbeing, when creating inclusive learning environments using a combination of class-, group- and individual-level interventions.
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| 2. |
- Cinar, Eda, et al.
(författare)
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A Preliminary Study to Develop a Collaborative Tiered School-Based Physical Therapy Service Delivery Model : Results from an International Delphi Consultation
- 2022
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Ingår i: International Journal of Physiotherapy. - : International Journal of Physiotherapy. - 2349-5987 .- 2348-8336. ; 9:2, s. 45-63
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Tidskriftsartikel (refereegranskat)abstract
- Background: Physical therapy (PT) is increasingly provided at schools to help students participate in educationalactivities. Recent rehabilitation models emphasized the benefits of using collaborative tiered services for serviceprovision, yet no model is available to guide how these services should be delivered. Therefore, this study aims to determine the core attributes and PT interventions of a collaborative tiered school-based PT model that could guide how PT services are delivered in schools worldwide.Methods: A modified Delphi method was used to identify the core attributes and the PT interventions that would be part of the model. An introductory webinar followed by three Delphi rounds with 24 international experts was conducted. Similar ideas generated in Round 1 were combined into statements; the statements reaching the predetermined consensus level in Rounds 2 or 3 were retained. Categories were created to present core attributes and Tiered interventions that were retained.Results: 41 core attributes were identified and grouped under seven categories. Tiered interventions were grouped under 15 categories which included 37 interventions for Tier 1, 24 interventions for Tier 2, and 60 interventions for Tier 3.Conclusion: The recommended core attributes and interventions will support the development of an international framework for school-based PT services, fostering health promotion for all children, and supporting those with disabilities.
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| 3. |
- Cinar, Eda, et al.
(författare)
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Perspectives of International Experts on Collaborative Tiered School-Based Physiotherapy Service Delivery
- 2022
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Ingår i: Physical & Occupational Therapy in Pediatrics. - : Taylor & Francis. - 0194-2638 .- 1541-3144. ; 42:6, s. 595-614
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Tidskriftsartikel (refereegranskat)abstract
- AimsThe purpose of this Phase II study is to identify the perceived strengths and weaknesses of a collaborative tiered school-based physiotherapy (PT) service delivery model, considering its core attributes and tiered interventions identified in the first phase of the study (Phase I), and explore the potential facilitators and barriers to implementing the model internationally.MethodsThree focus group discussions were conducted with international experts (n = 16) Discussions focused on the core attributes and tiered interventions of the model in Phase I. Data were analyzed using a framework approach and SWOT (strengths, weaknesses, opportunities, and threats) analysis.ResultsThemes surrounding the perceived characteristics of the model included comprehensiveness, guiding document, collaborative approach, and inclusiveness. Additional themes were related to the implementation that included governance, professional roles, workload, implementation in different countries, advocacy, and available opportunities. A framework table was tabulated to present the strengths and weaknesses of the service delivery model and available opportunities, and potential barriers to implementation.ConclusionsThis study revealed international perspectives regarding a proposed collaborative tiered school-based PT service delivery model and presented a framework to guide clinicians, researchers, and policymakers for the implementation of tiered approaches.
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| 4. |
- Hekne, Linnéa, et al.
(författare)
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Early access to physiotherapy for infants with cerebral palsy : A retrospective chart review
- 2021
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:6
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Forskningsöversikt (refereegranskat)abstract
- AimThis study aimed to investigate whether children with cerebral palsy (CP) had equal access to timely physiotherapy. Additionally, to learn more about clinical characteristics of infants with CP, we explored differences in neonatal clinical history and CP profile between children referred by a neonatologist or enrolled in neonatal follow-up and those referred by other healthcare professionals as well as those referred before and after 5 months corrected age.MethodsWe conducted a retrospective chart review study including children born in Uppsala County, Sweden, from 2010 to 2016, who had received a CP diagnosis by July 2019. Entries by doctors and physiotherapists working at Uppsala University Children’s Hospital were reviewed.ResultsThirty-eight children were included (21 girls, 55.3%) in the study. Twenty-two (57.9%) were born at term. Twenty-five children (66%) had their first visit to a physiotherapist before 5 months corrected age, and this included all children (n = 22, 57.9%) referred by a neonatologist or enrolled in neonatal follow-up. The latter group had significantly earlier access to physiotherapy compared to children referred by other healthcare professionals, with a median of 1.9 (min-max: -1-4) and 7.6 (min-max: 1–24) months, respectively (p < 0.0001). Referral source explained unique variance in predicting time of referral to physiotherapist (R2 0.550, B 4.213, p < 0.0001) when controlling for both number of risk factors and severity of motor impairment. However, number of risk factor was vital for early access to physiotherapy for children referred by other health care professionals.Children referred by a neonatologist or enrolled in neonatal follow-up or referred before 5 months corrected age differed on all measured variables concerning neonatal clinical history and CP profile, compared to children referred by other healthcare professionals or after 5 months corrected age. The latter groups had milder forms of CP. In total, twenty-eight children (73.7%) were ambulatory at 2 years of age. Bilateral spastic CP was most common among those referred by a neonatologist or enrolled in neonatal follow-up or referred before 5 months corrected age, while unilateral spastic CP was most common among those referred by other healthcare professionals or after 5 months corrected age.ConclusionInfants with CP have unequal access to timely physiotherapy, and children considered at low risk for CP receive therapy later. Neonatal follow-up of infants considered at high risk for CP that involves an assessment of motor performance using an evidence-based method during the first months of life corrected age seems to be effective in identifying CP early. Conversely, measuring milestone attainment seems to be a less reliable method for early identification. To provide safe and equal care, all professionals performing developmental surveillance should receive proper training and use evidence-based assessment methods. Physiotherapy should be available prior to formal medical diagnosis.
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| 5. |
- Johansen, Kine, et al.
(författare)
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Can nurses be key players in assessing early motor development using a structured method in the child health setting?
- 2015
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 21:4, s. 681-687
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Tidskriftsartikel (refereegranskat)abstract
- Rational, aims and objectivesIncreasing evidence highlights the importance of early interventions for motor disorders in children. Given the key medical role of the nurse within the Swedish Child Health Service (CHS), we aimed to examine if nurses could apply a structured assessment of early motor development at the child health centre to enable early identification of children at risk. MethodsStructured Observation of Motor Performance in Infants (SOMP-I) assesses infant's level of motor development and quality of motor performance using subscales converted to total scores. The total score for both level and quality can then be plotted within the SOMP-I percentile distribution at the child's age for comparison with a reference population. Fifty-five infants (girls: 30) were assessed according to SOMP-I at three child health centres. Assessments were performed by nurses (n=10) in a clinical setting; one nurse performed the assessment while another nurse and a physiotherapist observed. ResultsAgreement for the assessment of level as a continuous variable was excellent [intraclass correlation coefficient (ICC) 0.97-0.98], but was lower for quality (ICC 0.02-0.46). When the children were categorized according to the percentile range categories, the assessors were in agreement for the majority of the children, with respect to both level (78-82%) and quality (78-87%). ConclusionDespite brief experience with SOMP-I, the agreement was excellent when assessing the level of motor development, but was less satisfactory for the assessment of quality of motor performance. More extensive education and training may be necessary to improve the nurses' ability to assess quality, as this domain was an entirely new concept to the nurses. Further research is warranted to determine the applicability of SOMP-I as a standardized method for nurses to assess motor development within the CHS.
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| 6. |
- Johansen, Kine, et al.
(författare)
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Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services
- 2017
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:7
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study aimed to evaluate the clinical utility of the Structured Observation of Motor Performance in Infants (SOMP-I) when used by nurses in routine child healthcare by analyzing the nurses' SOMP-I assessments and the actions taken when motor problems were suspected.Method: Infants from three child health centers in Uppsala County, Sweden, were consecutively enrolled in a longitudinal study. The 242 infants were assessed using SOMP-I by the nurse responsible for the infant as part of the regular well-child visits at as close to 2, 4, 6 and 10 months of age as possible. The nurses noted actions taken such as giving advice, scheduling an extra follow-up or referring the infant to specialized care. The infants' motor development was reassessed at 18 months of age through review of medical records or parental report.Results: The assessments of level of motor development at 2 and 10 months showed a distribution corresponding to the percentile distribution of the SOMP-I method. Fewer infants than expected were assessed as delayed at 4 and 6 months or deficient in quality at all assessment ages. When an infant was assessed as delayed in level or deficient in quality, the likelihood of the nurse taking actions increased. This increased further if both delay and quality deficit were found at the same assessment or if one or both were found at repeated assessments. The reassessment of the motor development at 18 months did not reveal any missed infants with major motor impairments.Interpretation: The use of SOMP-I appears to demonstrate favorable clinical utility in routine child healthcare as tested here. Child health nurses can assess early motor performance using this standardized assessment method, and using the method appears to support them the clinical decision-making.
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| 7. |
- Johansen, Kine, et al.
(författare)
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'Now I use words like asymmetry and unstable' : nurses' experiences in using a standardized assessment for motor performance within routine child health care
- 2016
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 22:2, s. 227-234
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE, AIMS AND OBJECTIVES:There is an increasing recognition that early intervention is important for children with motor disorders. The use of standardized assessment methods within the Swedish Child Health Services (CHS) may improve early identification of these children and thereby their development and quality of care. Given the key role of nurses within the CHS, we explored their experiences of using a structured assessment of motor performance (SOMP-I) in a clinical setting, and investigated possible barriers and facilitators for implementation of the method within the CHS.METHODS:The study was conducted in 2013 in Uppsala County, Sweden. Ten child health nurses participated in two focus group interviews, which were analysed using systematic text condensation.RESULTS:The analysis yielded three themes: (1) increased knowledge and professional pride - nurses described their desire to provide high-quality care for which SOMP-I was a useful tool; (2) improved parent-provider relationship - nurses felt that using SOMP-I involved both the parents and their infant to a greater extent than routine care; and (3) conditions for further implementation - nurses described that the time and effort needed to master new skills must be considered and practical barriers, such as lack of examination space, resource constraints and difficulties in documenting the assessment must be addressed before implementing the SOMP-I method in routine care.CONCLUSION:Child health nurses felt that the SOMP-I method fitted well with their professional role and increased the quality of care provided. However, significant barriers to implementing SOMP-I into routine child health care were described.
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| 8. |
- Johansen, Kine
(författare)
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Towards an evidence-based assessment of early motor performance in the child health services : Psychometric properties and clinical utility of the Structured Observation of Motor Performance in Infants
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish child health services (CHS) have a unique position in that they reach almost all children 0-6 years of age. The child health nurse has the main responsibility for developmental surveillance. Twelve scheduled visits with the nurse during the child’s first year of life make this an ideal setting to systematically identify infants with motor problems, ranging from asymmetric head positioning that may lead to plagiocephaly to more severe forms such as cerebral palsy (CP). However, the CHS lack evidence-based methods to assess motor development.The Structured Observation of Motor Performance in Infants (SOMP-I) assesses motor performance in two domains, i.e. level of motor development and quality of motor performance. SOMP-I is quick, non-invasive, requires minimal handling, and is suitable for a busy clinical setting when applied by physiotherapists. Given the importance of early detection, the increased likelihood of detecting motor problems when using evidence-based assessment methods and the key role of nurses within the CHS, the overall aim of this thesis was investigate the psychometric properties and clinical utility of SOMP-I when used by child health nurses. Furthermore, we aimed to establish the ability of SOMP-I to detect CP.Our results show that child health nurses can reliably assess the level of motor development in infants using SOMP-I. More variability was found when they assessed the infants’ quality of motor performance. Although the nurses expressed concern about introducing a more time-consuming assessment in an already tight schedule, they were able to integrate the SOMP-I assessment in routine care. The nurses reported that barriers to using SOMP-I were mostly logistic and practical in nature, and they pointed out the necessity of education and practice in order to become proficient assessors. Using SOMP-I appears to have supported the nurses in the decision-making process regarding motor performance in routine care. SOMP-I detected CP during the first months of life in neonatal intensive care recipients.To our knowledge, these studies are the first to evaluate child health nurses’ assessment of early motor performance using an evidence-based assessment method in routine care. The results are promising, but further research is warranted.
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| 9. |
- Lang, Christina, et al.
(författare)
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Parents want Swedish child health services to focus more on motor development and practical advice
- 2021
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:8, s. 2415-2423
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Tidskriftsartikel (refereegranskat)abstract
- Aim Parents' experiences and expectations are key to developing evidence-based approaches that respond to family needs. However, little is known about how parents regard the motor assessments in well-child surveillance and what they need to support their child's motor development. This study explored their experiences. Methods We conducted 11 semi-structured interviews with Swedish-speaking parents whose children had been referred to a physiotherapist by child health services (CHS) before 18 months of age. Consecutive sampling was conducted from March to November 2018. The data were analysed using systematic text condensation. Results The three themes that emerged were that that parents liked the CHS setting, but had concerns about the lack of focus on motor development during routine health visits and wanted more dialogue about this area. The parents said that the assessments varied considerably and that their concerns were not always taken seriously. They wanted to know more about the professionals' observations, how their child was expected to develop and what they could do to support their motor development. Conclusion Parents wanted a greater focus on motor development during routine health visits. This included advice on how they could support their child's development.
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| 10. |
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