An Exploration of the Implementation of the PedsQL in Pediatric Outpatient Rehabilitation

PURPOSE: Children with special needs attend occupational (OT), physical (PT), and/or speech (ST) therapy to improve their ability to participate in meaningful activities. During the therapeutic process, children participate in standardized testing to measure performance. Therapists and parents often observe or report improvements in a child’s ability, however, these assessments do not always demonstrate measurable change in function as a child progresses through therapy. Additionally, while standardized tests are necessary, participation and quality of life are often not targeted formally during the therapy process. This study aimed to probe the feasibility and implementation of the Pediatric Quality of Life Inventory (PedsQL) as a centralized measure to support standardized assessments within pediatric rehabilitation. This study examined the use of a tool that could be adopted by the therapeutic team (OT, PT, and ST) to reduce redundancy and potentially streamline the process by including an assessment that can provide vital information regarding a child’s true performance changes across all disciplines involved in the child’s care.

DESIGN: This was an exploratory study to probe the feasibility and impact of the PedsQL in the therapy process. The PedsQL was piloted by a rehabilitation network in Northeast Florida, therefore therapists were recruited from these locations. A brief survey was administered to determine feasibility, acceptability, and barriers to implementation. After the survey, clinicians were recruited to be interviewed to provide additional insight.

METHOD: A mixed-methods study was conducted over four months that used quantitative surveying and qualitative interview methods. Survey questions were guided by the Usage Rating Profile-Assessment ([URP-A], Chafouleas, et al., 2012) to probe therapists’ perceptions of the feasibility of the PedsQL as an outcome measure. Due to the probative nature of this research, semi-structured interviews were also conducted to attempt to gain additional perceptions of the PedsQL across the therapeutic team. Quantitative data were analyzed non-parametrically using the Mann-Whitney U test to explore differences across OT, PT, and ST in six areas of the URP-A: system support, feasibility, understanding, collaboration, system climate, and acceptability. Qualitative data were analyzed descriptively.

RESULTS: Twenty-four therapists were recruited from three outpatient locations. Fourteen OTs, PTs, and STs agreed to participate and completed the URP-A. Three clinicians further agreed to interviews to provide additional information regarding the PedsQL. All three disciplines reported agreement with understanding of the PedsQL and the need for parent collaboration. Statistically significant differences were noted between OT and PT when compared to ST in the areas of acceptability (p <.01), additional support needed (p<.05), feasibility (p<.01), and clinic climate (p<.01). Following the survey, three interviews were conducted to probe for further perceptions regarding inclusion of the PedsQL within the therapeutic process. During the interviews, all therapists expressed a need for additional time to implement the PedsQL however also noted the need for inclusion of a quality of life measure.

CONCLUSION: OT and PT demonstrated overall support for inclusion of the PedsQL while ST reported that the administration of was burdensome.

IMPACT STATEMENT: This study probed the importance of inclusion of a centralized quality of life measure across disciplines in pediatric rehabilitation, however revealed the need for further exploration as to why this tool was not a measure that was accepted across the therapy team.

References

Chafouleas, S. M., Miller, F. G., Briesch, A. M., Neugebauer, S. R., & Riley-Tillman, T. C. (2012). Usage Rating Profile – Assessment. Storrs, CT: University of Connecticut.

Varni, J.W., Seid, M., & Rode, C.A. (1999). The PedsQL™: Measurement model for the pediatric quality of life inventory™. Medical Care, 37, 126-139.

Bennett, L. E., Jewell, V. D., Scheirton, L., McCarthy, M., & Muir, B. C. (2019). Productivity standards and the impact on quality of care: A national survey of inpatient rehabilitation professionals. The Open Journal of Occupational Therapy, 7(4), 1–11. https://doi.org/10.15453/2168-6408.1598