Jane Case-Smith

Play Preferences of Typically Developing Children and Children with Developmental Delays between Ages 3 and 7 Years

This cross-sectional survey research investigated play preferences of children with and without developmental delays who were between 3 and 7 years old. Parents completed questionnaires regarding their childs play activity and context preferences. Valid results were obtained for 166 children, 83 of whom had developmental delays. Preference ratings were compared by gender, age, and delay status. Play preference did not differ by gender. Rough-and-tumble play and computer/video game play increased with age, whereas object exploration decreased. Children with developmental delays had higher preferences for rough-and-tumble play and object exploration and lower preferences for drawing and coloring, construction, and doll and action figurine play than typically developing children. This comparison of childrens play preferences across ages, gender, and developmental status enhances our understanding of how these variables influence childrens play.

Development and Testing of Interventions in Occupational Therapy: Toward a New Generation of Research in Occupational Therapy:

Development, refinement, and testing of occupational therapy interventions require a systematic approach. The authors explain the four phases for clinical trials used in pharmaceutical research and apply them to the development and testing of occupational therapy interventions. The challenges faced by occupational therapy researchers in designing clinical trials include difficulties in specifying the intervention, blinding subjects, therapists, and evaluators, and identifying objective but client-centered measures of primary outcomes. Examples are provided of researchers who have developed and tested occupational therapy interventions in phases.

Comparison of In-Hand Manipulation Skills in Children with and without Fine Motor Delays

In-hand manipulation was investigated in a sample of 15 children with fine motor developmental delays and a comparison sample of typical children. The children were 4 to 6 years old, the age range in which in-hand manipulation skills are refined (Exner, 1990). Time scores were computed for two tasks that required in-hand manipulation using small pegs: complex rotation and translation with stabilization. The number of times pegs were dropped or stabilized on external surfaces was computed, and continuous rotation of the peg among the fingertips was scored by counting the number of rotations prior to dropping. The children with developmental delays were significantly slower than the typical children in time required to complete the first two tasks and in number of drops and times they stabilized the pegs. The results of this pilot study indicate that children with fine motor delays appear to be slower and less efficient performing in-hand manipulation skills. Children with less efficient in-hand manipulation skills may require assistance performing daily living skills, and occupational therapy focused on the development of in-hand manipulation skills may increase their daily living skill independence.

Reliability and Validity of the Posture and Fine Motor Assessment of Infants

The Posture and Fine Motor Assessment of Infants (PFMAI) (Case-Smith, 1987) is a newly developed instrument for assessing the quality of motor function in infants. The test measures components of posture and fine motor control as they first develop. The purpose of this study was to support the tests reliability and validity. Interrater reliability, analyzed with intraclass correlation coefficients (ICCs), was high (.989 for total scores). Test-retest reliability, measured by ICCs, was .853 and .913 for the two test sections. The PFMAI demonstrated concurrent validity with the Peabody Developmental Motor Scales, Revised (Folio & Fewell, 1983) (correlations were .673 and .829 for the individual sections). Scores on the PFMAI were highly correlated with the infants ages (.892 to .941); this finding provided one indication of construct validity.

Translating Research Findings to Clinical Practice

In this issue of OTJR: Occupation, Participation and Health, we continue our series on emerging research methods helpful to building occupational therapy research programs. The first report in this series described four phases in developing and validating interventions (Johnston & Case-Smith, 2009). This first report encouraged researchers to develop and test interventions by conceptualizing their research programs as a series of phases that logically build on each other. The article concluded that to develop evidence-based interventions, researchers must systematically complete series of related studies of increasing rigor, in which each study logically extends previous results. The article by Graham, Reistetter, Mallinson, and Ottenbacher in this issue introduces and explains a tool for interpreting the clinical significance of findings from an intervention trial. Because a “p value” does not provide an indication of how effective an intervention is (or how much the control and experimental groups differ), other methods, such as effect sizes, have been developed. Effect sizes define the magnitude of difference between the groups and are computed using post-test mean scores and standard deviations for the treatment and comparison groups. Graham et al. extend this concept by describing methods for interpreting the clinical significance of findings when a practitioner is interested in a specific amount of clinical improvement (i.e., a specific score difference) or a specific level of function (i.e., a particular score value) following intervention. Confidence levels can be computed using the 95% confidence intervals for the control and experimental groups. A confidence level is expressed as a probability that the treatment group met or exceeded a specific outcome. Therefore, a confidence level of .60 would suggest that there is a 60% probability that the treatment group met or exceeded a particular outcome value (i.e., achieved a meaningful change). Graham et al. enhance our understanding of what is meant by “clinical significance.” When interpreting a set of statistically significant findings, we often guess when deciding whether the level of change in the treatment group was of clinical significance. The proposed method considers not only the difference in control and treatment group means, but also the relative difference based on the confidence intervals for those group means and a predetermined target. This article advocates for reporting measures of variability (e.g., standard deviations, standard error of measure, or confidence intervals). It also encourages practitioners to identify intervention targets that define successful outcomes and suggests that practitioners define meaningful clinical change as score values on particular functional measures. By defining these targets and analyzing how findings from trials meet these targets, healthcare professionals can predict if and how an intervention will result in positive outcomes and estimate the percentage of clients who will achieve a positive outcome. Therefore, intervention targets, as defined by changes in scale scores or levels on a particular test, and confidence levels can be helpful in identifying successful treatment outcomes and in making decisions about intervention frequency, intensity, duration, and discharge. By reporting effect sizes and confidence levels, occupational therapists can translate statistically significant findings into specific levels of benefit achieved by a particular intervention and probabilities that an intervention will result in a meaningful change. These methods for translating our research findings will enable occupational therapists to make evidencebased decisions and to use science-driven practices. We are pleased to present this article and express our gratitude to Graham, Reistetter, Mallinson, and Ottenbacher for sharing their insight on how to apply research findings to evidence-based practices.