Browsing by Author "Bundy, Anita, advisor"
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Item Open Access Development, validation, and implementation strategies for the exercise in cancer evaluation and decision support (EXCEEDS) algorithm(Colorado State University. Libraries, 2021) Covington, Kelley R., author; Bundy, Anita, advisor; Pergolotti, Mackenzi, advisor; Sharp, Julia, committee member; Leach, Heather, committee memberBackground: Clinical practice guidelines recommend referral to cancer rehabilitation or exercise services (CRES) to optimize survivorship. Yet, ability to connect the right survivor with the right CRES at the right time is an ongoing challenge and barrier to utilization of these services. Objective: I aimed to develop a CRES decision support algorithm and used Delphi methodology to systematically: (1) evaluate the algorithm's acceptability and utility; and (2) establish consensus for implementation priorities including key stakeholders, platforms and strategies. Method: I performed a literature review and synthesis, then convened a multidisciplinary expert stakeholder group to participate in algorithm development. We worked iteratively and collaboratively until consensus was reached for content and format of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm and conceptual model. Then I recruited international clinical and research experts to participate in the two-part (three survey) online modified Delphi study. In Part 1, participants completed one survey including: (1) CRES recommendations for two randomized case studies in two conditions (using EXCEEDS vs. without EXCEEDS); (2) the Acceptability of Implementation Measure (AIM); and (3) open-ended feedback on the algorithm. Following this survey, I compared decision efficiency (accuracy and duration) between conditions (EXCEEDS vs. independently) for each case study using frequencies (hypothesis ≥75% accurate) and paired samples t-test (p <.05), then calculated consensus for each AIM domain ("meets approval", "is appealing", "welcome in my field/practice"; hypothesis ≥70% agreement) and overall score (hypothesized mean ≥ 4.0). These results were reported to participants in Part 2. I also performed inductive thematic analysis of open-ended feedback. In Part 2 of the Delphi study, participants completed a series of two surveys including ranking the following items using curated lists: (1) stakeholder group (1 -most likely to 7- least likely to benefit), (2) platform (1 - most likely to 6- least likely to be beneficial) and, implementation strategies (1 - most important to 15- least important for successful implementation). I performed preliminary analysis of each ranking using measures of central tendency (median and IQR), then calculated the proportion of participants who ranked each option as a high priority. Ten implementation strategies were ranked as high priority and returned to participants for the final survey where they rated each strategy in terms of effort associated with using the strategy (1 - low effort to 4 - high effort) and potential impact of the strategy on successful implementation of the EXCEEDS algorithm (1 – low impact to 4 - high impact). Following the Eisenhower Urgent-Important Matrix Method, I plotted the effort/impact scores in four quadrants representing effort and impact for each strategy to determine implementation priorities. Results: The final EXCEEDS algorithm combines biomedical and individual characteristics associated with need for supervised skilled CRES into 11 risk-stratified dichotomous (yes/no) questions, organized into two sections: (1) pre-exercise medical clearance recommendation, and (2) CRES triage recommendation. Delphi study participants (N=133) represented all CRES stakeholder groups (oncology, physical medicine and rehabilitation, exercise science, etc.). Loss to follow up between surveys ranged 28% (survey 3) to 43% (survey 2). When using the EXCEEDS algorithm, decision accuracy improved in six (of eight) conditions (75%) and duration improved in all conditions (N=4, p <.05). Consensus was achieved in three AIM domains (75%); overall AIM score was M=3.90 ± 0.473 (range = 1.0 – 5.0). Qualitative themes from participant feedback include: (1) algorithm strengths (n = 123, 40.9%), (2) implementation considerations (n=93, 30.5%), and (3) areas for revision (n=87, 28.5%). Oncology clinicians and administrators were the highest-ranked stakeholder group (Median=2.0, IQR= 1.0 – 3.75, 75.0% agreement) and the only one to achieve consensus. Open-access internet was the highest-ranked implementation platform (Median =2.0, IQR= 1.0 – 3.5, 72.4% agreement) and the only one to achieve consensus. Consensus was achieved for eight of the ten highest-ranked implementation strategies (80%, inter-rater agreement range = 93.4% - 71.1%). Two strategies were categorized as urgent/important: "develop educational materials" and "remind clinicians". Seven strategies were categorized important/not urgent. One strategy, "model and simulate change", was categorized as not important/not urgent. Conclusion: The EXCEEDS algorithm is an acceptable and efficient evidence-based solution to identify and connect the right survivor, with the right CRES, at the right time. Thus, implementation of the EXCEEDS algorithm guided by the consensus-based priorities identified in the Delphi study has the potential to improve CRES coordination and utilization. Future hybrid studies will be used to determine prospective efficacy and best practices for implementation.Item Open Access Parents' tolerance of risk in play and parents' country of birth predict children's abilities to assess risk: a pilot study with implications for occupational therapists(Colorado State University. Libraries, 2019) VanSkiver, Alison K., author; Bundy, Anita, advisor; Stephens, Jaclyn, committee member; Gloeckner, Gene, committee memberImportance: Many parents do not allow their children to engage in risky play despite its many benefits on health and development. Objective: We investigated to what extent parents' tolerance of risky play predicts children's abilities to assess risk in a virtual street-crossing task. Other factors that were examined include age, sex, motor coordination, mothers' education level, and parents' country of birth. Design: Correlational, cross-sectional pilot study. Participants: Nineteen children (11 boys, 8 girls; M age = 8 years) and their parents (9 immigrant; 10 native to U.S. or Canada). Outcome and Measures: Tolerance of Risk in Play Scale (TRiPS); Motor Assessment Battery for Children (MABC-2); and virtual street-crossing task where we evaluated frequency of hits and close calls from virtual cars. Results: Parents' tolerance of risky play significantly predicted hits and close calls on the virtual street-crossing task (R2=.29, F(1,16)=6.52, p<.05). When all variables were forced into the regression analysis, parents' country of birth was the only significant predictor of hits and close calls (R2=.304, F(1,16)=6.99, p<.05). There was a strong correlation between parents' tolerance of risky play and parents' country of birth (r=.704, p<.01). Conclusions and Relevance: There was a co-occurrence for both parents' tolerance of risky play and country of birth as significant predictors of hits and close calls. This suggests that children whose parents have a higher tolerance for risky play are more likely to demonstrate safe pedestrian behavior. Additionally, children whose parents are immigrants, especially from Mexico, may be less likely to tolerate risky play, which may have a negative effect on children's abilities to cross the road safely. What This Article Adds: Occupational therapists can use these findings to encourage risky play opportunities through parent education to enhance children's abilities to assess risk and reduce chance of pedestrian injuries.Item Embargo Personal and contextual influences on Saudi parents' willingness and tolerance for children's risky play(Colorado State University. Libraries, 2024) Alarawi, Rana M., author; Bundy, Anita, advisor; Lane, Shelly, committee member; Hepburn, Susan, committee member; Hickey, Matthew, committee memberObjective: The purpose of this dissertation was to examine personal and environmental factors that influence Saudi parents' willingness to promote, and tolerance of, risk taking in children's play. In this dissertation, I tested a conceptual model that explains the transactions among multiple constructs: factors affecting parental risk willingness, coping efficacy, perceptions of child, and risk tolerance. I also introduced a new tool, the Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS) to assess personal, social and cultural factors affecting parental tolerance for risk in play. Lastly, I examined variations between Saudi mothers and fathers in relation to their willingness to allow and tolerate risk in play. Importance: Risky play is defined as "thrilling and exciting forms of physical play that involve uncertainty and a risk of physical injury" (Sandseter, 2010, p.22). Benefits of children's participation in "risky play" are broadly recognized (Barker et al., 2014; Brussoni, Olsen, et al., 2012; Gray et al., 2015; Sandseter, 2007; Sandseter & Kennair, 2011). However, most related research originates in Western countries; none focuses on outdoor play in Eastern countries, including Saudi Arabia. Further, while the literature identifies varying perspectives on risky play among parents, there is limited understanding of parental, social, and cultural contexts shaping and influencing Saudi parents' tolerance of risk in play. Participants: The sample included 90 Saudi parents with children ages 7 to 10 years who were able to read and speak English. Parents of this age group are expected to accept risky play. Method: This cross-sectional, quantitative dissertation encompassed three studies. In the first study, I used moderation analysis to test a conceptual model examining the relationship among factors contributing to parents' willingness to allow risky play and their risk tolerance. I also investigated the moderating effects of parental coping self-efficacy and parents' perceptions of their children's coping ability on the relationships among factors contributing to parents' willingness to allow risky play and their risk tolerance. In the second study, I utilized Rasch analysis to explore evidence for construct validity and internal reliability of data gathered with the FAC-TRiPS. In the third study, I examined gender variations in Saudi parents' willingness to promote, and tolerance for, risk taking in children's play by answering two research questions: (1) Do Saudi mothers and fathers differ systematically on FAC-TRiPS items? and (2) How does the inclusion of gender influence the relationship among factors affecting parental perceptions of tolerance for children's risky play? Results: Findings of the first study showed that play factors contributing to parents' willingness to allow risk (e.g., fear of injury and fear of negative judgment) were negatively correlated with risk tolerance. Additionally, parents' coping self-efficacy significantly moderated the relationships among play factors contributing to parents' willingness to allow risk and their tolerance for encouraging children to engage in risk taking. That is, parents with high self-efficacy were more inclined to perceive less stress in such situations and were more apt to allow their children to engage in risky play. However, parental perceptions of their children's coping ability did not have a moderating effect on the interaction between factors contributing to parents' willingness to allow risky play, and their tolerance for, risky play. In the second study, preliminary analysis suggested that the FAC-TRiPS yielded valid and reliable data measuring factors influencing parents' risk tolerance. Because the instrument in its early stages of development, further research with a larger sample is needed to refine items and enhance the instrument's functionality and precision. In the third study, although parent gender did not significantly predict risk tolerance, Saudi mothers and fathers exhibited systematic differences on three FAC-TRiPS items. Mothers reported more fears surrounding potential negative judgment and repercussions from an authority while fathers were more influenced of Media reports. Within the context of other factors, gender appeared to play a complex and indirect role in determining parents' risk tolerance. Conclusion: This research serves as a useful foundation for understanding the impact of context on parents' willingness to promote children's participation in risky play. Key themes across the three studies indicate that risk tolerance is likely influenced by a multitude of factors including personal, psychological, and cultural factors. This research represents the first to study a sample from Saudi Arabia, contributing an Eastern perspective to the existing body of research on risky play. Nevertheless, its findings invite further exploration into gender, societal, and cultural influences on how parents perceive and approach their children's participation in risky play environments. Additionally, further validation of the FAC-TRiPS and the Risk Tolerance model is needed. Findings of this research lend further support to the critical role of environmental facilitators and barriers on functioning as well as raise a need for creating a culture in which the duty of care is balanced with the dignity of risk in order to enable children of all abilities to participate in playful and age-appropriate risk-taking opportunities.Item Embargo Rasch analysis of the evaluation in Ayres sensory integration (EASI)(Colorado State University. Libraries, 2022) Grady, Patricia, author; Bundy, Anita, advisor; Lane, Shelly, committee member; Hepburn, Susan, committee member; Sharp, Julia, committee memberSensory Integration (SI) refers to the neurological process by which a person takes in sensory information, interprets this information, and uses it to inform movement and goal-directed action (Ayres, 1989). For children with a variety of diagnoses, as well as some children who are otherwise typically developing, SI may be impaired or delayed (Bundy & Lane, 2020a). Occupational therapists and other clinicians who treat children with sensory integration (SI) dysfunction face a dearth of appropriate instruments to evaluate SI function. The Evaluation in Ayres Sensory Integration (EASI; Mailloux et al., 2018) is a novel assessment tool that may allow therapists to evaluate SI in a way that is aligned with SI theory. EASI consists of 21 individual tests that measure constructs of SI. The EASI authors have collected normative data for children across the globe. However, this data must be assessed for validity and reliability before it can be used as the basis for normative scoring on the EASI. In this dissertation, I used Rasch analysis to evaluate data with 19 of the 21 tests. The Rasch model is a latent-trait psychometric model that (1) transforms ordinal-level data to interval-level data and (2) allows users to assess evidence for construct validity (unidimensionality and invariance) and internal reliability (Bond, Yan & Heene, 2020). For each of the 19 tests, I evaluated item fit statistics, rating scale fit statistics, person fit statistics, principal components analysis (PCA) of standardized residuals, differential item functioning (DIF) based on sex, person reliability index and strata. The dataset for this study comprised 2653 children from 51 countries; all data were collected by trained EASI examiners. Overall, results revealed promising evidence for construct validity and internal reliability of data collected using 16 of the19 EASI tests evaluated in this dissertation. However, across many tests, I observed lower-than-desired person fit statistics and reliability. Notably, these results were not far from the desired values. I hypothesized that these findings are the result of the overall high ability level of the normative population. EASI is designed to evaluate children with lower-than-average or poor SI function; therefore, these findings are not unexpected nor are they particularly concerning. Three EASI tests (Proprioception: Force, Proprioception: Joint Position, and Balance) required substantial revision as a result of these analyses; each had threats to construct validity that exceeded my expectations. In this dissertation, I provided potential solutions for these three tests; future studies will evaluate the extent to which these solutions resolve concerns. In conclusion, the normative data form an acceptable basis for creating norm-based scores for clinical interpretation. However, larger studies must be conducted with clinical populations to ensure that the tests can differentiate between children with and without SI dysfunction. Further, future studies should investigate the role of culture, language and other factors on the validity of EASI test scores.Item Open Access Teacher tolerance of risk in play scale (T-TRiPS): evaluating the psychometric properties of a new measure(Colorado State University. Libraries, 2021) Ihrig, Kristina M., author; Bundy, Anita, advisor; Land, Shelly, committee member; Aberle, Jennifer, committee memberA small amount of risk is a natural component of play that provides children with developmental benefits, increasing: competencies, autonomy and self-efficacy. The purpose of this study is to examine validity and reliability of data produced with a new instrument, Teacher Tolerance of Risk in Play Scale (T-TRiPS). T-TRiPS, a 25-item instrument, was administered to 99 teachers of children with disabilities, aged 4-12. Rasch analysis was used to analyze data. Findings support strong evidence for unidimensionality of the construct: positive point measure correlations, goodness-of-fit statistics in the acceptable range, and a logical item hierarchy. A strata value of 3.01 and person reliability index of 0.80 support internal reliability. T-TRiPS produces valid and reliable data regarding teacher tolerance of risk in play. T-TRiPS can serve as the basis for self-reflection or intervention aimed at increasing children's access to developmentally beneficial risky play.Item Open Access The scale of parental playfulness attitude (PaPA): evaluating the psychometric properties with Latino caregivers in the U.S.(Colorado State University. Libraries, 2021) Goertzen, Kayley Michelle, author; Bundy, Anita, advisor; Lane, Shelly, committee member; Reinke, Jennifer, committee member; Yuma, Paula, committee memberPlay is a meaningful occupation for individuals across the lifespan. Often, play occurs in the context of caregiver-child joint play in which the playfulness of the caregiver can be a support or a barrier to the child's play participation. Occupational therapists (OTs) who seek to optimize performance and participation in joint play must consider the caregiver's level of playfulness when designing interventions. Any measure of caregiver playfulness must be valid and reliable for a given client population. OTs often work with clients from the growing and diverse Latino population in the U.S. Review of literature reveals few measurement tools assess caregiver playfulness, and none have been validated for the Latino American population. To this end, I administered the Scale for Parental Playfulness Attitude (PaPA; Román-Oyola et al., 2019) to 50 Latino American caregivers of children between 29 and 85 months old. Data collected with the PaPA demonstrated preliminary evidence for construct validity (positive point-measure correlations, 93% of items fit Rasch expectations, 4.46 eigenvalues in principal components analysis contrast, consistent rating scale, limited item spread, logical item hierarchy), excellent evidence for internal reliability (person-reliability index = 0.85, strata = 3.55), and good evidence cross-cultural validity (25/28 or 89% of items formed similar hierarchy for participants in the U.S. and Puerto Rico). The findings of this study suggest the PaPA may be useful to establish a baseline measure of caregiver playfulness, show change in playfulness over time, and guide interventions to promote quality performance and participation in the co-occupation of joint play.Item Open Access Validity and reliability of a test of environmental supportiveness(Colorado State University. Libraries, 1997) Harding, Pamela S., author; Bundy, Anita, advisor; Barrett, Karen C., committee member; Hanzlik, Jodie Redditi, committee memberThrough playful interactions with people and objects an individual gains valuable knowledge about the world around them. These interactions are also crucial to nurturing play. Research shows the most prominent features of the environment that affect a child's play are--caregivers, playmates (of all ages), objects, and the physical surroundings. The development of a valid way to measure these important features is a crucial step in achieving the knowledge needed to promote play and playfulness. The Test of Environmental Supportiveness (TOES) was designed to provide a comprehensive picture of the environmental features that can affect play. The TOES assesses not just if the features are present but whether or not they are supportive for each child's play. This study investigated the TOES for preliminary validity and inter-rater reliability for use with children 19 to 121 months. The results show promise of both content and construct reliability as well as inter-rater reliability. The TOES was also found to be an easy tool to use requiring no special equipment. Minimal training is needed to score the items.Item Open Access What children do on the playground: a Rasch analysis approach to measurement on the playground(Colorado State University. Libraries, 2018) Grady, Patricia, author; Bundy, Anita, advisor; Eakman, Aaron, committee member; Hepburn, Susan, committee memberGiven the many benefits of play and children's right to play, as established by the United Nation's Convention on the Rights of the Child (1990), researchers interested in play have designed a multitude of interventions that aim to support children's engagement in this primary occupation. The school playground is a natural context for these play interventions. Because of the play deficits often associated with autism spectrum disorder (ASD) and intellectual disability (ID), many interventions target these populations. However, review of current literature suggests that researchers are limited by the lack of measurement tools to quantitatively analyze what children do together during a playground session. In this study, I present a Rasch analysis-based measure of what children do on the playground. In this measure, the playground session itself is the unit of analysis – this allows play promoters to compare playground sessions before and after an intervention, under different weather conditions, or with different groups of children. This measure was developed based on observation data collected in the context of a larger study aimed to promote playground play for children with ASD and ID. Through Rasch analysis, I demonstrate preliminary validity and reliability of data collected using this observation-based instrument. The findings of this study suggest that observation-based playground measurement tools can effectively quantify play and non-play sophistication.