Killeen Hazel, Anaby Dana R
College of Medicine, Nursing and Health Sciences, Áras Moyola, National University of Ireland, Galway, Galway, H91 TK33, Ireland.
McGill University, School of Physical and Occupation Therapy, 3630 Promenade Sir-William-Osler, Hosmer House Rm. 302, Montreal, Quebec, H3G 1Y5, Canada.
Contemp Clin Trials Commun. 2022 Jun 14;28:100942. doi: 10.1016/j.conctc.2022.100942. eCollection 2022 Aug.
Preterm birth continues to be a major public health challenge that has long term consequences on participation into adulthood. However, little is known about effective interventions to improve the participation of children born preterm.
This study gathered initial evidence on the usefulness of a goal-focused, environmental-based approach (Pathways and Resources for Engagement and Participation (PREP)) in improving the participation of children born preterm, and living in Ireland. Three school-age boys (6-7 years old) with a history of preterm birth participated in the 12-week PREP intervention. A 36-week single-subject AB design was employed and replicated across 3 different participation goals within each child and across 3 children. Activity performance was measured repeatedly, through parental involvement, using the Canadian Occupational Performance Measure (COPM), providing 9 individual outcome trajectories. Visual inspection and mixed-effects segmented regression were used.
Goals were selected from various participation domains and settings. Throughout the baseline phase, once goals were set, significant improvements in activity performance were observed for all participants (t = 14.06, p < 0.001). Further clinically significant improvements (2.58 on the COPM) for all 9 participation goals were seen in overall performance during the intervention phase. These changes remained at follow-up.
Findings support family-centered practice and draw attention to the power of goal setting in improving participation within this context. Challenges with single-subject design with this population were also highlighted. Results demonstrate the potential impact of parent involvement when using an environmental-based approach to improve the participation of this underserved population.
早产仍然是一项重大的公共卫生挑战，对成年后的参与能力会产生长期影响。然而，对于改善早产儿童参与能力的有效干预措施，我们知之甚少。
本研究收集了初步证据，以证明一种以目标为导向、基于环境的方法（参与和融入的途径与资源（PREP））在改善爱尔兰早产儿童参与能力方面的有效性。三名有早产史的学龄男孩（6-7岁）参与了为期12周的PREP干预。采用36周的单受试者AB设计，并在每个孩子的3个不同参与目标以及3个孩子之间进行重复。通过家长参与，使用加拿大职业表现测量量表（COPM）对活动表现进行反复测量，提供9条个体结果轨迹。采用视觉检查和混合效应分段回归分析。
目标从各种参与领域和环境中选取。在整个基线期，一旦设定目标，所有参与者的活动表现均有显著改善（t = 14.06，p < 0.001）。在干预阶段，所有9个参与目标的总体表现均有进一步具有临床意义的改善（COPM评分为2.58）。这些变化在随访时仍然存在。
研究结果支持以家庭为中心的实践，并提请注意在这种情况下目标设定对改善参与能力的作用。同时也强调了针对该人群的单受试者设计所面临的挑战。结果表明，采用基于环境的方法时，家长参与对改善这一服务不足人群的参与能力具有潜在影响。
