Development of a reliable, valid measure to assess parents' and teachers' understanding of postural care for children with physical disabilities.

Schools play an important role in facilitating the day time aspects of postural management programmes for children with physical disabilities, enabling children to participate at school and engage in functional tasks associated with school work; however, the majority of teachers and teaching assistants are inexperienced and lack confidence in how to manage the needs of children with a physical disability (Hutton & Coxon 2010).

“Definition: A postural management programme is a planned approach encompassing all activities and interventions which impact on an individual's posture and function. Programmes are tailored specifically for each child and may include special seating, night-time support, standing supports, active exercise, orthotics, surgical interventions, and individual therapy sessions. Gericke (2006)

A small exploratory study of the views of teachers and teaching assistants recommended that information about postural care be made widely available to parents and teachers in order to assist them in their role as care givers for children with disabilities. In response to these findings, a booklet, the “A-Z of Postural Care” was developed by a team of researchers, therapists, teachers and parents of children with a disability (Hutton et al., 2009).

Aim

The aim of this study was to develop and validate an outcome measure designed to assess teachers’ and parents’ understanding, and knowledge of postural care, together with their confidence in providing such care. This measure will be used in the evaluation of a training programme, based on the content of the ‘ A-Z of postural care’ as a before and after measure of parents and teachers understanding, knowledge and confidence of postural care.

Method

An initial list of questionnaire items was developed via discussions with occupational therapists, physiotherapists, parents and teachers, based on the content of the A-Z of postural care. Items were designed to assess knowledge and understanding of postural care for children with disabilities; two further subscales were included to assess, confidence and concerns in relation to providing postural care in the school and/or home environment. The outcome measure was then tested for validity and reliability on 152 participants. Participants were recruited from a range of professions and were divided in to two groups to enable a comparison of scores between an experienced/knowledgeable group (e.g., occupational therapists and physiotherapists) and a less experience/knowledgeable group (e.g., medical engineers, student physiotherapists, teachers).

Results

To assess the reliability of the scale we examined Cronbach’s Alpha (a measure of internal consistency) for each of the three subscales and for the total scale. Results indicate adequate reliability (>.70) for all three subscales (Knowledge and Understanding: α = .96; Confidence: α = .92; Concerns: α = .87) and for the total scale ( α = .82). Known groups validity analysis was also conducted to determine the validity of the measure. ‘Known groups’ expectation was defined as the experienced group showing statistically significant higher levels of knowledge, understanding and confidence, while also demonstrating lower levels of concerns compared to less experienced group. In line with expectations, the more experienced group had higher levels of knowledge and understanding (M = 65.97 vs. M = 54.45, p <.001); and confidence (M = 77.76 vs. M = 63.64, p <.001); and lower levels of concerns (M = 12. 81 vs. M = 15.98, p<.001) than the less experienced group.

Conclusion

These results suggest that the outcome measure known as the ‘postural care, understanding knowledge and confidence scale’ (PC-UKC), is a valid measure of understanding, knowledge and confidence when providing postural care. This measure will be used as a before and after measure of parents and teachers knowledge and confidence which will form part of a wider evaluation of a training programme, based on the content of the ‘A-Z of postural care’.