It has been postulated that occupational therapists when choosing an appropriate intervention method, use theoretical and practical knowledge (factors), based upon identifying client's goals to guide their clinical reasoning. The overall aim of this study was to identify factors and their relative contributions to the decisions occupational therapists make in the management of upper limb (UL) hypertonicity of children and adolescents with cerebral palsy (CP). Studies about general factors which influence occupational therapists' decision making have been addressed widely in the literature. However, studying influential factors in specific areas such as in the management of UL hypertonicity of clients with CP is limited. The information obtained from studies of decision making with other client groups can not readily be generalised as it has been demonstrated that specific task characteristics induce different types of cognitive thinking. For example, working with clients with orthopaedic problems may induce logical thinking, while practicing with clients with neurological problems promotes intuitive thinking. The management of UL hypertonicity of clients with CP was chosen as the focus of this study for two main reasons. First, the incidence of CP is high, manifesting in between 1.4 and 2.4 of 1000 live births. Second, people with CP are one of the major client groups referred to occupational therapy (OT) clinics as outpatients. The literature reviewed highlighted a lack of evidence about what therapists attend to when making decisions about the management of UL hypertonicity for clients with CP. To identify and evaluate these factors, the current research employed Social Judgment Theory (SJT). This methodology was selected because it had the capacity to access intuitive thought or tacit knowledge that is very difficult for experienced therapists to explain. Furthermore, SJT is most relevant in situations where there is no optimal decision. The current study proceeded in five phases. Phases One to Three were conducted to identify the most relevant factors to be used in the case vignettes necessary for the application of SJT. This process involved a review of the literature, consultation with clinical experts and then involved twelve experienced therapists in a process of identifying, refining, and ranking the relevant factors in order of priority. As a result of the processes in Phases One to Three 37 factors and their ranked importance were identified. The identified factors were reduced from 37 to 12 on the basis of ranking, cluster analysis and consultation with experts and appropriate scales identified for their measurement. These factors formed the basis of Phase Four of this study. In Phase Four 10 sample case vignettes as well as an administration manual were developed and four therapists were asked to make decisions for these cases. On the basis of therapists' comments, some changes were made in case vignettes and administration manual. Finally, 110 case vignettes were generated randomly (20 were repeated to examine consistency) for Phase Five of the study. In Phase Five, eighteen occupational therapists (16 females and 2 males), mean age of 36.7 years (SD = 7.6 years) who had worked with people with CP for a mean of 10.4 years (SD = 6.0 years) made decisions for the generated case vignettes. The findings of Phase Five revealed that therapists used three factors mainly in their decisions including severity of spasticity, wrist and finger posture, and client and family background. They had poor insight into their decision making (r = 0.36) and demonstrated only moderate consistency (r = 0.46). When therapists were divided into two groups based on their level of performance in respect to therapists' consistency and their ability to discriminate between cases, both groups used severity of spasticity and wrist and finger posture in their decision making. However, the higher performing group used limitation in passive range of movement and previous intervention in their decision making, and the low performing group used client and family background.
| Identifer | oai:union.ndltd.org:ADTP/254318 |
| Creators | Rassafiani, Mehdi |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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