Relationship of school-based physical therapy to outcomes for children with disabilities in the United States

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(firm versus compliant foam) conditions during the game were varied within each session. Children were asked to report their impressions of playing the game. Mixed repeated measure ANOVAs were used to compare scores pre to post and between STABEL and control groups. Results: Children in the STABEL group completed a mean of 205 minutes (SD = 32.5) of intervention. The majority of the STABEL group (11/13) reported that the intervention was very fun. There were significant interactions as follows: compared to the control group, children in the STABEL group showed increases in their MABC-2 Balance Composite scale scores (P = 0.04) and MABC-2 Total Motor Scores (P = 0.01) after STABEL training. Children in the STABEL group also showed better post-test P-CTSIB2 total scores (P = 0.07). However, there was no difference in DGI scores either between groups or pre-post sessions (P = 0.30). Conclusion(s): Children who received the STABEL found it acceptable and fun and demonstrated greater improvement in balance and motor skill than a control group. The DGI may not be sensitive enough to show change in these children. Implications: The STABEL intervention may be an appropriate intervention that can be employed in rural areas to improve motor ability. Further research within larger sample sizes of children with balance disorders is warranted. Keywords: Balance training; Virtual reality; Gaming Funding acknowledgements: The National Institute on Alcohol Abuse and Alcoholism, award number R21AA019579, funded this project. Ethics approval: The study was approved by the University of Washington Institutional Review Board for use of humans within research. http://dx.doi.org/10.1016/j.physio.2015.03.1828 Research Report Poster Presentation Number: RR-PO-17-10-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 RELATIONSHIP OF SCHOOL-BASED PHYSICAL THERAPY TO OUTCOMES FOR CHILDREN WITH DISABILITIES IN THE UNITED STATES S.W. McCoy 1 , S. Effgen 2 , L. Chiarello 3 , L. Jeffries 4 , H. Bush 2 1 University

of Washington, Rehabilitation Medicine, Seattle, USA; 2 University of Kentucky, Lexington, USA; 3 Drexel University, Philadelphia, USA; 4 University of Oklahoma Health Sciences Center, Oklahoma City, USA Background: Children receive physical therapy (PT) services within schools to support their educational programs in

the United States (US) and other countries. Minimal evidence supports school-based PT. Purpose: We examined relationships of school-based PT to individual change using Goal Attainment Scaling (GAS) and standardized change using the School Function Assessment (SFA). We hypothesized that service amount and type, activity focus, and interventions used would predict GAS and SFA outcomes. Knowing relationships between student outcomes and PT should influence practice, research, and professional development worldwide. Methods: Our prospective, multi-site observational study, PT related Child Outcomes in the Schools (PT COUNTS), of school-based PT was completed across 4 US regions, involving 111 physical therapists and a random sample of 296 of their 5 to 12 year-old students who received PT at least monthly. Diagnoses varied with 39% at Gross Motor Function Classification System (GMFCS) Level I, 39% Level II/III and 22% Level IV/V. Physical therapists tested students early in the 2012-2013 school year and again at year-end. After pre-testing, PT services were reported weekly for 6 months using the School-Physical Therapy Interventions for Pediatrics system including data on amount of PT, activities and interventions used, types of service delivery, and amount/type of service on behalf of the students (services without students present). Researchers categorized GAS goals (posture/mobility, self-care, recreation/fitness, academics) and physical therapists identified their primary goal. Primary goal GAS scores were dichotomized into scores ≥1 (n = 119) and < 1 (n = 105). SFA scores for the Participation, Travel, Maintaining/Changing Positions, Recreational Movement, and Manipulation with Movement sections were categorized into standardized change scores of <−5 (n = 9–14), −5 to 5 (n = 151–157), and >5 (n = 123–134). Group comparisons and logistic regression were used to examine relationships of services to outcomes. Results: Primary GAS goals were predominantly posture/mobility (58%). Comparison of GAS groups for the primary goals showed significant differences for recreation activities (p = 0.04) and service minutes on behalf of the student (p = 0.04). Regression analyses showed age, severity, and minutes on behalf of the student predicted higher GAS scores. Students who were younger and had lower GMFCS ratings showed greater change on SFA. Regression analysis revealed significant (p < 0.05) predictors of SFA as: more use of mobility assistance, motor learning, aerobic conditioning, ongoing assessment, balance, strengthening, mobility interventions such as hall/stairs/door training interventions, and higher engagement by students within therapy sessions. Conclusion(s): Age and functional level were related to both GAS and SFA outcomes. Students who improved the most on GAS received more recreation activity and services on behalf of the student (consultation, documentation). Students who improved most on the SFA had more time spent on active practice that facilitated mobility in the school environment and higher student engagement in therapy sessions.

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Implications: Some aspects of school-based physical therapy services are associated with improvement in student outcomes. Physical therapists should consider the time spent on behalf of students, a focus on active mobility practice in school environments utilizing motor learning intervention, a focus on decreasing balance, strength and endurance impairments, and making therapy sessions engaging. Keywords: School practice; Pediatrics; Interventions Funding acknowledgements: This project was funded by the United States Department of Education, Institute of Education Sciences, R324A110204. Ethics approval: The study was approved by the University of Washington Institutional Review Board and boards at all other involved institutions. http://dx.doi.org/10.1016/j.physio.2015.03.1829 Special Interest Report Platform Presentation Number: SI-PL-2548 Monday 4 May 2015 08:30 Room 334–335 Q-METHODOLOGY AS A VALUABLE RESEARCH APPROACH IN PHYSIOTHERAPY: AN ILLUSTRATION USING A STUDY OF SELF-MANAGEMENT IN CHRONIC LOW BACK PAIN C. McCrum 1,2 , P. Stenner 3 , E. Defever 1 , V. Cross 1 , J. McGowan 4 , A. Moore 1 1 University

of Brighton, Centre for Health Research, Eastbourne, United Kingdom; 2 East Sussex Healthcare NHS Trust, Physiotherapy, Eastbourne, United Kingdom; 3 The Open University, Faculty of Social Sciences, Milton Keynes, United Kingdom; 4 East Sussex Healthcare NHS Trust, Pain Management, Eastbourne, United Kingdom Background: The exploration of opinions, attitudes, experiences and other perspectives of interest are important areas of research in physiotherapy to enhance understandings of many issues. These interests are often explored using approaches such as survey, questionnaire and Delphi studies, or qualitative strategies involving interview, focus group or diary methods, and increasingly through mixed method approaches. Q-Methodology offers a valuable research alternative being increasingly applied in health fields to explore issues of a subjective nature. Q-Methodology involves entwined qualitative and quantitative approaches, combining the strengths and insights each brings to enhance understanding of issues of a subjective nature. Purpose: An overview of Q-Methodology is described and the processes involved are outlined. The approach is illustrated using a recent UK study applying this methodology to explore patient and healthcare provider perspectives on self-management in chronic low back pain. The focus

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of Q-Methodology is on identifying the range and nature of perspectives held on a topic within a population of interest. It uses factor analysis or principle components analysis to identify a number of shared viewpoints/perspectives. These viewpoints can then be examined in qualitative detail and compared systematically with the other viewpoints for similarities and differences. The findings can then be considered and contrasted with existing theory, literature, research and policy, or matters relating to clinical practice, service delivery or education. Methods: Q-Methodology involves four stages: 1) Q-set development: A set of statements of opinion (40–60 statements) are developed that encompass the full range of views on the topic through a review of relevant literature, policy, media, interviews, focus groups, internet/social media sources 2) Q-sorting: Participants rank-order the Q-set statements across an agree/disagree continuum, offering comment on statements and ranking decisions 3) Q-Analysis: By-person factor analysis of Q-sorts to identify groupings of similarly ranked/arranged Q sorts, each of which correlates significantly with a given factor. Q-factor Interpretation: Factors and the statement rankings reflected are examined and contrasted for commonalities and differences, with interpretation supported by participants’ comments and biographical/characteristics data. Results: Using Q-Methodology, four different and distinct perspectives on self-management in chronic low back pain were identified across patients (n = 60) and health providers (n = 60), accounting for 117/120 participants. The approach enabled perspectives to be compared and contrasted for similarities, differences and important tensions that have significant implications for current policy, service delivery, clinical practice and education. Learning of the differing views within and across stakeholders supports improvements in current approaches and tools to facilitate and sustain selfmanagement. Conclusion(s): Q-Methodology offers a robust, systematic and insightful research approach that enables in-depth study of topics of a subjective nature. It draws on the qualities of both quantitative and qualitative strategies, allowing independent expression of personal views and for their comparison across a population using statistical analysis to capture the range, diversity and commonalities. Implications: As physiotherapy continues to advance its theory, evidence base, practice knowledge and healthcare endeavours, the expansion of potential research strategies provides opportunities to enhance this process. Q-Methodology offers a valuable addition to our research repertoire for developing insightful, considered physiotherapy knowledge and research capability. Keywords: Quantitative research; Qualitative research; Mixed Methods research