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Integrated Models of Pediatric Physical and Occupational Therapy: Regional Practice and Related Outcomes

Nolan, Karen W. PT, MS, PCS; Mannato, Lori MS, PT; Wilding, Gregory E. PhD

Research Report

Purpose: This study examined the use of integrated models of service delivery by pediatric physical therapists (PTs) and occupational therapists (OTs). Child and environmental characteristics and variables that influence use of integrated models and perceptions of therapists regarding variables influencing the effectiveness of the model were identified. The study also compared outcomes achieved by subjects who received integrated or isolated therapy.

Methods: Regional data were obtained using a questionnaire. Respondents were from 11 urban, suburban, and rural practice settings within a 30-mile radius of Rochester, NY. Outcomes data were gathered through retrospective review of records.

Results: Of the 220 questionnaires sent out, 107 (49%) were returned. Results showed 55.3% of children (ages up to 13 years 10 months) received the majority of therapy services in isolated settings, while 24.7% received a majority of services in integrated settings. The remaining 20% of the children received therapy services that were equally blended between both models. Significant differences were noted when comparing the caseload percentages of PTs to OTs. Children with developmental delay and multiple handicaps received integrated therapy most frequently. Variables reported to influence use and effectiveness of integrated therapy included child behavior and attention span, classroom structure, and activities addressed in therapy.

Conclusions: PTs and OTs provide services in both integrated and isolated settings often using both approaches based on the treatment objectives, child, and environment variables. We found no evidence that an integrated model is more effective than an isolated approach to intervention.

This report of the results of a survey of practive patterns and treatment outcomes for children indicates that PTs and OTs prefer integrated therapy models, but that the majority continue to provide service in and isolated setting. The authors found no differences between isolated and integrated settings in the percentage of treatment objectives accomplished for either PTs or OTs.

Department of Physical Therapy, Ithaca College-University of Rochester Campus (K.W.N.) and Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center (K.W.N., L.M.), Rochester, NY; and Division of Biostatistics, Department of Social and Preventative Medicine, University of Buffalo, The State University of New York (G.E.W.), Buffalo, NY

Address correspondence to: Karen W. Nolan, PT, MS, PCS, Department of Physical Therapy, Ithaca College-University of Rochester Campus, 300 East River Road, Suite 1-102, Rochester, NY 14623. Email: knolan@ithaca.edu

Grant support: This work was partially supported by a Maternal and Child Health Bureau Training Grant, Leadership in Education in Neuro-developmental and Related Disabilities, grant no. 6 T73 MC 00029-08-01 that provided a fellowship for Lori Mannato.

© 2004 Lippincott Williams & Wilkins, Inc.