Critically Appraised Topic 1 Critically Appraised Topic Project Measuring Functional Progress in Children with Cerebral Palsy Patricia Pooler Measuring Functional Progress in Children with Cerebral Palsy Evidence-Based Practice Question
Critically Appraised Topic 2 Which is a better assessment tool for measuring functional progress in children with Cerebral Palsy (CP) who are receiving school-based therapy, the Pediatric Evaluation of Disability Inventory (PEDI) or the School Function Assessment (SFA)? Clinical question submitted by Dr. April Rockwood. Question was modified by writer to include functional and who are receiving school-based therapy, after discussing with Dr. Rockwood the context in which the PEDI and SFA would be used. Dr. Rockwood was looking to utilize either the PEDI or the SFA as a measure of functional progress in a school for students with disabilities setting. Introduction Effective assessment of outcomes, through the use of evaluation tools, is especially important in children with chronic health conditions (Sakzewski, Boyd, & Ziviani, 2007). Occupational therapy practitioners require measurement tools that are cost-effective, available, psychometrically sound, and clinically useful. Evaluation of therapy services are important for third party payers, to monitor outcomes, to guide health policy, assess individuals needs, set goals, collaboration planning of interventions, and evaluate intervention (Sakzewski et al., 2007). The trend of current therapy for children with cerebral palsy (CP) in school-based settings is broadening to promote improved function across all performance domains. This means that outcome measures for children with CP need to evaluate a broader perspective of functioning rather than performance in actual life situations. There must be an emphasis on the top-down approach to assessment of children with CP in order to determine how the child participates in occupations in different environments (Sakzewski et al., 2007). The above mentioned clinical question is looking at outcome measures from a functional perspective. Function outcomes are most commonly used in a school environment and are fundamental to the evaluation of rehabilitation services for children with special needs (King et al., 1998). In the literature there is a need for the examination of functional outcomes or progress in a school-based therapy setting (King et al., 1998). When evaluating children with CP there needs to be a comprehensive evaluation across all domains of the International Classification of Functioning, Disability, and Health (ICF) within the context of the environment (Sakzewski et al., 2007). Evaluation tools are required to show this progress over time, which means that the tool can detect small, clinically important changes in function (Harvey, Robin, Morris, Graham, & Baker, 2008). This is known as responsiveness, which is the sensitivity of the evaluation measures to detect real change within individuals. Two measures that are useful when describing a child's activity and participation in a school-based setting are the Pediatric Evaluation of Disability Inventory (PEDI) and the School Function Assessment (SFA). The PEDI is a wide-scope functional status scale used in children ages six month to seven years. It contains two scales, the function scale and the caregiver assistance scale. The functional scale has 197 skills that measure whether the activities can be performed or not. The SFA measures performance of non-academic school tasks and activities by children with disabilities (King et al., 1998). Both the PEDI and the SFA are commonly used and accepted pediatric assessment tools, both with excellent psychometric properties in terms of reliability and validity, however, overall, there are a limited number of studies that evaluate school-based therapy outcomes using the PEDI and the SFA for children with CP. The aim of this critically appraised topic (CAT) project is to investigate the use of PEDI and SFA in a school-based setting, in order to determine which tool is a better measure of functional progress in children with CP. Criteria for Selecting Evidence
Critically Appraised Topic 3 Types of Participants: Only the populations of children with CP were included. Types of Intervention: Responsiveness of PEDI and SFA as functional measurement tools in a school-based setting. Functional and school skills domains of measure. Types of Studies: 1998-current Systematic Reviews of measures of function in children with CP Pretest-Posttest studies. Single group design. Randomized Controlled Clinical Trial. Levels of Evidence II, III, and IV. Best Evidence: Since no paper directly answered the clinical question, research was selected to analyze the PEDI and SFA separately. Only one paper looked at a school-based intervention using both the PEDI and SFA as assessment measures. Therefore, the following articles were appraised in order to provide the best evidence to analyze the clinical question: Systematic review of participation measures for children with CP Harvey, A., Robin, J., Morris, M., Graham, H., & Baker, R. (2008). A systematic review of measures of activity limitations for children with cerebral palsy. Developmental Medicine & Child Neurology, 50, 190-198. Systematic review of measure of activity for children with CP Sakzewski, L., Boyd, R., & Ziviani, J. (2007). Clinimetric properties of participation measures for 5-13-year old children with cerebral palsy: A systematic review. Use of both PEDI and SFA as outcome measures
Critically Appraised Topic 4 Wright, F. Boschen, K., & Jutai, J. (2005). Exploring the comparative responsiveness of a core set of outcome measures in a school-based conductive education programme. Child: Care, Health, and Development, 31, 291-302. Analyzing the responsiveness of the PEDI in school-based setting Stiller, C., Marcoux, B. C., & Olson, R. E. (2003). The effect of conductive education, intensive therapy, and special education services on motor skills in children cerebral palsy. Physical and Occupational Therapy in Pediatrics, 23, 31-50. with Analyzing the responsiveness of the SFA in school-based setting King, G., Tucker, M.A., Alambets, P., Gritzan, J., McDougall, J., Ogilvie, A., et al. (1998). The evaluation of functional, school-based therapy services for children with special needs: A feasibility study. Physical and Occupational Therapy in Pediatrics. 18, 1-27.
Critically Appraised Topic 5 Table Summarizing the Evidence References Study Objectives Level of Evidence/Design/ Sample Harvey, Level of Evidence Robin, Level IV Morris, Graham, & Baker. (2008). This research paper was a systematic review and critical appraisal of literature regarding outcome measures used for children with CP. The focus was evaluation measures that were used to determine the magnitude of change over time, as well as were able to show responsiveness to change. The aims of this paper were: (1) identify evaluation outcomes used to assess activity limitations in children with CP and identify which dimension of activity they measure, (2) appraise critically the study design and psychometric properties, (3) determine the consideration of environmental and assistive devices were used in the measurement process, and (4) appraise the clinical utility and feasibility of the measures. Sample Tools were included if they were used on children ages 0-18 with CP, measured activity (focus on gross motor function & mobility). Tools were excluded if they looked at developmental status, were not evaluating a sample of children with CP, did not look at psychometric properties, were not developed for children with CP, and if they focused on association between tools. Note: The SFA was not mentioned or included in this review. Design Systematic review and critical appraisal of literature. Intervention & Outcome Measurements Intervention data were extracted from two independent reviewers. This included organizing themes from the data, such as aim, participation selection, characteristics, description of measurement tools, psychometrics, and feasibility and clinical utility. The articles were then reviewed, and if a disagreement was found between the two reviewers, then a third author was involved until consensus was reached. The outcome measures were then summarized in a table. The clinical utility of each measure was discussed, as well as the psychometric properties. Outcome Measurements eight different outcome measures were included. These included ASK, CHQ, FAQ, GMFM, PEDI, PODCI, FMS, and WeeFIM. Assessment Procedure The search was conducted in August 2006, with the databases MEDLINE, Embase, CINAHL, and PsychINFO. Keywords included: cerebral palsy, psychometrics, validity, reliability, and responsiveness. Results PEDI Overall, the PEDI was found to be the second most commonly used tool, of the eight tools analyzed in this paper. The authors examined five articles that used the PEDI as the measurement tool. The age range of samples in the studies assessing the PEDI was younger samples. Regarding the feasibility of the PEDI, the authors stated that it was the most time consuming, taking 45 to 60 minutes. The PEDI also requires training sessions and trial use of software for scoring. In terms of the psychometric properties of the PEDI, the domain of mobility performed better than self care and social domains in terms of reliability and validity. Responsiveness was found in some studies, yet not in others, therefore further examination of responsiveness- is required. Conclusion The authors conclude that no one measure adequately addresses all aspects of the ICF, and therefore clinicians are advised to select the tool based on established psychometric properties and the purpose of the measurement. Of the eight outcome measures that they found to assess activity limitations in children with CP, each examined a different dimension of activity limitation. In order to assess a child with CP thoroughly, a range of tools is
Critically Appraised Topic 6 Sakzewski, Boyd, & Ziviani. (2007) This systematic review analyzed the validity, reliability, sensitivity to change, and clinical utility of measurements of participation for children with cerebral palsy aged 5 to 13 years. Level of Evidence Level IV Sample Only assessments that measured participation, or had at least 30% of the assessment components addressed participation. Note: The PEDI was not mentioned or included in this review because the emphasis was on participation for children with cerebral palsy. Design Systematic review Intervention The authors compared the clinometric properties of each assessment on the basis of clinical utility, validity, reliability, and responsiveness. Three independent raters defined the search strategy and selected the papers for review. These raters were two OTs and one PT, each with considerable experience (18-33 years). Outcome Measurements Seven measures were selected, which included: CAPE, SFA, SOM, Children helping out: responsibilities, expectations, and supports (CHORES), LIFE-H, COPM, and GAS. Nine assessments were excluded (PEDI being one of them). Assessment Procedures Databases that were used included Medline, CINAHL, EMBASE, and PsychINFO. Terms used were cerebral palsy, physical disability, outcome assessment, and participation (school or home or community was the focus). required. There are seven generic measures of participation suitable for children with CP. Not one measure looks at all the possible areas of outcomes as defined by the IFC. Of the seven measure found, the three that cover home, school, and community are the SFA, CAPE, and LIFE-H. SFA The reliability and validity of all three measures are strong. The SFA was found to have a test-retest of 0.80-0.99. Internal consistency was found to be between 0.92-0.98. Interrater reliability ranged from 0.68 to 0.78. The responsiveness of the SFA remains unknown due to the limited data available. The greatest burden of administration time of all measures was found to be the SFA, with a total of 1 ½ to 2 hours for initial assessment. Discussion The authors state the importance of the difference between participation and activity. The PEDI was excluded from this study because it primarily measures activity. Activity was defined as a specific task or action undertaken by the individual, whereas participation was defined as involvement within a life situation. Evaluation of outcomes for children with CP is a challenge, with the ultimate outcome of rehabilitation being enhanced participation. Wright, To determine which Level of Evidence Intervention The intervention Change scores were determined by
Critically Appraised Topic 7 Boschen, & Jutai (2005). outcome measures of a school-based conductive education (CE) program were most responsive to change. Measures included physical, functional, psychosocial, school, and participation domains. The authors aimed to identify measures that are wellsuited to: (1) detect change, and (2) are practical to use in a school-based setting. Level III Sample 9 children with CP in Kindergarten or Grade 1 (ages 4-8 years) who attended the pediatric rehabilitation facility located in Toronto, Canada. According to the Gross Motor Function Classification System levels, three of the children were level III, three were level IV, and three were level V. Design single group design involved a full day CE class for the children with CP. The classroom had an integrated education and therapy program, consisting of physiotherapists, occupational therapists, and education teacher. Education, treatment, motor learning, and language were combined in order to allow for motor learning using group activities, task series, and verbal cueing. Outcome Measurements the measures that were chosen for this study were selected based on: (1) the child s status in the areas of body structures and function, activity, and performance, (2) recognized outcomes in literature in children with CP, and (3) purpose of measure, which was designed to evaluate outcomes. For the measures in the domain of Gross Motor, fine motor, and function, the PEDI were selected. For the domain of school skills, participation at school was measured using the SFA. Assessment Procedure baseline assessment occurred in the second month of school and repeated eight months later. The classroom team completed the SFA, and the research assistant conducted the PEDI. combining year one and year two results. The Standardized Response Mean (SRM) was calculated based on the ratio between change score and SD of change. A SRM >0.80 was considered large, indicating greater responsiveness to change. A SRM between 0.51-0.80 is medium effect size. SFA - The SFA was completed for six children. Only parts I and II were completed due to difficulties completing part III for the young children. Part I (overall participation) did not show any change from year one. Part II did show gains, with the largest mean score gain in the cognitive assistance sub-scale. In all parts of the SFA the SRM was less than 0.80. Only part II physical adaptations had a SRM that was greater than 0.50. PEDI The PEDI was completed for all nine children. In both part I (functional skills) and part II (caregiver assistance) there were changes in all three domains (self-care, mobility, and social function). When looking at the SRMs for Part I, all three domains had a value less than 0.50, indicating small effect size. Part II was found to have SRM values greater than 0.60 for all three domains. Discussion The PEDI was only found to be responsive to change in Part II (caregiver assistance), which is scored by parents. The lack of additional new skills in Part I (found as not responsive to change) was surprising to the authors. They stated that perhaps the students had
Critically Appraised Topic 8 not yet applied motor gains to functional abilities or lacked the opportunity to try new skills at home. When looking at the SFA, the authors found that Part I (participation) did not show any changes in mean criterion score. Part II was only found to have a gain in score in the subscale of cognitive assistance. The authors felt the SFA was too lengthy to administer, required the entire team to complete, and that many of the functional skills were too advanced for the population of this study. Therefore both the SFA and PEDI (Part I functional skills) were not responsive to change and are not measures that are suited to evaluate change within this context. Stiller, Marcoux, & Olson. (2003). This study compared the effects of intensive therapy, conductive education, and special education in children with cerebral palsy. This is the first study to compare, simultaneously, conductive education to both intensive therapy and special education using three standardized tests. Level of Evidence Level II Sample total of 19 children participated in this study. Children were all diagnosed with CP and between the ages of two years five months and nine years. Children were excluded if they were blind of deaf, had uncontrollable seizures, had a mental impairment to the extent that the child could not follow instructions, or were enrolled in another therapy program (such as therapeutic horse riding or swimming). 68% of the participants were males. 11 Intervention children were assigned to the following groups: IT Group 8 children were randomly assigned to the intensive therapy (IT) group, which included 1 hour per day of physical therapy, 1 hour per day of occupational therapy, 1 hour per day of speech therapy (if needed), and 1 hour of group therapy. The children also participated in twiceweekly OT group session, twice-weekly PT group session, and once weekly speech group session. Each session was 60 minutes. This equaled a total of five days that this group received the therapy. Each child s pre and post test scores were compared to see how much change occurred during the study. "Clinical change" was defined as an increase of 10% from pre-test to post-test. The only group to show statistically significant differences using paired t-test to compare pre- and post- test scores was the IT Group. Results of PEDI significant differences were found on the IT group of self-care (p=0.009) and social function (p=0.005). Discussion professional staff and parents who were surveyed indicated that they perceived all children made gains in some areas. Only the SE group was reported by parents and staff to have
Critically Appraised Topic 9 children were diagnosed as Diplegic CP, 1 child was Hemiplegic CP, and 7 children were Quadriplegic. Design Randomized Controlled Clinical Trial. Evaluators were blinded to group assignment. SE Group 4 children were randomly assigned to special education (SE). This group met 5 days a week for 6 hours, which involved physical therapy, occupational therapy, and speech therapy. An average of two 45 minute sessions of PT, OT, or ST was received by each child weekly. CE Group 7 children were assigned to the conductive education (CE) group. This group met five days per week for six hours per day. A standardized CE program was followed. Outcome Measurements The Gross Motor Function Measure (GMFM), the PEDI, and PDMS was administered before and after the five week treatment program. Therapists administered these assessment measures; however no reliability testing of the therapists was performed. Assessment Procedure This study was approved by the IRB. Children were recruited from OTs, PTs,SLPs, and parent group that was promoting conductive education. Physician approval and informed consent for all participants was obtained prior to the project. An initial evaluation was performed on the children by an OT, PT, and SLP using standardized improvements in areas of cognitive and academic skill.
Critically Appraised Topic 10 evaluations. Therapists were blinded to the group assignment of the children and were not affiliated with any facilities where the children were treated. The therapists had a range of experience, from 2-24 years. King, Tucker, Alambets, Gritzan, McDougall, Ogilvie, et al. (1998). The purpose of this feasibility study was to determine: (a) utility of Goal Attainment Scaling (GAS) for evaluating functional therapy outcomes in children in a school setting, (b) the ability of several standardized measures to capture change in function, (c) utility of satisfaction questionnaires in assessing parents and teachers satisfaction with services, and (d) whether issues related to therapy had implications for a full program evaluation study. Level of Evidence Level III Sample 16 children (3 girls and 13 boys) between the ages of 6 to 13 years old. 3 children had clinical description of speech and language disorder, 5 had primary diagnosis of cerebral palsy, and 8 had a clinical description of developmental coordination disorder. Inclusion Criteria the children had to be receiving therapy from the Thames Valley Children s Centre in Ontario, Canada, had to be attending at least 50% of the time, and had a clinical description of a speech language disorder, developmental coordination disorder, or a primary diagnosis of cerebral palsy. Design pretest-posttest. Intervention This study was conducted at the Thames Valley Children`s Centre in Ontario, Canada. The children received therapy based on their functional needs and goals. They either received occupational therapy, physical therapy, or speech-language therapy. Each session was 45 minutes in length. The average time from the first to the last therapy session was 16 weeks, with a total number of sessions ranging from 8 to 17. Outcome Measurements The pretest and posttest evaluations that were chosen included the Arizona Articulation Proficiency Scale (AAPS) by the speech-language pathologists, the Vineland Behavior Scales- Classroom Edition by teachers of children with problems in productivity, and the SFA by therapists, teachers, and parents to children with mobility difficulties. Assessment Procedure This study was conducted during the 1995-1996 school year. The assessment of the children occurred first in order to determine if the children were eligible. The consent forms and background Pre-and post-intervention mean scores for both the AAPS and the Vineland showed that the measure captured statistically significant change in children s performance. Pre-and post-intervention mean scores for the SFA indicated trends towards statistical significance in children s participation levels and resource requirements. In the task area of mobility, the SFA did not indicate either statistically or clinically meaningful change. T-value for total participation was found to be 1.63 (p-value less than or equal to 0.10). Discussion The authors concluded that the Vineland standardized measure was a useful measure for evaluating the outcomes of occupational therapy services in the school setting. However, it should be noted that the SFA was responsive to change and able to detect clinically significant change in Part I (participation levels) and in Part II (task supports, but not in the task area of mobility (travel and maintaining and changing positions). The authors stated that perhaps the children in this study (and children with CP in general) are less likely to show improvements in skill level in a four-tofive month intervention period. It is
Critically Appraised Topic 11 information was obtained on the children and teachers. During this preliminary period, the therapists took four orientation and training sessions over a period of one year. The pre-test evaluations were then performed, followed by goal setting using the GAS procedure. Therapeutic intervention followed by the OT, PT, and SLT. Goal ratings were then conducted by the therapists, followed by post-test measures for the standardized tests. Finally satisfaction and study procedure questionnaires were given out. hypothesized by the authors that the activity scales of the SFA are not sensitive to change in a short period of time. The overall responsiveness of the SFA and its effectiveness as an evaluation tool was unable to be determined since measures were only completed for five of the nine children in this study.
Critically Appraised Topic 12 Summary of Evidence No single paper directly answered the clinical question. Evidence regarding the use of PEDI and SFA as a measure of progress in children with CP in school-based setting exists at level II (1 randomized clinical trial), level III (2 pre-test post-test studies), and level IV (2 systematic reviews). Feasibility and clinical utility of both the PEDI and SFA were found to be the most time consuming tool, taking 45-60 minutes and 90-120 minutes respectively to administer (Harvey et al., 2008; Sakzewski et al., 2007). It was also concluded that the SFA was not of sufficient value to warrant the time it took to administer (Wright, Boschen, & Jutai, 2005). Both the PEDI and the SFA were found to have excellent psychometric properties in terms of reliability and validity (Harvey et al., 2008; Sakzewski et al., 2007). Systematic reviews of both the PEDI and SFA found that the results of PEDI were slightly better. The inter-rater reliability of the PEDI was found to be excellent with values between 0.15-0.95 (Harvey et al., 2008), whereas the SFA was found to be adequate with values between 0.68-0.73 (Sakzewski et al., 2007). Responsiveness of both the PEDI and SFA require further investigation as there currently are no absolute standards for interpreting effect size and standardized response mean values (Harvey et al., 2008; King et al., 1998). Both the PEDI and the SFA were found to capture clinically significant change in participation levels and in resource requirements (SFA) and self-care and social function (PEDI), but not in mobility domains (both SFA and PEDI) (King et al., 1998; Sakzewski et al., 2007). In the two studies analyzing the effect size (responsiveness) of the PEDI, both found the mean score to increase from pretest to posttest. The first study found a small effect size with mean change in scores ranging from 1.1-7.5 (Wright et al., 2005). The other study found the total PEDI mean change in score ranged from 1.25 7.0 (Stiller, Marcoux, & Olson, 2003). However, the PEDI considers a change in ability to occur when a score shifts by 5 points (Wright et al., 2005), therefore for the domains that scored less than 5 points, it was concluded that it was not "statistically significant" and therefore those domains were not responsive to change. In the two studies analyzing the effect size (responsiveness) of the SFA, both were unable to determine the overall responsiveness due to small sample size and incomplete data (Wright et al., 2005; King et al., 1998). It is thought that either children with CP are less likely to show improvement in skill level in a four to five month intervention period or that the SFA is not sensitive to change in these children (King et al., 1998). The SFA was found to consist of functional skills that are too advanced for children with CP, and thus not accurately describing the child (Wright et al., 2005). The PEDI was found to measure performance of what the child does do rather than what they can do (Harvey et al., 2008). Compared with the SFA, the PEDI is better able to measure progress and is sensitive enough to measure clinically significant changes in function in children with cerebral palsy in a schoolbased setting; however further research is needed in the evaluation of outcome measures in children with CP to determine the responsiveness and clinical utility of these tools.
Critically Appraised Topic 13 Implications for Consumers Consumers who would benefit from the evidence presented in this paper include therapists, teachers, parents, third party payers, students, and researchers. Consumers need to be skeptical of the current evidence regarding the PEDI and SFA as tools that measure functional outcomes in children with CP, in that both the PEDI and the SFA are useful for evaluation of skills of individual children diagnosed with cerebral palsy; however the responsiveness to change or progress needs to be further analyzed. Clinicians need to weigh the characteristics of both assessment tools, such as their purpose, psychometric properties, method of administration, and assessment burden. The PEDI and SFA are both very comprehensive outcome measures that take a long time to administer (taking 45-60 minutes and 90-120 minutes respectively). Therapists must analyze the assessment burden, feasibility and clinical utility of assessment tools before administering them (Harvey et al., 2008; Sakzewski et al., 2007). Clinicians do not want to waste time administering an assessment if the results are not helpful or accurately show any clinical significance. Parents and teachers of children with CP may be involved in the assessment of functional progress, therefore there needs to be consistency in regards to both the school and home environments and improving skills. Parents and teachers need to use the assessment tool that they are more comfortable with and that accurately allows for a clear picture of the functioning of their child or student. They need to be informed that the assessment tool being used on their child may not accurately show the progress that their child may be making. Through the use of assessment tools, such as the PEDI, third party payers are able to see that the therapeutic intervention is an accurate measure of change, and thus able to continue funding. For researchers, there are many implications that can be taken from this project. Firstly, there needs to be better rigorous research in children with cerebral palsy in the school based setting. The study by Wright et al. (2005) looked at both the PEDI and SFA as outcome measures in a school-based setting, yet this study only had a sample size of nine children. The PEDI was also completed by the research assistant. This study needs to be replicated with a larger sample size, and with measurement tools administered by the OT in order to allow for better statistical analysis. Research is needed in order to allow for proper measures of responsiveness and the interpretation of evaluation outcome measures for children with CP. This will allow for researchers to clearly understand the scores of both the PEDI and SFA in children with CP. The question that needs to be analyzed is how much change is clinically important? Each child is different and this makes it difficult to assess the value of what amount of change is clinically significant. Important variables that need to be taken into account are age and severity of the child with cerebral palsy. Recommendations for Best Practice The SFA may be more useful for clinical assessment purposes rather than program evaluation or measuring progress of therapy intervention in a school-based setting (King et al., 1998).
Critically Appraised Topic 14 The scales of the SFA may not be responsive to change in a short period (King et al., 1998) and therefore do not accurately measure the small changes seen in children with CP. Therapists need to have a longer intervention period between tests in order to utilize the SFA. Therapists may also consider longer treatment duration between administering the PEDI in order to verify that changes seen are due to the treatment effects rather than developmental maturation (Stiller et al., 2003). The functional skills of the SFA were found to be too advanced for children with CP (Wright et al., 2005), therefore therapists need to search for the proper assessment tools that will accurately evaluate the child. Therapists should consider the PEDI as a useful tool in both the initial assessment and in measuring progress of children with CP in a school based setting, especially in children younger in age (Harvey et al., 2008; Sakzewski et al., 2007). The PEDI or SFA does not cover all domains of the ICF, therefore the therapist may have to use a range of tools in order to get a complete picture of the child (Harvey et al., 2008; Sakzewski et al., 2007). Responsiveness of both the PEDI and SFA require further investigation as there currently are no absolute standards for interpreting effect size and standardized response mean values (Harvey et al., 2008; King et al., 1998). References Harvey, A., Robin, J., Morris, M., Graham, H., & Baker, R. (2008). A systematic review of measures of activity limitations for children with cerebral palsy. Developmental Medicine & Child Neurology, 50, 190-198. King, G., Tucker, M.A., Alambets, P., Gritzan, J., McDougall, J., Ogilvie, A., et al. (1998). The evaluation of functional, school-based therapy services for children with special needs: A feasibility study. Physical and Occupational Therapy in Pediatrics. 18, 1-27. Sakzewski, L., Boyd, R., & Ziviani, J. (2007). Clinimetric properties of participation measures for 5-13-year old children with cerebral palsy: A systematic review. Stiller, C., Marcoux, B. C., & Olson, R. E. (2003). The effect of conductive education, intensive therapy, and special education services on motor skills in children with cerebral palsy. Physical and Occupational Therapy in Pediatrics, 23, 31-50.
Critically Appraised Topic 15 Wright, F. Boschen, K., & Jutai, J. (2005). Exploring the comparative responsiveness of a core set of outcome measures in a school-based conductive education programme. Child: Care, Health, and Development, 31, 291-302. Search Log Date Database Search Terms September 28 th, 2009 Academic Search Complete Pediatric Evaluation of Disabilities Inventory, School Function Assessment, Cerebral Palsy, outcome measure October 1 st, 2009 Academic Search Complete, CINAHL Outcome Measures, PEDI, SFA, function, cerebral palsy, progress, change October 4 th, 2009 CINAHL, Medline OVID Assessment, cerebral palsy, function, school, PEDI, outcomes, SFA October 8 th, 2009 CINAHL Cerebral Palsy + School Function Assessment (IN-Instrument) + Pediatric Evaluation of Disabilities Inventory (IN-Instrument ) = 1 result (Wright, Boschen, & Jutai, 2005) October 12 th, 2009 Google Scholar, Cochrane Cerebral Palsy, SFA, PEDI, school Library October 15 th, 2009 Proquest Research Library School Function Assessment, Pediatric Evaluation of Disabilities Inventory, occupational therapy, cerebral palsy Medline PEDI + SFA + responsiveness, reliability, validity, outcomes
Critically Appraised Topic 16