Using an evidence-based and theory-based approach to occupational therapy intervention development to improve participation outcomes for children with Developmental Coordination Disorder

Background Developmental Coordination Disorder (DCD) is a developmental disorder, which affects motor proficiency skills. It causes occupational performance and participation restriction across life areas. Aim The overarching aim of this doctoral thesis was to use an evidence and theory-based approach to the development of occupational therapy intervention to improve participation outcomes for children with DCD. The development phase of the Medical Research Council (MRC) framework for the development of complex interventions development guided the research objectives, which were to identify the efficacy of interventions that improve participation outcomes for children with DCD, to conceptualise children and young people’s experiences of living with DCD, and to explore current occupational therapy practice with children with DCD. Methods A mixed-methods approach was used. Firstly, a systematic review of the literature was undertaken to identify and synthesise the evidence for effective interventions that improve participation outcomes for children with DCD. Next, a methodology study detailing the protocol for a systematic review and meta-ethnography to synthesise and conceptualise the child and young person’s experience of living with DCD was developed. Following the development of this protocol, a qualitative evidence synthesis using a meta-ethnographic approach to synthesise and conceptualise the child and young person’s experience of living with DCD was conducted. Finally, a qualitative descriptive study involving an online qualitative vignette survey was undertaken to determine current occupational therapy practice for children with DCD. Results Findings from the systematic review showed that little is known about effective interventions to improve participation outcomes for children with DCD. The qualitative synthesis revealed that children and young people with DCD felt left out and marginalised. They also experienced many difficulties in daily activities and utilise a broad range of strategies and supports to navigate everyday life. Examining occupational therapy practice revealed that therapists work collaboratively with children with DCD and their families, and typically use occupation-focused, and multicomponent interventions to address occupational performance difficulties. Conclusions Findings generated from this research and pre-existing theory were subsequently employed to develop guiding principles for future occupational therapy intervention research and practice for children with DCD. Some of the guiding principles include the need to objectively and subjectively measure participation outcomes, evaluate current occupational therapy practice to determine if it influences participation outcomes in family/home-based occupations, future occupational therapy intervention research for children with DCD should address and prioritise social occupations and targeting friendships and measuring friendship as a participation outcome.