non standardised outcome measures occupational therapy

non standardised outcome measures occupational therapynon standardised outcome measures occupational therapy

. The outcome measures used by the students included: modified Functional Independence Measure (two settings), the Functional Independence Measure (one setting), the Boston University 6 click AM-PAC (one setting), the Canadian Occupational Performance Measure (one setting), and self-reported goals by patients (one setting). Association of impaired functional status at hospital discharge and subsequent rehospitalization, Journal of Hospital Medicine; 9(5), 277-82. Chapter 7: Reliability (Alison Laver Fawcett, PhD, DipCOT.). Clients have a profile of scores for the 4 domains and scores are not summed. Change from admission to discharge for clients, Using Wilcoxon Signed Ranks Test, all significant, p<.001, for mixed client population including: Abu-Awad, Y., Unsworth, C.A., Coulson, M., & Sarigiannis, M. (2014). In January 2018, U.S. News & World Report ranked occupational therapy is 11th of the 100 best jobs for 2018. This study is part of the devel- opment of a performance-based outcome assessment called the Spinal Cord Injury-Movement Index (SCI-MI). The students chose at least one outcome measure used in the facility and documented the baseline and final performance after therapy on the outcome measure. The American Journal of Occupational Therapy, 64(5), 768-775. doi:10.5014/ajot.2010.09041, Ottenbacher, K. J., Msall, M. E., Lyon, N. R., Duffy, L. C., Granger, C. V., Braun, S. (1997). What Can We Really Expect from 5G? Epub 2013 Jan 24. What is important to patients in palliative care? Clinical judgement and clinical reasoning. Self-Care-Participation/ Restriction: Scale 5. Validity of using the Assessment of Motor and Process Skills to determine the need for assistance. Canberra: Australian Institute of Health and Welfare. Limitless? . Crennan, M., & MacRae, A. Developing a short form of the Berg Balance Scale for people with stroke. The Occupational Therapy Journal of Research, 19(3), 203-215. doi:10.1177/153944929901900303. (2016). This paper will present the review process, describe in more detail eight assessments that fulfilled many of the review criteria, discuss the limitations of these measures using the "Guidelines for the Client-centred Practice of Occupational Therapy as the framework, and make recommendations for the development of a new outcome measure for use . International Journal of Health Sciences and Research, 5 (8), 369-376. Prerequisite course work. We have reviewed nearly 300 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others. Reflecting on purposes of assessment in your own practice. Assessment is a key component of the curriculum in both OT and physiotherapy undergraduate training, Embodies current thinking on a shift towards standardized assessment as well as client-centred practice, Evaluates methods of test critique using case studies and provides sources for published tests, Reviews models of function (eg National Council for Medical Rehabilitation 5 level model, WHO ICDIH-2 International Classification of Impairments). The Assessment of Motor and Process Skills (AMPS) is an observational assessment that measures the performance quality of tasks related to activities of daily living (ADL) in a natural environment. International Psychogeriatric Association, 11(4), 399-409. Scoping reviews in occupational therapy: the what, why, and how to. Insight: Occupational Therapy Outcome Measures Workbridge British Journal of Occupational Therapy, 78(9), 570-575. Archives of Physical Medicine and Rehabilitation, 76, 1144-1151. doi: 10.1016/S0003-9993(95)80124-3. Evaluation & Assessment | AOTA Transfers-Participation/ Restriction: Fristedt (2013) as reported above studied interrater and intrarater reliability. Bachelor's or Master's degree from a regionally accredited institution. (2006). Confidence interval of 95% = (+ 0.49) and (+ 0.39) logits respectively. Objective To estimate the dose-response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population. Physical Therapy, 83(3), 224-236. First, this is a retrospective study and our students only practiced eight weeks during their fieldwork course. The relationship between the Assessment of Motor and Process Skills (AMPS) and the Large Cognitive Level (LACL) test in clients with stroke. Jette, D. U., Grover, L., & Keck, C. P. (2003). Albert, S., Castillo-Castaneda, C., Sano, M., Jacobs, D., Marder, K., Bell, K et al. 2017 May 30;17(1):375. doi: 10.1186/s12913-017-2311-3. (2015). We discuss what patient-reported outcomes measures are and. In all six acute settings, OT students provided activities of daily living (ADL) training (bathing/showering, toileting and toilet hygiene, dressing, functional mobility, personal hygiene and grooming). There is little consensus regarding the meaning of quality of life (QOL) within occupational therapy literature. (2015). Self-Care and Scale 5 (Transfers) with 7 OTs rating 6 or 3 cases (respectively) with a range of conditions including: spinal cord injury, amputation, schizophrenia, hip replacement, muscle disease, and cancer. Fort Collins, Colorado: Three Star Press, Inc. Fingerhut, P., Madill, H., Darrah, J., Hodge, M. & Warren, S. (2002). Standardized outcome measures (SOMs) are tools used for measuring the changes in the patients' performance, function or participation over time. Communication, insight and capacity issues. Minimum GPA of 3.0 *. Reliability coefficients and standard error of measurement. Even for the few standardized outcome tools used by the OT, often only parts of the tool were used. 1-844-355-ABLE. . Case study: Mrs Ellis Initial Assessment Process by Karen Innes and Alison Laver Fawcett. Enter your zip code . OTs have an interest in finding ways to increase accuracy in predicting discharge. Demonstrated concern for individuals from diverse backgrounds and their . 2. feedback given to client. United Kingdom, Canada, New Zealand, Singapore, Sweden). International Journal of Therapy and Rehabilitation, 12(8), 340-346. Therapists select from 12 function-focused scales that match client goals as follows: Each scale scores the client in relation to 4 domains: Each domain is scored on a 6-point scale from 0 (low) through to 5 (high) with half points possible (providing 11 possible scores for each domain). Keywords: These measures are often completed at the start of therapy to determine baseline function and then again, at the end of therapy to assess progress and determine treatment efficacy. 1-844-355-ABLE. Examples of how therapists combine different assessment methods. Unauthorized use of these marks is strictly prohibited. The 16 ADL motor skill items are divided into 4 domains (Body Position, Obtaining and Holding Objects, Moving Self and Objects, Sustaining Performance). It begins by defining what is meant by assessment, outcome, evaluation and measurement and discussing the complexity of therapy assessment and measurement, including the challenge of measuring human behaviour and the impact of factors such as task demand and context, including the environment. London . International Journal of Social Research Methodology, 8, 19-32. Multi-disciplinary team meeting with Carol. ADL process skills rate the competency when one selects and interacts with tools and materials and changes performance when problems are encountered. Occupational Therapy - Tests, Assessments, Tools and Measures The Use of Non-Standardised Assessments in Occupational Therapy with Rater reliability and internal scale and person response validity of the school assessment of motor and process skills. Differences between persons with right or left cerebral vascular accident on the Assessment of Motor and Process. *Scores higher than .9 may indicate redundancy in the scale questions. They acknowledged the benefits and necessity of a standardized tool but felt this would be difficult due to the medical acuity for acute care patients, the diversity of diagnoses, and the difficulty of finding outcome measures that encompass all aspects related to discharge. . Nova Southeastern University. Copyright 2023 Royal College of Occupational Therapists. A Young Scientist's Journey after a Stroke, Care by the Numbers: Skilled Nursing versus Inpatient Rehabilitation, WSJ: Recognizing Aphasia and Seeking Treatment, Shirley Ryan AbilityLab Ranked No. 3. adjustments can be graded (harder or easier) Cognitive Assessments Used in Occupational Therapy Practice - Hindawi Conclusions: A clear conceptualisation of QOL that incorporates occupational therapy values such as client-centredness and holism is needed to advocate for the profession's role in health care and to encourage the development of suitable outcome measures. (1993). BAYLEY SCALES OF INFANT DEVELOPMENT (BSID) ADL motor skills are observed when an object is moved or when one moves oneself. A New Ecosystem of Scientific Sharing and What it Would Mean, Preprints and Trust in Peer Review: A Q&A With Alberto Pepe of Authorea, Re-Entering the Classroom in a Time of Trauma and Stress, Cultivating an Inclusive Learning Experience, Wiley "Stay the Course Grant" Winners Tell Their Stories, 4 Things to Consider When Choosing an Online Platform That's Right for You, Determine Your Organizations Digital Skills Level. Therapists select from 12 function-focused scales that match client goals as follows: 1. 4. one-way relationship. Summary of the results other team members assessments. 2013 Sep;35(19):1636-46. doi: 10.3109/09638288.2012.748845. "This is a useful textbook for occupational therapists and physiotherapists or those studying to become one." The review was completed by searching six databases using occupational therapy-related and QOL-related terms. Reflective practice as a component of continuing professional development. Scandinavian Journal of Occupational Therapy, 6(3), 111-118. doi:10.1080/110381299443690, Haslam, J., Pepin, G., Bourbonnais, R., & Grignon, S. (2010). Change data has been published for clients with Diseases of nervous system, circulatory system, musculoskeletal system and Injury/poisoning (Unsworth, 2005b; Abu-Awad, 2014; Chen, 2015). With the growing requirement to objectively measure impairments and utilize standardized measures to confirm patient changes, the ability to integrate and use outcome measures is a key skill necessary for today's successful practice. ; The EORTC Quality of Life Group. Only three settings documented both baseline and final outcome measurement data. Two settings completed only baseline evaluations and one recorded only the baseline goals. As occupational therapists, the authors are aware that the performance of children, such as their level of cooperation, varies across settings and in the presence of different professionals or people. Factors impacting the use of outcome measures were identified as: 1) challenges selecting the appropriate outcome measure; 2) too time consuming for patients to complete and difficult to complete independently; 3) short length of stay; 4) limited time for therapists to complete the evaluation; 5) fast-paced and dynamic environment (different floors, different teams/members); 6) timing problems where patients undergoing tests/procedures were off the floor; 7) and patients were medically unstable at the time of the attempted/scheduled evaluation. From the literature, OTs working at acute care settings recognized the potential benefits of using standardized outcome measures and expressed strong interest in using those tools (Blaga & Robertson, 2008; Crennan & MacRae, 2010; Jette, et al., 2003; Jette et al., 2014; Matmari et al., 2014; Robertson & Blaga, 2013; Smith-Gabai, 2016). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Smith-Gabai, H. (2016). In 2021, your cash gifts may also favorably impact your taxes, thanks to the extension of many of the charitable provisions in the Coronavirus Aid, Relief and Economic Security (CARES) Act. Before their fieldwork, we asked students to create a dataset of all the patients they worked with over an 8 week time period during summer 2017. VAT Reg. What are standard outcome measures? Ventricular tachycardia ablation through radiation therapy (VT-ART) for sustained monomorphic ventricular tachycardia seems promising, effective, and safe. There is no one standardized tool currently available that is comprehensive enough for the acute care setting. Chapter 12: The Final Case Study: Carol experience of a Chronic Pain Service (Alison Laver Fawcett, PhD DipCOT, Gail Brooke, Dip Phys, Cert in Health Service management, and Heather Shaw, DipCOT). La Trobe University, Melbourne. A survey study on 72 OTs working in acute care settings in New Zealand reported similar results that the majority of outcome measures used are non-standardized and include both subjective interview and observations of the patient carrying out functional tasks (Robertson & Blaga, 2014). More importantly, therapists questioned applicability of the tools to the acute care setting where they would have to be administered bedside to patients who were often critically ill, vulnerable, or not feeling or performing at their best. Skeat, J., Perry, A., Morris, M., Unsworth, C., Duckett, S., Dodd, K., Taylor, N. (2003). Self-Care-Participation/Restriction: Fristedt (2013) reported ICCs between .58 and .93 for the Intrarater reliability of the 15 raters across the case studies, for the 12 AusTOMs scales. Comparing statistical methods for evaluating reliability. An ethnographic study indicated that non-standardized functional-based outcome measures are the most frequently used method in discharge assessment with inconsistency in the use of standardized tools at acute care settings (Crennan & MacRae, 2010). Disclaimer. The AMPS is designed to examine interplay between the person, the ADL task and the environment. Timing of assessment in the therapy process. Understanding quality of life within occupational therapy - PubMed The AMPS manual provides further information regarding detailed steps for AMPS administration, cultural activity considerations, situational circumstances that may impact administration, and additional information needed to properly administer the assessment. Determination of the minimum clinically important difference on the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT)? The Group intervention programme: Turnabout. International Classification of Functioning, Disability and Health (ICF). Outcomes of occupational therapy are: Occupational performance Prevention Health and wellness Use of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) in an early supported discharge program for stroke patients in Singapore. Introduction. 77- 81). Domestic life- inside house 9. Effect of occupational therapy intervention on the quality of life of HIV positive clients and study of knowledge about HIV on clients and occupational therapists. (2012). The assessment of process and motor skills of persons with psychiatric disorders. The use of outcome measures to demonstrate changes in patient's functional ability as well as evaluating service effectiveness is crucial for the profession to work in an evidence based practice manner. Scand J Occup Ther. 496Pages, Request permission to reuse content from this site. In Australian Institute of Health and Welfare, ICF Australian user guide. By not using standardized outcome measurement tools, the value and benefits of OT services such as ADL and IADL training, patient and caregiver education, and training to use adapted equipment/assistive devices is anecdotal at best. Further research is needed to identify common outcome measures suited for use by OTs in acute inpatient hospital settings. OTs need easy access to information about the clinical utility and psychometric qualities of various measures to help with the appropriate selection and clinical applicability of standardized outcome measurement tools to measure functional outcomes in acute inpatient hospital practice. Occupational therapy discharge assessment of elderly patients from acute care hospitals. Download Product Flyer is to download PDF in new tab. After Friday 19 November 2021, you will need to register for a new website account so you can log in and access the member-exclusive section and webpages on the website. The students avoided documenting any protected information as designated by the Health Insurance Portability and Accountability Act identifiers. BMC Health Serv Res. Assessment as a core part of the therapy process. Levels of evidence and grades of recommendations. A qualitative study of clinical decision making in recommending discharge placement from the acute care setting. Other OT services included IADL (care of others/pets, health management and maintenance, meal preparation and clean up), formal/informal patient education, practice and simulation activities, preparatory tasks, exercises, rest and sleep, play, leisure and social participation, and assistive technology. The AusTOMs-OT is a measure ofglobal functional outcomes for clients of all ages, all diagnoses and in all settings. Fourteen different standardised measures and two non-standardised measures were utilised. Shirley Ryan AbilityLab does not provide emergency medical services. National Library of Medicine If this is an emergency, please dial 911. Careers. intervention and service provision; occupational therapy research; quality of life; reviews. Hongwu Wang, PhD1,2; Cyndy Robinson, OTD, OT/L, FAOTA1; Jessica Tsotsoros, PhD, OTR/L, ATP1, 1Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, 2Harold Hamm Diabetic Center, University of Oklahoma Health Sciences Center. Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016). Medical Care Research and Review, 119. In this study, a non-standardised assessment tool to measure severity of disability was compared with a standardised tool to assesswhether there were differences in outcomes and what, if any, were the consequences for service entitlement. The wide use of this measure is consistent with earlier studies specific to cognitive impairments [ 11] as well as other general occupational therapy assessments [ 12 ]. The impact of health and social care policy on assessment practice. Extracurricular and interpersonal life experiences. (2020). Out of the 32 second year OT students, seven of them completed fieldwork at six acute inpatient hospital settings providing OT for 205 patients, including 99 male and 106 female patients with an average age of 63.2915.86. (PDF) Routine standardised outcome measurement to evaluate the The type of speech impairment most commonly reported in hereditary ataxias is dysarthria. This is a dummy description. To be considered relevant, difference should exceed + 1.96 SEM. Experiences, academics and prerequisites that indicate a focus and intention of joining the field of occupational therapy. Phase I = Administration Preparation; Phase II = Occupational therapy interview; Phase III = Observe and implement a performance analysis; Phase IV = Score the AMPS observation, After AMPS administration, the clinician interprets AMPS reports to define and interpret reasons for the person's ineffective ADL performance. The inter-rater and test-retest reliability of the Self-care and Transfer scales and intra-rater reliability of all scales of the Swedish translation of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT-S). 1347374). Care-giver and parent burden scales). Detecting differences in activities of daily living between children with and without mild disabilities. Main Outcome Measures: Not applicable. Your gift of Ability affects everythingwe do every day at Shirley Ryan AbilityLab from the highest-quality clinical care and groundbreaking research to community programs that improve quality of life. Assessments form an integral component in the occupational therapy process. Methods of data collection (e.g. This textbook on assessment and outcome measurement is written for both occupational therapy and physiotherapy students and qualified therapists. Step 7: Client feedback about the test results and implications. Improving assessment and measurement practice: where to begin? A scoping review of the patient's perspective. All rights reserved. March 2013 An Outcome Measure is the result of a test that is used to objectively determine the baseline function of a patient at the beginning of treatment. Based on the current literature, there is significant variability in the use of standardized tools to measure OT outcomes at the time of discharge from the acute inpatient hospital. Assessment of Motor and Process Skills | RehabMeasures Database Occupational Therapists' Experiences in Conducting Home Assessments and OTs use outcome measurements in different settings to help inform colleagues and other medical professionals of the complexity of the patients diagnosis, increase effectiveness, and improve patient outcomes. Occupational Therapy International, 15(4), 253-268. doi: 10.1002/oti.258, Kizony, R. & Katz, N. (2002). 2019 Dec 26;7(24):4420-4425. doi: 10.12998/wjcc.v7.i24.4420. Occupational therapists . A Young Scientist's Journey after a Stroke, Care by the Numbers: Skilled Nursing versus Inpatient Rehabilitation, WSJ: Recognizing Aphasia and Seeking Treatment, Shirley Ryan AbilityLab Ranked No. Wades (1988) 4-level model for people with stroke. Carrying out daily life tasks and routines 5. non-standardized assessments Flashcards | Quizlet Other OT services included instrumental activities of daily living (IADL) (care of others/pets, health management and maintenance, meal preparation and clean up), formal/informal patient education, practice and simulation activities, preparatory tasks, exercises, rest and sleep, play, leisure and social participation, and assistive technology. The statistic used to calculate the level of reliability can impact the results. Copyright 2000-2023 by John Wiley & Sons, Inc., or related companies. Mapping your current assessment and measurement process. Older adults were defined as being 70 years or older to reflect the increase in life expectancy in western countries [ 15 ]. Bjorkdahl, A., Nilsson, A. L., Grimby, G. & Sunnerhagen, K. S. (2006). Upper limb use 4. The average length of stay was 6.607.43 days. Seven out of 32 OT students completed their fieldwork at six acute inpatient hospital settings providing OT services for 205 patients, including 99 male and 106 female patients with an average age of 63.2915.86. Initial review and summary completed by Amanda Timmer and Carolyn Unsworth. Canadian Journal of Occupational Therapy, 79(3), 167-174. https://doi.org/10.2182/cjot.2012.79.3.6, Gantschnig, B.E., Page, J., & Fisher, A.G. (2012). Scott (2006) also studied Scale 7. Parallel form reliability (equivalent or alternate form). This page presents the best available information on how outcome measures for stroke might be classified and selected for use, based upon their measurement qualities. Chapter 8: Test administration, reporting and recording (Alison Laver Fawcett, PhD, DipCOT and Rachael Hargreaves, BSc(Hons) SROT). Assessment and outcome measurement goals for effective practice. OTs agree that they were unfamiliar with any standardized outcome measurement currently available that addressed the diversity of patients in acute care. Chapter 11:Implementing the optimum assessment and measurement approach (Alison Laver Fawcett, PhD, DipCOT). Questions for undertaking a Test Critique. In order to measure change, the assessment has to be standardised: developed through research. Using Outcome Measures In Occupational Therapy By Pamela Eakin 36 items (16 ADL motor skill items, 20 ADL process skill items), AMPS can be administered in any task-relevant setting, Jenine Ampudia, OTS, University of Illinois at Chicago, Courtney Heidle, OTS, University of Illinois at Chicago, Johnny Sok, OTS, University of Illinois at Chicago, Jennifer Yi, OTS, University of Illinois at Chicago, Schizophrenia: (Haslam et al., 2010; n = 20; Mean Age = 44.3 (8.49) years), Psychiatric Disorders: (Pan and Fisher, 1994; n = 60; Mean Age = 37.9 (14.9); Sample included diagnosis ofaffective disorders, delusional disorders, schizophrenia, or alcohol hallucinosis), Psychiatric Disorders: (Merritt, 2011; n = 8556; Mean Age = 55.1(17.9) years; Subset of data fromAMPS Project International database), Psychiatric Conditions associated with cognitive impairments: (McNulty & Fisher, 2001; n = 20; Mean Age = 58 (16.05) years), Psychiatric Disorders: (Pan & Fisher, 1994; n = 60; Sample includes diagnosis of affective disorders, delusional disorders, schizophrenia, or alcohol hallucinosis), Stroke: (Bernspang & Fisher, 1995; n =230; Individuals with history of RCVA (n = 71), history of LCVA (n = 76), and nondisabled (n = 83)), Stroke: (Fisher & Bray Jones, 2010 as cited in Poulin et al., 2013; n = 8801; subset of AMPS Project International database; adults with hemispheric stroke), Stroke: (Fisher & Bray Jones, 2010 as cited in Poulin et al., 2013), Stroke (Marom, Jarus & Josman, 2006; n= 30; Individuals in their first week home during stroke recovery), Hemispheric Stroke: (Merritt, 2011;n = 17568;Mean Age = 61.7 (20.6); Subset of AMPS Project International database: Individuals with hemispheric stroke ( n = 8801) and individuals with other neurological conditions ( n = 8767), Stroke:(Dickerson, Reistetter & Trujullo, 2010; n = 46; Mean Age = 71.67 (10.76); Community sample referred for driving assessment), Stroke (Kizony & Katz, 2002; n = 30; Mean Age = 71.3 years; Inpatient acute care, 4-5 weeks Post-Stroke), Stroke: (Bjorkdahl et al., 2006; n = 58; Assessed at discharge, three weeks, three months, and one year after discharge; Swedish sample), Geriatric: (Doble, Fisk, Lewis & Rockwood, 1999; n = 55; Mean Age = 77.9 (7.0) years; Community-dwelling elderly adults), Geriatric: (Fioravanti et al., 2012; n = 54; Mean Age = 80 (8.6) years; Mean Length of Stay = 24 (12) days; Canadian sample in a geriatric and neuro-oncology inpatient rehabilitation unit, Geriatric: (Doble, Fisk, Lewis & Rockwood, 1999), Geriatric with cognitive impairments: (Doble, Fisk, Lewis & Rockwood, 1999; Rockwood, Doble, Fisk, MacPherson, & Lewis as cited in Fisher, 2003), Excellent test-retest reliability: (Motor Scale r = 0.88 - 0.9; Process Scale r = 0.86 - 0.87), Excellent test-retest reliability: (Motor: r = 0.88; Process: r = 0.86), Older adults: (Wales, Clemson, Lannin & Cameron, 2016; Mean Age > 70 years; Analysis of 56 papers with RCT design detailing functional assessments for older adults), Geriatric with Memory Impairments: (Robinson & Fisher, 1996), Older Adults: (Wales, Clemson, Lannin & Cameron, 2016), Geriatric with Memory Impairments: (Robinson & Fisher, 1996; n = 51; Mean Age = 75.4 (9.56) years), Older Adults with Dementia of the Alzheimers Type (DAT) (Hartman, Fisher & Duran, 1999; n = 788; Independent Older Adults ( n = 329, Mean Age = 70.5 (5.9)), Older Adults with minimal DAT ( n = 167, Mean Age = 71.2 (9.7)), Older Adults with moderate DAT ( n = 292, Mean Age = 74.5 (8.4)); Sample selected from AMPS database), Older Adults with Dementia of the Alzheimers Type (DAT) (Hartman, Fisher & Duran, 1999), Geriatric with Alzheimers disease: (Doble, Fisk & Rockwood, 1999; n = 26; Mean Age = 76.8 (6.6) years; Canadian sample), Older Adults with Dementia (Fisher & Jones, 2012; n = 5417), Dementia (Merritt, 2011; n = 2488; subset of AMPS Project International database), School-Aged Children with Identified Disability: (Atchinson, Fisher & Bryze, 1998; n = 54; Mean Age = 4.0 (0.7) years; Students receiving occupational therapy for an identified disability (n = 32) and typically developing students as comparison group (n = 22)), School-Aged Children with Identified Disability or At-Risk: (Munkholm, Berg, Lofgren & Fisher, 2010; n = 984; Age Range 3-13; Students from North America, Australia, New Zealand, United Kingdom and Nordic countries), School-Aged Children with Identified Disability: (Atchinson, Fisher & Bryze, 1998), School-Aged Children: (Fingerhut et.

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