JMIR Publications

ABSTRACT

Background:

Determining the appropriate dosage of pediatric occupational therapy, physical therapy, and speech-language pathology services is important for supporting families of children with disabilities. Documentation of therapy dosage is lacking in pediatric studies, and documentation of the ways caregivers do or do not apply strategies between formal therapy sessions is even less common. Ecological momentary assessment (EMA) is one way to document caregiver practice between therapy sessions and can be a tool for determining factors that influence this practice.

Objective:

The objective of our study was to pilot the use of EMA to measure caregiver practice between therapy sessions, compare EMA data with caregiver recall, and identify factors significantly associated with changes in caregiver practice.

Methods:

Patients were recruited from pediatric therapy programs. They completed an initial survey including demographic information and the amount of practice they expected to complete. Following this, they completed 30 days of EMA, logging the practice they completed with their child. After 30 days, they participated in a follow-up conversation to provide more information about their practice experiences.

Results:

A total of 5 caregivers participated, for a total of 150 days of EMA. Participants logged 55% (82/150) days of practice, identifying in follow-up conversations that they often did not log on days practice did not occur. Participants reported an average of 2.65 practice bouts per day, with an average of 6.48 minutes per bout, for a total average of 23.19 minutes of practice per day. Factors significantly associated with increased caregiver practice were having at least 4 therapy sessions per month (compared to a referent group of 2 sessions per month) (β=17.52, p<.0001), therapy strategies fitting into daily routines (β=11.02, p<.0001), therapy that was fun for the child (β=10.77, p=.0009), and remembering support received from the therapist (β=6.66, p<.0087).

Conclusions:

As shown by the EMA data, caregivers practice most when their therapy supports occur frequently, incorporate daily routines, are fun for the child, and are memorable for the caregiver. Caregivers tend to practice multiple times daily for less than 10 minutes at a time, which further emphasizes the importance of teaching strategies that can be accomplished quickly during existing routines. Our sample size was small, but this pilot study demonstrates the potential of EMA to document caregiver practice between sessions and provides a basis for future studies with larger sample sizes. Clinical Trial: n/a