Effectiveness of Occupational Therapy Interventions for Fine Motor Skills in School-Age Children

PURPOSE: The purpose of this study was to define commonly used occupational therapy interventions and determine their effectiveness in the treatment of fine motor delays in school-age children. Fine and visual motor delays are a common reason for referral to occupational therapy in school-age children (Case-Smith & O’Brien, 2015). Although effectiveness studies exist, there is ambiguity in defining occupational therapy interventions (Cramm & Egan, 2015). In addition, occupational therapy practitioners tend to use a variety of treatment approaches in addressing fine motor delays (Marr et al., 2003), making effectiveness studies difficult to perform and apply.

METHOD: This retrospective study used a mixed methods design to examine commonly used occupational therapy interventions in the treatment of fine motor difficulties of school-age children using a text mining approach. The study also examined the effectiveness of these interventions by comparing pretest and posttest scores on a standardized fine motor assessment, the Bruininks–Oseretsky Test of Motor Proficiency, Second Edition (BOT–2; Bruininks & Bruinunks, 2005). We used deidentified medical records from an outpatient occupational therapy clinic of children aged 5–15 at the time of initial assessment who received at least 10 visits of occupational therapy and demonstrated a delay in fine motor skills as identified by the BOT–2. A total of 157 therapy records were included in the sample.

The objective portion of the daily narrative note was examined using a text mining approach. The top 200 words and phrases were identified using NVivo (QSR International, Melbourne, Australia). Six occupational therapy practitioners, blinded to one another, categorized the top 200 words into intervention categories based on current published evidence for occupational therapy fine motor interventions. The second phase of the study examined records that had both a pretest and posttest score available. A total of 21 records from the original sample met this criterion. Pretest fine motor composite scores on the BOT–2 were compared to posttest scores using a Wilcoxon signed-rank test to compare means.

RESULTS: The most commonly used interventions for fine motor delay were the multisensory approach and the motor development approach. More than one intervention was used within a single treatment session for all the notes analyzed. Results for comparison of means from pretest and posttest scores revealed significance at the p < .05 level.

CONCLUSION: This study provides information on the effectiveness of occupational therapy interventions used in practice. The study is unique in that it not only demonstrated significance in standardized motor test scores but also identified and defined the occupational therapy interventions used in treatment of fine motor delays. The study provides evidence that occupational therapy practitioners use a variety of evidence-based interventions in the treatment of fine motor delay and that these interventions are effective in improving fine motor skills as evaluated by the BOT–2.

Overall, this study provides evidence of the effectiveness of occupational therapy in the treatment of fine motor delays. Although a single-site study, it is an important first step in determining the efficacy of interventions used in the daily practice of occupational therapy. Because the study comes from practice, what it lacks in internal validity it makes up for in external validity. Therefore, results are easily translated to direct practice of occupational therapy, and interventions performed in practice are validated as effective interventions.

References

Bruininks, R. H., & Bruininks, B. D. (2005). Bruininks–Oseretsky Test of Motor Proficiency: Second edition manual. Bloomington, MN: Pearson.

Case-Smith, J., & O’Brien, J. C. (2015). Occupational therapy for children and adolescents (7th ed.). St. Louis, MO: Mosby/Elsevier.

Cramm, H., & Egan, M. (2015). Practice patterns of school-based occupational therapists targeting handwriting: A knowledge-to-practice gap. Journal of Occupational Therapy, Schools, and Early Intervention, 8, 170–179. https://doi.org/10.1080/19411243.2015.104094

Marr, D., Cermak, S., Cohn, E. S., & Henderson, A. (2003). Fine motor activities in Head Start and kindergarten classrooms. American Journal of Occupational Therapy, 57, 550–557. https://doi.org/10.5014/ajot.57.5.550