Doctoral Case Study Capstone: Examining the Effect of High-Intensity Therapy

PURPOSE: The purpose of this study was to summarize the occupational therapy process and describe the outcomes of pediatric case studies conducted by doctor of occupational therapy (OTD) students at the University of Toledo for their experiential component. The case study capstone option facilitates the development of professional autonomy by emphasizing fidelity to a model of practice (MOP), innovativeness, and high-intensity intervention.

METHOD: We conducted an exploratory systematic review of the pediatric case study disseminations, combining all relevant information and summarizing the findings. Inclusion criteria were as follows: the case study was (1) completed by an OTD student at the University of Toledo, (2) the dissemination of an experiential component, and (3) conducted with a client under age 18.

We analyzed disseminations according the occupational therapy process of evaluation, intervention, and outcomes outlined in the Occupational Therapy Practice Framework: Domain and Process (American Occupational Therapy Association [AOTA], 2014b). We quantified the use of assessment methods and described the distribution of client goals according to performance skills, areas of occupation, and parent or teacher education. Three researchers established interrater agreement of 85% ± 4% for goal categorization. All OTD students selected a MOP to guide interventions and reported the interventions they provided. Fidelity to MOP was determined on the basis of whether or not there was evidence in the dissemination of core components of each model.

RESULTS: Since 2007, 29 case studies were conducted that met the inclusion criteria. The mean age of the clients in these case studies was 7.0 ± 4.8 yr; seven were girls and 23 were boys (one study examined twin boys). The most common diagnoses were autism spectrum disorder (n = 6) and developmental delay (n = 5). Results are reported below in accordance with the stages of the occupational therapy process.

The primary evaluation methods used were clinical observations, interviews, and standardized assessments; 38 different standardized assessments were administered. The most common assessments were Dunn’s (1999) Sensory Profile (n = 9) and Folio and Fewell’s (2000) Peabody Developmental Motor Scales (n = 7). Students set an average of 12.6 ± 5.5 goals for each client. Goals were sorted into 12 categories by targeted outcome, the most common categories being performance skills (n = 96) and occupations of daily living (n = 67).

Interventions were based on theoretical MOP. On average, models were used with 90% ± 0.01 fidelity. The average duration of intervention was 6.7 ± 3.1 wk and average number of sessions per week 2.1 ± 1.1. The specific intervention methods fell into 15 distinct categories, the most common being gross motor and caregiver education.

Regarding outcomes, of the standardized assessments administered during the evaluation process, 41.1% were readministered after intervention, and all yielded results suggesting that scores had at least modestly improved. Overall, 51.0% of goals were met, 15.3% of goals were not met, 16.7% of goals were partially met, and 17.0% of goals were not addressed in outcomes descriptions.

CONCLUSION: This study supports the efficacy of the case study dissemination at the University of Toledo as a method to enhance clinical reasoning. AOTA (2014a) asserted that graduates with a doctoral-level education are best prepared to demonstrate professional autonomy. With the capstone experience one of the key distinctions between the OTD and master of occupational therapy degrees, this study advocates for the value of the doctoral-level degree. Additionally, the high level of fidelity to theoretical models further establishes the importance of evidence-based practice.

References

American Occupational Therapy Association (2014a). AOTA Board of Directors position statement on entry-level degree for the occupational therapist. Retrieved from https://www.aota.org/AboutAOTA/Get-Involved/BOD/OTD-Statement.aspx

American Occupational Therapy Association. (2014b). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/ajot.2014.682006

Dunn, W. (1999). Sensory Profile. San Antonio, TX: Psychological Corporation.

Folio, M. R., & Fewell, R. R. (2000). Peabody Developmental Motor Scales: Examiner’s manual. Austin, TX: Pro-Ed.