Influence of a Brief Autism Education Intervention on Peer Engagement and Inclusion At Mainstream Day Camps: A Mixed-Methods Pilot Study.

To explore the benefits of a brief autism education intervention on peer engagement and inclusion of autistic children at day camps. A convergent, parallel, two-arm (intervention/no intervention), non-randomized, mixed-methods design was used. The individualized, peer-directed, 5-10 min intervention included four components: (1) diagnostic label, (2) description and purpose of unique behaviors, (3) favorite activities and interests, and (4) strategies to engage. A timed-interval behavior-coding system was used to evaluate engagement between each autistic camper and their peers based on videos taken at camp (days 1, 2, 5). Interviews with campers and camp staff explored why changes in targeted outcomes may have occurred. Percent intervals in which the autistic campers were jointly engaged with peers improved in the intervention group (n = 10) and did not change in the control group (n = 5). A large between group intervention effect occurred by day 5 (Z = - 1.942, η2 = 0.29). Interviews (5 autistic campers, 34 peers, 18 staff) done on the last day of camp in the intervention group garnered three themes: (1) Changed behavioral attribution, (2) Knowledge facilitates understanding and engagement, and (3) (Mis)perceptions of increased inclusion. A brief educational intervention that includes individualized explanatory information and strengths-based strategies might improve peers' understanding of and social engagement with autistic children in community programs such as camps.

A multi-center, pragmatic, effectiveness-implementation (hybrid I) cluster randomized controlled trial to evaluate a child-oriented goal-setting approach in paediatric rehabilitation (the ENGAGE approach): a study protocol.

BACKGROUND: Child-oriented goal-setting in pediatric rehabilitation may improve child motivation, engagement in therapy, child outcomes related to therapy, and service delivery efficiency. The primary objective of this trial is to determine the effectiveness of a principles-driven, child-focused approach to goal-setting, Enhancing Child Engagement in Goal-Setting (ENGAGE), on pediatric rehabilitation outcomes compared to usual practice. The three secondary objectives are to 1) compare costs and secondary outcomes of the ENGAGE approach to usual practice, 2) determine the influence of child, parent and therapist characteristics on child engagement in therapy and rehabilitation outcomes, and 3) identify barriers and facilitators to the implementation of ENGAGE. METHODS: This research protocol describes a pragmatic, multi-site, cluster, effectiveness-implementation (hybrid type 1 design) randomized controlled trial. Therapists (n = 12 clusters of two therapists) at participating sites (n = 6) will be randomized to 1) the ENGAGE intervention group, or 2) usual care (control) using a computer-generated, permuted-block randomization sequence with site as a stratification variable designed by a statistician (RR). Each therapist will recruit four children 5-12 years old with neurodevelopmental conditions (n = 96), who will receive ENGAGE or usual care, according to therapist group allocation. ENGAGE therapists will be trained to use a 'toolbox' of evidence-driven, theory-informed principles to optimize child and parent motivation, engagement in the goal-setting process, and performance feedback strategies. Outcomes include goal performance (primary outcome), engagement in therapy, functional abilities, participation, and parent and child quality of life. Qualitative interviews with children, parents, ENGAGE therapists, and managers will explore challenges to implementation and potential mitigation strategies. Mixed effects multiple linear regression models will be developed for each outcome to assess group differences adjusted for clustering. A cost-effectiveness analysis will combine cost and a measure of effectiveness into an incremental cost-effectiveness ratio. Qualitative data on implementation will be analyzed inductively (thematic analysis) and deductively using established implementation science frameworks. DISCUSSION: This study will evaluate the effects of collaborative goal-setting in pediatric rehabilitation and inform effective implementation of child-focused goal-setting practices. TRIAL REGISTRATION: NCT05017363 (registered August 23, 2021 on ClinicalTrials.gov).

Child, parent, and clinician experiences with a child-driven goal setting approach in paediatric rehabilitation.

PURPOSE: To explore child, parent, and clinician experiences with a child-driven approach to rehabilitation goal setting. METHODS: Nine children receiving inpatient and outpatient rehabilitation aged 5.0-12.3 years (x¯ = 8.3, SD = 2.3; 5 females) and their parents (n = 9) participated in a goal setting process intended to maximize child engagement with their physical or occupational therapist. Qualitative interviews were conducted with children (n = 7), their parents (n = 9), occupational therapists (n = 2), a nurse practitioner and a physician to explore their experience with the child-driven approach to goal setting. RESULTS: Three themes that reflect child, parent, and clinician experience with a child-driven approach to goal setting were identified: (1) children have voice and insight, (2) child identified goals are rewarding and motivating for children, and (3) we are a team: goal setting as a co-constructed process. CONCLUSIONS: Engagement in goal setting resulted in the identification of functional goals that were perceived as motivating for children. Children described feeling valued and heard. Parents and clinicians recognized they had previously underestimated the capacity of children to identify their own goals. Parents wanted input from therapists, particularly related to shaping their goals to focus on shorter-term outcomes. Relational autonomy, which emphasizes the social and relational aspects of decision-making, may be more useful than traditional, individualistic views of autonomy for conceptualizing clinician roles in collaborative goal setting.IMPLICATIONS FOR REHABILITATIONChildren are often not optimally involved in setting their own rehabilitation goals.In this qualitative study, we report that children, parents, and clinicians recognized the value of optimizing child engagement in goal setting including children feeling heard, valued and more motivated to participate in therapy.Parents expressed a need for a collaborative approach to goal setting that respects child, parent, and clinician input.Relational autonomy may be a useful framework for reframing the role of clinicians in collaborative goal setting processes.

What Motivates Engagement in Work and Other Valued Social Roles Despite Persistent Back Pain?

Purpose The prognosis of persistent back pain is variable, with some individuals adjusting poorly and others continuing to actively engage in work and other valued social roles. The aim of this study was to better understand why some individuals, despite persistent back pain, continue to actively engage in work and other valued social roles. Methods Individuals with persistent back pain, who were participating in their regular duties as a full-time employee, homemaker, student or any combination of these, were recruited from a multidisciplinary pain centre and orthopedic physical therapy clinics in Alberta, Canada. A qualitative study was conducted using semi-structured interviews of 15 participants and a thematic analysis to analyze the data. Results There were two motivators identified for participating in the work role: (1) participation formed part of the participant's self-schema (a cognitive framework that includes one's beliefs about oneself) and (2) participation made it possible to achieve a valued outcome. Conclusions Further understanding of important motivators for maintaining engagement in work and other valued social roles despite persistent back pain can help inform the development of more successful disability and pain management programs.

A review of goal setting theories relevant to goal setting in paediatric rehabilitation.

BACKGROUND: Goal setting in paediatric rehabilitation is influenced by shifting parent, sibling, caregiver, and child roles over time and evolving child developmental capacity for participation in the process. A theoretical and evidence-informed approach to goal setting, specific to paediatrics, would provide a framework for goal setting in practice and facilitate systematic evaluation of the effects of goal-setting processes on child and family outcomes. OBJECTIVE: To provide an overview of relevant goal-setting theories and their implications for paediatric rehabilitation. METHODS: Prevalent theories were identified from relevant rehabilitation, motivation, behaviour change, and goal-setting literature. Implications for goal setting in paediatrics are summarized according to goal-setting and action-planning phases: (1) preparation, (2) formulation of goals, (3) formulation of action plan, (4) coping planning, and (5) follow up. RESULTS: Social cognitive theory, self-determination theory, Health Action Process Approach, Mastery Motivation, and goal-setting theory are reviewed. Examples of implications for goal setting include, sharing information with families about the purpose of goal setting; identifying goals that are specific, proximal, challenging, and important to the child; and addressing self-efficacy. CONCLUSION: The theories reviewed have clear implications for paediatric rehabilitation research and practice. They address considerations not typically discussed in adult rehabilitation such as observing children to obtain information about meaningful goals when they are unable to communicate them directly and the importance of establishing flexible processes that will accommodate changing family roles over time. Research is needed to evaluate the effects of goal-setting processes and strategies on outcomes in paediatric rehabilitation.

Measuring participation in patients with chronic back pain-the 5-Item Pain Disability Index.

BACKGROUND CONTEXT: Of the three broad outcome domains of body functions and structures, activities, and participation (eg, engaging in valued social roles) outlined in the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF), it has been argued that participation is the most important to individuals, particularly those with chronic health problems. Yet, participation is not commonly measured in back pain research. PURPOSE: The aim of this study was to investigate the construct validity of a modified 5-Item Pain Disability Index (PDI) score as a measure of participation in people with chronic back pain. STUDY DESIGN: A validation study was conducted using cross-sectional data. PATIENT SAMPLE: Participants with chronic back pain were recruited from a multidisciplinary pain center in Alberta, Canada. OUTCOME MEASURES: The outcome measure of interest is the 5-Item PDI. METHODS: Each study participant was given a questionnaire package containing measures of participation, resilience, anxiety and depression, pain intensity, and pain-related disability, in addition to the PDI. The first five items of the PDI deal with social roles involving family responsibilities, recreation, social activities with friends, work, and sexual behavior, and comprised the 5-Item PDI seeking to measure participation. The last two items of the PDI deal with self-care and life support functions and were excluded. Construct validity of the 5-Item PDI as a measure of participation was examined using Pearson correlations or point-biserial correlations to test each hypothesized association. RESULTS: Participants were 70 people with chronic back pain and a mean age of 48.1 years. Forty-four (62.9%) were women. As hypothesized, the 5-Item PDI was associated with all measures of participation, including the Participation Assessment with Recombined Tools-Objective (r=-0.61), Late-Life Function and Disability Instrument: Disability Component (frequency: r=-0.66; limitation: r=-0.65), Work and Social Adjustment Scale (r=0.85), a global perceived participation scale (r=0.54), employment status (r=-0.30), and the Usual Activity domain of the 15D (r=0.50). The expected correlations observed indicating a moderate or strong association provided supporting evidence for the construct validity of the 5-Item PDI as a measure of participation. The Oswestry Disability Index and the 5-Item PDI were also strongly correlated (r=0.70). The 5-Item PDI was associated to a lesser degree with depressive symptoms and resilience, as measured by the Hospital Anxiety and Depression Scale (HADS) (r=0.25) and the Connor-Davidson Resilience Scale (r=-0.28), as would be expected. No statistically significant association was found between the 5-Item PDI and the HADS Anxiety score. CONCLUSIONS: It is important that outcome measures of participation are included in back pain research to gauge the effects of painful spinal conditions and interventions on maintaining valued social roles. A simple, concise measure would be very useful for this purpose in clinical and research settings. The results of this study support the construct validity of the 5-Item PDI as a brief measure of participation in people with chronic back pain. These findings are likely most applicable to those with chronic back pain attending pain clinics and other tertiary centers for care.

The relation of social support and depression in patients with chronic low back pain.

PURPOSE: Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes. Social support is a modifiable factor that may influence depressive symptoms in people with LBP and, if so, could be a consideration in LBP management when depression is an issue. The aim of this study was to examine social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP. METHOD: Patients with LBP (n = 483), recruited from four imaging centers in Canada, completed an initial survey following imaging and a follow-up survey one year later, including the Medical Outcomes Study (MOS) Social Support Survey and the Center for Epidemiologic Studies Depression Scale. Multivariable regression analyses were used to examine the relationship between social support and depression. RESULTS: More social support (overall functional social support) at baseline was associated with recovery from depression (OR = 0.24; 95% CI 0.10, 0.55) and less depressive symptoms (ß = 1.68; 95% CI = 0.36, 3.00) at one-year follow-up. In addition, associations were found between specific aspects (subscales) of social support and the two depression outcomes. CONCLUSIONS: Functional social support as a prognostic factor for depression and possible target of LBP management warrants further investigation. Implications for Rehabilitation Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes. This study provides evidence for social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP problems. Management of pain conditions may be enhanced by a better understanding of modifiable risk factors for depression, such as social support.

A Pilot Study Evaluating the Effectiveness of Platelet-Rich Plasma Therapy for Treating Degenerative Tendinopathies: A Randomized Control Trial with Synchronous Observational Cohort.

OBJECTIVE: This pilot study aimed to inform future research evaluating the effectiveness of Platelet Rich Plasma (PRP) injection for tendinopathy. DESIGN: Randomized control trial (RCT) and synchronous observational cohort studies. For the RCT, consecutive consenting patients treated at an academic sports medicine clinic were randomly assigned to either a PRP or placebo control group. SETTING: The Glen Sather Sport Medicine Clinic, Edmonton, Canada. PATIENTS: The RCT included 9 participants with rotator cuff tendinopathy. The cohort study included 178 participants with a variety of tendinopathies. INTERVENTIONS: Patients receiving PRP were injected with 4 ml of platelets into the supraspinatus and/or infraspinatus, while patients in the placebo group were injected with 4 ml of saline. All participants undertook a 3-month standardized, home-based, daily exercise program. MAIN OUTCOME MEASURES: Participants in the RCT were re-evaluated 3, and 6 months post-injection. Change scores before and after injection on pain, disability and MRI-documented pathology outcomes were compared. In the cohort study, pain and disability were measured at 1, 2 and 3 months post-injection. RESULTS: For the RCT, 7 participants received PRP and 2 received placebo injections. Patients receiving PRP reported clinically important improvements in pain (>1.5/10 on VAS), disability (>15 point DASH change), and tendon pathology while those receiving placebo injections did not. In the observational cohort, statistically and clinically significant improvements in pain and disability were observed. CONCLUSION: This pilot study provides information for planning future studies of PRP effectiveness. Preliminary results indicate intratendinous, ultrasound-guided PRP injection may lead to improvements in pain, function, and MRI-documented tendon pathology. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN68341698.

Depression as a prognostic factor of lumbar spinal stenosis: a systematic review.

BACKGROUND CONTEXT: The clinical syndrome of lumbar spinal stenosis (LSS) is a commonly diagnosed lumbar condition associated with pain and disability. Psychological factors, including depression, also affect these and other health-related outcomes. Yet, the prognostic value of depression specifically in the context of LSS is unclear. PURPOSE: The aim of this systematic review was to examine the literature on depression as a prognostic factor of outcomes in patients with LSS. STUDY DESIGN: Best-evidence synthesis. PATIENT SAMPLE: Patients receiving the diagnosis of LSS and surgery. METHODS: A best-evidence synthesis was conducted, including articles published between 1980 and May 2012. Each article meeting inclusion criteria, including a longitudinal design, was critically appraised on its methodological quality by two authors independently, who then met to reach consensus. Only studies deemed scientifically admissible were included in the review. RESULTS: Among the 20 articles that met the inclusion criteria, 13 were judged scientifically admissible. The evidence supports an association between preoperative depression and postoperative LSS-related symptom severity (a combination of pain, numbness, weakness and balance issues) and disability. The effect size for these associations was variable, ranging from no effect to a moderate effect. For example, an increase of 5 points on a 63-point depression scale doubled the odds of being below the median in LSS-related symptom severity at follow-up. Findings on the association between preoperative depression and postoperative pain alone and walking capacity were more variable. CONCLUSIONS: Findings support that preoperative depression is likely a prognostic factor for postoperative LSS-related symptom severity and disability at various follow-up points. The prognostic value of depression on the outcomes of pain and walking capacity is less clear. Nonetheless, depression should be considered in the clinical care of this population.