Home and community occupational therapy for children and youth: A ...

LAW ET AL.
TABLE 2
Services paid for out-of-pocket.
Services N (%)
Speech and Language Pathology 15 (9.0 %)
Respite 12 (7.2 %)
Physiotherapy 11 (6.6 %)
Chiropractor 8 (4.8 %)
Naturopath 8 (4.8 %)
Educator/Developmental Specialist 7 (4.2 %)
Psychologist/Psychiatrist 6 (3.5 %)
Orthotist/Orthopedist 5 (3 %)
Special Needs Worker 4 (2.4 %)
Audiologist 3 (1.8 %)
Social Work 2 (1.2 %)
Nutrition 1 (0.6 %)
the hypothesized causal relationships among the factors
developed in the measurement model (See Figure 1 for the
specific relationships tested within this study). These causal
pathways are estimated as regression coefficients in terms of
their direction, size, and statistical significance. Summary
measures of overall model fit are also available, and can be
used to compare models. Sample size requirements for structural
equation models are typically 5-10 participants per
hypothesized pathway. Mplus version 3.11 software was used
to perform the structural equation modeling analysis
(Muthen & Muthen, 1998-2004).
Results
Baseline/Demographics
Of the 175 participants for whom baseline data were collected,
study outcome data were available for 167 (dropout
rate of 4.6%). Of the 8 participants for whom final outcomes
TABLE 3
Equipment paid for out-of-pocket.
Equipment N (%)
Mobility
Orthotics 16 (9.6 %)
Splints 9 (5 %)
Wheelchairs 3 (1.8 %)
Walker 3 (1.8 %)
Activities of daily living
Communication device 11 (6.6 %)
Toilet aids (e.g. versa frame, commode) 8 (4.8 %)
Bathing aids (e.g. bath lift, grab bar, shower chair) 4 (2.4 %)
Computer with writing aids 4 (2.4 %)
Feeding pump 3 (1.8 %)
Medical
Ventolin 3 (1.8 %)
Catheters 3 (1.8 %)
Suction equipment and IV 1 (0.6 %)
Blood pressure pump 1 (0.6 %)
Asthma machine 1 (0.6 %)
were not collected, 2 were because of hospitalizations, 2
because the client terminated services before three visits were
completed, and 4 were because the attending therapist did not
complete a discharge visit, even after numerous requests from
the project office. Therefore, all analyses were performed on
the 167 participants for whom complete data were collected.
The study participants were primarily male (59%) with a
mean age of 4.8 years (standard deviation: ± 3.5 years, range; 15
months to 17 years). The youngest participant was 1.5 months
old at the initial visit while the oldest participant was 16 years
old. Almost 70% of the participants had a formal diagnosis
with the most common diagnoses being cerebral palsy, autism
spectrum disorder or developmental delay. Table 1 summarizes
the baseline characteristics of the study population.
Almost all children (93%) came from a family with at
least one working parent, and just over half (58.1%) of the
families had two parents employed. Approximately 45% of
the families involved in the study had a combined family
annual income of $60,000 CAD or greater. Children received
an average of 3 services (standard deviation, ± 2.3), of which
0.629 ± 1.08 were not publicly funded, in addition to occupational
therapy and any publicly funded services they were
receiving. These types of privately funded services are listed
in Table 2. Of these additional services 2.4% (N=4) were privately
funded occupational therapy. Payment of out-ofpocket
expenses for services was significantly related both to
family income (r = 0.28, p =