Article Critique

1. Article Critique Effectiveness of School-Based Occupational Therapy Intervention on Handwriting

2. Case-Smith, J. (2002). Effectiveness of  school-based occupational therapy  intervention on handwriting. American Journal of Occupational Therapy, 56, 17-  25.

3. Purpose To study the impact of occupational therapy intervention on handwriting in children and on other school activities.

4. Hypotheses �Compared with a control group of students with poor handwriting who do not receive occupational therapy, will students with poor handwriting who receive occupational therapy services make greater improvements in visual-motor skill, visual-perception skill, dexterity, in-hand manipulation skills, legibility, and handwriting speed?� �Will students with poor handwriting who receive occupational therapy services demonstrate statistically significant improvement over the course of the school year in school functions associated with visual-motor and manipulative skills?� (Case-Smith, 2002, p. 18)

5. Literature Review Handwriting is a primary reason for school system referral to occupational therapy Problems associated with poor hand writing Associated components of handwriting demonstrated to be problematic - visual-motor skills, in-hand manipulation skills OT interventions for handwriting skills - biomechanical interventions from Benbow and others, sensory integrative components - (Amundson, 2001; Cermak, 1991) Compensatory approaches to handwriting (computer)

6. Sample Recruited from 5 school districts in central Ohio Teacher identification of students with handwriting problems 43 second, third and fourth grade students (see Table 1) (31 with intervention, 13 without) None with diagnosed medical conditions Informed consent from all Comparison group older, more second and third graders, slightly more males, primarily Caucasian, varied diagnoses (LD, ED, DD)

7. Were the groups comparable?What about the students who didn�t receive therapy - why not??

8. Outcomes Measures Visual perception Visual motor skills In-hand manipulation Handwriting Using materials and written work Subtests of the Developmental Test of Visual Perception Subtests of the BOTMP Components of in-hand manipulation using the 9 hole peg board test ETCH Subtests of the School-based Function Assessment

9. Reliability and Validity Reliability and validity reported for the DTVP, BOTMP, reliability for the ETCH, and SFA In-hand procedures described in earlier Case-Smith studies but no reliability or validity studies ??? Process of using subtests rather than the whole battery � use of subtests negates reliability and validity studies

10. Frequency of Outcomes Assessment Assessments were carried out pre and post intervention; pre-intervention measures taken in September/October of 1998/1999 and 1999/2000 Post intervention measures taken in April-May of 1998/1999 and 1999/2000

11. Intervention All students receiving intervention received regular direct intervention (approx. 30 min per week on the IEP) Records kept of each session - duration, frequency, goals, group vs. individual intervention, type of activities Mean time of session interventions and overall summed times calculated Frequency of the following parameters were calculated - sessions, goals, activities, and service delivery models

12. Follow-up interviews were held with all treating therapists to clarify issues in the data.

13. Could you replicate this study easily?

14. Results Performance Components Means comparison given for IG students only IG made significant changes in 2 DVPT subtest and in-hand manipulation ANOVA indicates that significant IG group changes over CG were seen in visual-motor control and in-hand manipulation

16. Results Handwriting and School Function Results The only significant change was in the IG, which made significantly more improvement in total percentage of legible letters.

17. Drop-outs 38 of 44 students completed all testing procedures (29 getting intervention, 9 in the control group) two students (IG) dropped because they developed neurological problems 4 students (CG) never finished testing - 1 student expelled from school, 2 referred for OT, 1 not available for testing�.

18. Data lost on an additional 4 students in the IG

19. Interesting Features t test outcomes on CG never shown Author and 4 OTs completed the testing The author did most of the testing The testers were not blinded. Other school interventions received by either group were not recorded (PT, resource room) Maturation addressed by using standardized scores

20. Clinical Importance Were significant differences really significant?? Most important aspect of this study (my opinion) was the information on practice � amount and type of intervention, amount of communication between therapist and teacher

21. Conclusions Students with intervention improved most in handwriting letter legibility Need for study of specific interventions for handwriting No discussion of changes seen in the control group Is the time and effort spent on increasing handwriting worth it???