A randomised control trial comparing occupational therapy interventions that aim to improve developmental outcomes for HIV9positive children (aged 6 months - 5 years) on ART

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dc.contributor.advisorGretschel, Pamen_ZA
dc.contributor.advisorRamugondo, Elelwanien_ZA
dc.contributor.authorMeissner, Robyn Jessen_ZA
dc.date.accessioned2017-01-23T07:40:16Z
dc.date.available2017-01-23T07:40:16Z
dc.date.issued2016en_ZA
dc.description.abstractBackground: Antiretroviral treatment (ART) has reduced the mortality rate of HIV-positive children significantly, and is known to prevent the development and progression of HIV encephalopathy. However, even with ART, perinatal HIV infection places HIV-infected children at increased risk for encephalopathy and associated developmental delays. Research is lacking in the extent of developmental delay on children established on ART, along with evidence-based occupational therapy interventions to treat these developmental delays. A play-informed, caregiver-implemented, home-based group occupational therapy intervention (PICIHBI) presents one possible service delivery option to be explored. Aim: To determine whether children attending an experimental group (PICIHBI) versus children attending a control group (conventional, individual occupational therapy intervention) would present similar results in their total developmental quotient – on the Griffiths Mental Developmental Scales (GMDS) and Paediatric Functional Independence Measure (WeeFIM). Methods: A randomised control trial, which was pragmatic in nature and single-blinded, was used. The research population was all HIV-positive children, pre-formal school-going aged (6 months – 5 years), on ART attending the Groote Schuur Hospital paediatric HIV clinic at the time of the study. Caregiver and child dyads were randomly assigned to either the experimental or control group, and attended a monthly occupational therapy session. Differences in the GMDS and WeeFIM scores of each child after 5 and 10 months' intervention were compared. Results: Inter-rater reliability was established among the five researchers performing the GMDS before baseline assessments. Forty-two participants were recruited from a possible population of 72 participants and 39 participated in the baseline assessment. Twenty-eight participants completed mid and post assessments, 15 in the experimental PICIHBI group and 13 in the control group (90% power). Baseline averages on the GMDS showed the participants scoring at a borderline mental retardation level, with better performance in the locomotor and personal-social subscales, before interventions. Both groups had an average attendance of 5 sessions. Post-interventions, average total GMDS and WeeFIM scores between the two groups revealed similar scores within the predetermined non-inferiority margin and no significant differences at any time point. Conclusion: In conclusion, the low baseline scores confirm the need for occupational therapy intervention in pre-formal school-going HIV-positive children on ART. The PICIHBI intervention demonstrates a non-inferior impact in child development in this group compared to conventional, individual occupational therapy intervention. PICIHBI thus has potential for impacting occupational therapy practice in this field by providing an alternative equivalent treatment with increased reach.en_ZA
dc.identifier.apacitationMeissner, R. J. (2016). <i>A randomised control trial comparing occupational therapy interventions that aim to improve developmental outcomes for HIV9positive children (aged 6 months - 5 years) on ART</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Occupational Therapy. Retrieved from http://hdl.handle.net/11427/22874en_ZA
dc.identifier.chicagocitationMeissner, Robyn Jess. <i>"A randomised control trial comparing occupational therapy interventions that aim to improve developmental outcomes for HIV9positive children (aged 6 months - 5 years) on ART."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Occupational Therapy, 2016. http://hdl.handle.net/11427/22874en_ZA
dc.identifier.citationMeissner, R. 2016. A randomised control trial comparing occupational therapy interventions that aim to improve developmental outcomes for HIV9positive children (aged 6 months - 5 years) on ART. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Meissner, Robyn Jess AB - Background: Antiretroviral treatment (ART) has reduced the mortality rate of HIV-positive children significantly, and is known to prevent the development and progression of HIV encephalopathy. However, even with ART, perinatal HIV infection places HIV-infected children at increased risk for encephalopathy and associated developmental delays. Research is lacking in the extent of developmental delay on children established on ART, along with evidence-based occupational therapy interventions to treat these developmental delays. A play-informed, caregiver-implemented, home-based group occupational therapy intervention (PICIHBI) presents one possible service delivery option to be explored. Aim: To determine whether children attending an experimental group (PICIHBI) versus children attending a control group (conventional, individual occupational therapy intervention) would present similar results in their total developmental quotient – on the Griffiths Mental Developmental Scales (GMDS) and Paediatric Functional Independence Measure (WeeFIM). Methods: A randomised control trial, which was pragmatic in nature and single-blinded, was used. The research population was all HIV-positive children, pre-formal school-going aged (6 months – 5 years), on ART attending the Groote Schuur Hospital paediatric HIV clinic at the time of the study. Caregiver and child dyads were randomly assigned to either the experimental or control group, and attended a monthly occupational therapy session. Differences in the GMDS and WeeFIM scores of each child after 5 and 10 months' intervention were compared. Results: Inter-rater reliability was established among the five researchers performing the GMDS before baseline assessments. Forty-two participants were recruited from a possible population of 72 participants and 39 participated in the baseline assessment. Twenty-eight participants completed mid and post assessments, 15 in the experimental PICIHBI group and 13 in the control group (90% power). Baseline averages on the GMDS showed the participants scoring at a borderline mental retardation level, with better performance in the locomotor and personal-social subscales, before interventions. Both groups had an average attendance of 5 sessions. Post-interventions, average total GMDS and WeeFIM scores between the two groups revealed similar scores within the predetermined non-inferiority margin and no significant differences at any time point. Conclusion: In conclusion, the low baseline scores confirm the need for occupational therapy intervention in pre-formal school-going HIV-positive children on ART. The PICIHBI intervention demonstrates a non-inferior impact in child development in this group compared to conventional, individual occupational therapy intervention. PICIHBI thus has potential for impacting occupational therapy practice in this field by providing an alternative equivalent treatment with increased reach. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - A randomised control trial comparing occupational therapy interventions that aim to improve developmental outcomes for HIV9positive children (aged 6 months - 5 years) on ART TI - A randomised control trial comparing occupational therapy interventions that aim to improve developmental outcomes for HIV9positive children (aged 6 months - 5 years) on ART UR - http://hdl.handle.net/11427/22874 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/22874
dc.identifier.vancouvercitationMeissner RJ. A randomised control trial comparing occupational therapy interventions that aim to improve developmental outcomes for HIV9positive children (aged 6 months - 5 years) on ART. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Occupational Therapy, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/22874en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Occupational Therapyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherOccupational Therapyen_ZA
dc.titleA randomised control trial comparing occupational therapy interventions that aim to improve developmental outcomes for HIV9positive children (aged 6 months - 5 years) on ARTen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMScen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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