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Fulltext A Systematic Review on Clinimetric Properties of Play Instruments for Occupational Therapy Practice

Romli MH, Wan Yunus F

Occup Ther Int, 2020;2020:2490519.
PMID: 32821250 DOI: 10.1155/2020/2490519

Play is considered the main occupation for children. Pediatric occupational therapists utilize play either for evaluation or intervention purpose. However, play is not properly measured by occupational therapists, and the use of play instrument is limited. This systematic review was aimed at identifying play instruments relevant to occupational therapy practice and its clinimetric properties. A systematic search was conducted on six databases (Academic Search Complete, CINAHL, MEDLINE, Psychology and Behavioral Science Collection, Scopus, and ASEAN Citation Index) in January 2020. The quality of the included studies was evaluated using Law and MacDermid's Appraisal for Clinical Measurement Research Reports, and psychometric properties of play instruments were evaluated using Terwee's checklist while the clinical utility is extracted from each instrument. Initial search identifies 1,098 articles, and only 30 articles were included in the final analysis, extracting 8 play instruments. These instruments were predominantly practiced in the Western culture, which consists of several psychometric evidences. The Revised Knox Preschool Play Scale is considered the most extensive and comprehensive play instrument for extrinsic aspect, whereas the Test of Playfulness + Test of Environmental Supportiveness Unifying Measure is a promising play instrument for intrinsic aspect on play, where both instruments utilize observation. My Child's Play is a potential questionnaire-based play instrument. However, the current development of play instruments in the occupational therapy field is immature and constantly evolving, and occupational therapists should exercise good clinical reasoning when selecting a play instrument to use in practice.
Investigating the Feasibility of Exergame on Sleep and Emotion Among University Students

Wan Yunus F, Tan XZ, Romli MH

Games Health J, 2020 Dec;9(6):415-424.
PMID: 33301386 DOI: 10.1089/g4h.2019.0077

Sleep deprivation and emotional problems such as stress, anxiety, and depression commonly occur in university students. Exercise is beneficial to ameliorate those problems; however, university students are not serious to take up physical activity. Commercially available exergame such as Xbox® 360 Kinect is one of the alternatives. This study aims at investigating the feasibility and the potential efficacy of using Xbox 360 Kinect game among health care undergraduate students. A pilot two-armed parallel randomized controlled trial was implemented. A total of 36 undergraduate students was recruited and randomly allocated into the intervention group (playing Xbox 360 Kinect) or the control group (continue with normal daily routine). The intervention group received 30 minutes of Xbox Kinect activity, three times per week for 6 weeks. Information on psychology (Depression, Anxiety, and Stress Scale-21) and sleep (Functional Outcome Sleep Questionnaire-30) status was collected at pre- and post-experiment. The researcher-developed feasibility questionnaire was given to the participants in the intervention group at post-experiment. Repeated-measures analysis of variance was used to investigate within-between group comparison, and significance value was set at p ≤ 0.05. The analysis found potential improvement on sleep (p = 0.039) and psychological health (p = 0.002-0.067). The intervention protocol is feasible and highly accepted by the participants. The required optimum amount of dosage, sample size, and the use of outcome measures are suggested from the findings. This pilot and feasibility study supports the use of Xbox 360 Kinect games in practice and to be implemented for future research.
Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice

Romli MH, Wan Yunus F, Mackenzie L

Aust Occup Ther J, 2019 08;66(4):428-445.
PMID: 30821362 DOI: 10.1111/1440-1630.12572

INTRODUCTION: Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.
METHODS: An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).
RESULTS: A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.
DISCUSSION: Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.
A Scoping Review of Intervention Implementation for Self-Care Skills among Children with Developmental Delay

Alias NA, Kadar M, Wan Yunus F, Cremin K

Malays J Med Sci, 2024 Aug;31(4):78-90.
PMID: 39247118 DOI: 10.21315/mjms2024.31.4.6

Difficulties with self-care skills are frequently observed in children with developmental delays. Given the scarcity of robust evidence backing self-care interventions for this group, this scoping review is designed to aggregate existing literature on the implementation of such interventions. Therefore, this scoping review aims to collate literature on the nature of self-care intervention implementation to increase understanding of the current practice and inform future research directions. This scoping review endeavoured to explore the body of literature concerning the existence of self-care interventions and their implementation strategies in children who have developmental delays. Relevant studies were identified by searching through the following databases: Web of Science (W0S), Scopus, ASEAN Citation Index (ACI), CINAHL EBSCO and PubMed. Six types of interventions using various approaches were identified. Occupational therapists mainly manage intervention providers with multidisciplinary co-facilitator and parents' involvement. Whilst session information varied, some evidence suggests that at least 30 min per session, minimum once per week up to twice per week, ranging from 10 to 23 sessions, may be sufficient. Intervention plans should be tailored to each child's unique needs, taking into account the variety of available interventions. Collaboration among occupational therapists, parents, educators and health professionals in home programmes enhances self-care intervention outcomes. These results are set to inform future research and practice, paving the way for enhanced support and improved outcomes for children with developmental delays.
Self-regulated learning versus activity-based intervention to reduce challenging behaviors and enhance school-related function for children with autism spectrum disorders: A randomized controlled trial

Wan Yunus F, Bissett M, Penkala S, Kadar M, Liu KPY

Res Dev Disabil, 2021 Jul;114:103986.
PMID: 33965876 DOI: 10.1016/j.ridd.2021.103986

BACKGROUND: Self-regulated learning is an active learning cognitive approach which helps individuals to be aware of their own ability and environment and control their own learning.
AIM: This study examined the therapeutic effects of self-regulated learning on reducing challenging behaviors and enhancing school-related function in children with autism spectrum disorders.
METHODS: Forty children (aged 6-12) were randomized into a 12-week Self-Regulated Learning or Activity-Based intervention control group. Three outcome measures, assessing the behavior and school-related function of the children in both groups, were administered before and after the intervention and at one-month follow-up. The results between the two groups were also compared.
RESULTS: The Self-Regulated Learning group showed significantly better results in reducing concerning behaviors and enhancing the school-related function than the activity-based group post-intervention and at one-month follow-up.
CONCLUSIONS: The Self-Regulated Learning intervention was more effective compared to the Activity-Based intervention with particular benefits for on-going learning and improvements.
A systematic review of occupational therapy intervention for handwriting skills in 4-6 year old children

Kadar M, Wan Yunus F, Tan E, Chai SC, Razaob Razab NA, Mohamat Kasim DH

Aust Occup Ther J, 2020 02;67(1):3-12.
PMID: 31799722 DOI: 10.1111/1440-1630.12626

INTRODUCTION: Handwriting skills play a significant role in all stages of an individual's life. Writing interventions should be considered at a younger age to ensure proper development of writing skills. Hence, the aims of this study is to evaluate the current evidence of occupational therapy interventions in handwriting skills for 4-6 year old children.
METHODS: Published literature was systematically searched according to PRISMA guidelines using specific key terms. Initial search identified 785 studies; however only seven met the inclusion criteria and were assessed for final review. Studies were methodologically appraised using the McMaster Critical Review Form-Quantitative Studies.
RESULTS: The review found no randomised control trial study design pertaining to the reviewed area. However, it can be seen that occupational therapy interventions for writing skills in 4-6 year old children managed to increase the targeted skills. The results were similar across samples with or without disabilities. An effective integration of occupational therapy interventions into educational curriculum was found to save both time and cost.
CONCLUSION: The long-term benefit from these interventions and the effects of these interventions on a broader spectrum of fine motor abilities need to be explored further with stronger research designs. However, the lack of studies adopting high level study designs, i.e., RCT designs means, results need to be approached with caution by occupational therapists when implementing handwriting skills intervention in practice.
Translation, Validation and Reliability Testing of Community Integration Questionnaire-Revised (CIQ-R) Malay Version: A Preliminary Study

Razaob NA, Tham SY, Mohd Rasdi HF, Wan Yunus F, Kadar M

Occup Ther Health Care, 2020 Jan;34(1):32-47.
PMID: 31920126 DOI: 10.1080/07380577.2020.1712632

The Community Integration Questionnaire-Revised (CIQ-R) is a self-report standardized instrument designed to assess an individual's degree of community integration. The aim of this study was to translate, validate and conduct a reliability test of the CIQ-R Malay version. The development involved the three phases of translation, content validation and cognitive interviewing, test-retest reliability and internal consistency of the CIQ-R Malay version. The Content Validity Index (CVI) showed perfect agreement between the panel experts. The Intra-class Correlation Coefficient (ICC) demonstrated a moderate to excellent level of test-retest agreement (ICC 0.72 to 0.93). The Total CIQ-R Malay version and Home Integration subscale showed good internal consistency, with values of Cronbach's alpha ranging from 0.81 to 0.90. The findings from the present study provided preliminary support for the psychometric properties of the CIQ-R Malay version as a valid and reliable instrument to be used in Malaysia.
Fulltext An innovation on clinical placement for occupational therapy mental health during the COVID-19: A mixed-methods feasibility study

Wan Yunus F, Romli MH, Mohd Rasdi HF, Harun D, Kadar M

Front Med (Lausanne), 2022;9:967511.
PMID: 36341254 DOI: 10.3389/fmed.2022.967511

The COVID-19 pandemic altered the health profession's education. Educational activities were shifted to online, and clinical placements were compromised in certain countries. A mixed-methods study included 17 undergraduates undergoing a mental health placement. The first 3 weeks of clinical placement applied online case-based learning in written and in video format. The last 2 weeks involved hybrid remote and physical onsite clinical placement. SPICES model utilizing various active learning activities, case studies and client attendance, facilitator engagement, discussion and feedback were implemented. A self-administered System Usability Scale (SUS), e-learning preference level, focus group discussion, and reflective writing was conducted at the end of each week and the students' final marks were compared with the past cohort who attended conventional physical clinical placement. Two-way mixed ANOVA indicates no significant interaction was found on the SUS (p = 0.062, η p 2 = 0.062) and preference scores (p = 0.285, η p 2 = 0.079) according to week and practical site. There was no significant difference in the final mark among the online and onsite placement of the current cohort (p = 0.350, d = 0.47). The current cohort reported better marks than the previous cohort who attended conventional placement (p = 0.006, d = 0.99). Qualitative findings show positive responses where online activities have minimal restriction on the learning process. This innovative approach is acceptable for substituting conventional clinical learning during this restricted situation.