Co-Principal Investigators: Thubi Kolobe; Everett Smith (University of Illinois, Chicago)

Purpose: The purpose of the current study is to refine and validate a web-based version of the School Outcomes Measure (SOM™) for use in educational settings nationwide. The SOM™ measures the functional abilities of students ages 3 to 21 who receive school-based occupational therapy (OT) and/or physical therapy (PT) related services using the fewest number of items possible. Items measure students' level of independence in fulfilling tasks and roles in school that are necessary for participation in learning. Through the refinement and validation of the SOM™, the current study seeks to address one of the key challenges that school-based occupational therapists and physical therapists face, which is the valid measurement of students' functional abilities in the school setting. The project will also investigate the measure's responsiveness (i.e., ability to detect a difference or change when one is present) and develop a SOM™-specific online database that will allow related services providers to longitudinally collect, compare, and interpret student outcomes. The anticipated results of the current study will contribute to improved documentation of OT and PT services and students' functional abilities and improved services for students with disabilities.

Project Activities: The research will be conducted in four phases. In Phase 1, the researchers will examine item hierarchy and dimensionality in the SOM using an existing dataset of elementary and high school students. In Phases 2 and 3, therapists will collect baseline and follow-up data on the revised SOM™ and the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI-CAT) in order to establish the validity and responsiveness of the SOM™. In Phase 4, an open access online data collection system will be developed. The project aims to validate the SOM™ with all age groups of students receiving school-based OT and/or PT; examine the measure's responsiveness to changes in student functional abilities; and facilitate access to the SOM™ by related services providers nationwide.

Products: The primary product of this project will be a fully refined and validated web-based version of the SOM™ for OTs and PTs to measure the functional abilities of students in preschool through high school who receive school-based OT and/or PT services. Products will also include peer-reviewed publications and presentations.

Structured Abstract

Setting: Data collection will take place in preschools and elementary, middle, and high schools in five large school districts in New York, Illinois, Pennsylvania, Oklahoma, and New Mexico. Data will also be collected from independent occupational and physical therapists across the U.S.

Sample: Approximately 300 school-based occupational and physical therapists will participate in this research (approximately 250 therapists from the five school district sites and 50 independent therapists across the U.S.). Each therapist will recruit and collect SOM™ data from four students on their caseloads (students receiving OT and/or PT as designated by an IEP), totaling 1,200 students ages 3–21.

Assessment: The SOM™ is a 46-item measure that is completed by related services providers using the web-based data collection system. The SOM™ quantifies physical and behavioral functional abilities of students with disabilities who receive school-based OT and/or PT related services, with items that assess students' level of independence in fulfilling tasks and roles in school that are necessary for participation in learning. The SOM™ is a context-specific measure that assesses how all individuals perform in a given environment (i.e., school) regardless of age or type of disability. The measure also includes items related to student and therapist demographics, student's IEP (e.g., disability category, educational placement, and frequency of therapy), therapy activities, and services provided.

Research Design and Methods: Research activities will occur in four interrelated phases. Phases 1 and 2 activities intend to establish the construct validity of the SOM™ for all students receiving school-based OT and/or PT. In Phase 1, the researchers will use existing data from elementary and high school students to examine the item hierarchy and dimensionality of the measure and revise the SOM™ so that it is appropriate for all age groups of students. During Phase 2, baseline data on the revised SOM™ and the PEDI-CAT will be collected from a national sample of 1,200 students (stratified by age group and disability severity). Researchers will re-examine the item hierarchy and dimensionality of the SOM™ for each severity level and age group. In Phase 3, follow-up data on the SOM™ and PEDI-CAT will be collected 4.5 and 10 months after baseline. In conjunction with an anchor-based Rasch analysis approach, the PEDI-CAT will be used as a reference standard to determine the responsiveness of the SOM™ and the change scores representing the minimal significant function difference (i.e., amount of change that must be achieved to reflect a true difference in pre/post intervention scores beyond measurement error). Phase 4 will entail the production of an open access data collection system that therapists can use to collect SOM™ data nationwide and measure the effectiveness of their services.

Control Condition: Due to the nature of the research design, there is no control condition.

Key Measures: The PEDI-CAT will be used to assess the construct validity of the SOM™. The PEDI-CAT is a comprehensive measure that assesses functional skills, including daily activities in the home and community, of children in infancy through age 20.

Data Analytic Strategy: The primary data analytic approach will include the unidimensional and multidimensional Rasch rating scale and partial credit models. In Phases 1 and 2, Rasch analysis will be performed to examine internal consistency, dimensionality, rating scale functioning, and adherence to Rasch model requirements. In Phases 3 and 4, the researchers will conduct Rasch analysis and t-tests and compute a responsiveness coefficient (i.e., Guyatt Responsiveness Index for Responsiveness) to determine validity and responsiveness of the SOM™. Researchers will determine the measure's minimal significant function difference by comparing SOM™ scores to the established PEDI-CAT cutoff scores.