1

INCREASING CONFIDENCE & COMPETENCE OF OT

Increasing Confidence and Competence of Occupational Therapists

in an Intensive Therapy Program

A Capstone Project
Submitted to the Rangos School of Health Sciences
Department of Occupational Therapy

Duquesne University

In partial fulfillment of the requirements for

the degree of Occupational Therapy Doctorate

By: Sudhee Acharya, OTS

Capstone Chairpersons: Retta Martin, MS, OTR/L and Amy Mattila, PhD, OTR/L

DCE Site Supervisor: Kahli Hale, MS, OTR/L

2
INCREASING CONFIDENCE & COMPETENCE OF OT

Introduction

Intensive therapy techniques utilizing the universal exercise unit (UEU) were developed

in Poland by Izabella and Richard Koscielny in 1999 (Genius 4 Kids, n.d.). Since then, these

practices have been trending in various countries to address strength and movement deficits in

children with a variety of cognitive and physical disabilities. However, due to the novelty of

these techniques, there is limited evidence available about the topic. Additionally, the

international formulation of these protocols has led to inadequate availability of local trainings in

the United States for therapists to learn about UEU treatment methods.

According to the American Occupational Therapy Association (AOTA) (2022), “it takes

about 17 years for research to enter clinical practice” (n.p.). While research is continuously being

conducted and published, clinical practice does not always reflect the most current, efficient, and

effective interventions available. Döpp (2011) reported that 53% of occupational therapists

(OTs) find the task of incorporating evidence into practice to be too effortful and time-

demanding in addition to other required job responsibilities. These common challenges of having

limited time and increased job responsibilities have also been impacting the occupational therapy

(OT) staff at Reach for Speech and their ability to integrate current research in order to advance

UEU services.

Reach for Speech is a pediatric outpatient clinic which offers occupational, physical, and

speech therapy services, as well as a variety of specialty programs (Kids Reach for Speech,

2022a; Kids Reach for Speech, 2022b). One of these specialty programs, the Intensive Strength

Clinic provides intensive OT and physical therapy (PT) using the UEU for children 2-years-old

and above who require improved strength, balance, coordination, and motor skills in order to

promote development and facilitate participation in meaningful activities (Kids Reach for
3
INCREASING CONFIDENCE & COMPETENCE OF OT

Speech, 2022a). Reach for Speech is one of the few sites offering intensive UEU therapy within

Pennsylvania and the tri-state area. Their 3-week specialty program began at the clinic in 2020

and has continued to grow and develop over time.

There are currently 5 staff members, including 2 OTs and 3 physical therapists (PTs)

working the clinic. While the program has been successful, there are various areas that staff have

not been able to progress due to limited time and resources. Specifically, on-site staff identified

various needs of the program including the utilization of objective OT outcome measures,

education about specialized treatment techniques, and consistent provision of discharge

resources for clients. Consequently, all of these areas require the integration of current evidence.

This capstone project will consist of a staff training program for OTs involved with the

Intensive Strength Clinic at the Robinson and Center Township Reach for Speech locations. By

gathering multi-modal learning resources, creating virtual educational modules, and establishing

opportunities for hands-on training, this project will aim to advance all areas of the therapeutic

process within this specialty clinic. Specifically, OT staff will receive training about new

evaluation tools and evidence-based intervention techniques, as well as the creation and

distribution of home programs.

Literature Review

Intensive Therapy

While benefits of intensive therapy have been identified in recent research, specific

characteristics regarding its duration and rigorousness continue to be investigated. It has been

found that 2 to 4 weeks of intensive therapy is an appropriate time frame for children to

experience significant advancements in functional performance (Koscielny, 2004). Furthermore,

alternating brief durations of intensive treatment with long resting periods results in functional
4
INCREASING CONFIDENCE & COMPETENCE OF OT

improvements while also providing individuals with opportunities to apply learned skills within

their day-to-day routines (Trahan and Malouin, 2002).

Intensive therapy has the potential to promote both neural and motor function in children.

Effective use of intensive therapy promotes the brain’s ability to solely focus on learning and

developing new motor movements, as its repetitive and active nature prevents opportunities for

nonuse patterns to set-in (Damiano, 2009). On the contrary, if a child demonstrates ineffective

motor behaviors, intensive techniques can also be used to correct muscular movement patterns

and promote optimal performance by “[re-educating] the brain” (Martins et al., 2015, p. 349).

From a motor standpoint, targeting specific muscles causes a decrease in the coactivation of

other muscles; this reduces energy expenditure and spasticity, while increasing motor control

(Koscielny, 2004).

OT Role in UEU Treatment

The UEU, in conjunction with meaningful activities, can improve trunk control, sensory

awareness, motor function, and overall occupational performance in children with

neurodevelopmental disabilities (Afzal et al., 2015; Afzal & Manzoor, 2017; Azab & Hamed,

2014; Martins et al., 2015). Through resistive activities, UEU treatment improves balance and

coordination in children with CP (Koscielny, 2004). Additionally, a form of UEU therapy with

the addition of a head-to-toe resistive garment, called suit therapy, was found to be effective in

improving postural reactions, strength of trunk musculature, and trunk control in a randomized

controlled trial involving children with CP (Azab & Hamed, 2014). These concepts of using

UEU therapy to address trunk deficits are crucial, as the establishment of proximal stability leads

to improvements in distal mobility, and ultimately leads to greater functional ability (Fabrizio &

Rafols, 2014).
5
INCREASING CONFIDENCE & COMPETENCE OF OT

UEU therapy also promotes sensory integration through vestibular and proprioceptive

input (Martins et al., 2015; Bailes et al., 2010). Specifically, strategic placement of bungee cords

presents opportunities for proprioceptive input through joint compressions of targeted muscle

groups (Martins et al., 2015). Additionally, jumping and rocking movements performed within

the UEU cage offer vestibular input, which facilitates opportunities for trunk correction and

improved balance (Bailes et al., 2010; Martins et al., 2015). Through the introduction of sensory

stimuli during UEU therapy, children with neurodevelopmental disabilities can develop adaptive

responses, increase body awareness, improve coordination, and build self-regulation skills—all

of which affect overall participation and occupational performance abilities (Martins et al., 2015;

O’Brien & Kuhaneck, 2020).

Several studies highlighted intensive UEU interventions that resulted in significant motor

and self-care improvements for children with neurodevelopmental disabilities (Afzal et al., 2015;

Afzal & Manzoor, 2017; Bailes et al., 2010; Bailes et al., 2011; Christy et al., 2012). A study

comparing the effectiveness of intensive neurodevelopmental treatment (NDT) and TheraSuit

programs for children with CP found that both interventions improved motor and self-care

function (Bailes et al., 2010). This suggests that integrating NDT handling techniques into UEU

therapy may be beneficial, as specific facilitation and inhibition methods can be used to further

regulate tone and promote movements while in the UEU cage (Barthel, 2010). Consequently,

Afzal et al. (2015) investigated the effects of combining NDT with UEU therapy, and found

significant improvement in gross motor skills and functional ability in children with CP.

The ability to integrate individualized and client-centered OT interventions within UEU

treatment has led to improvements in goal-attainment for many individuals (Afzal et al, 2015;

Christy et al., 2012). For example, including social activities, attention tasks, self-help training,
6
INCREASING CONFIDENCE & COMPETENCE OF OT

and organized play within UEU therapy were found to improve not only motor function, but also

social and self-help function of a child with autism (Afzal & Manzoor, 2017). Additionally,

Bailes et al. (2011) embedded the occupations of feeding and dressing into UEU therapy through

the use of utensil management and fastener manipulation tasks for a child with self-care goals;

these interventions were found to correlate directly with improvements in self-care function.

While intensive OT treatment using the UEU has proven to be effective, there is limited

evidence available. Numerous studies emphasized a need for research with larger samples and

broad populations to identify additional benefits and possibilities of UEU therapy (Afzal &

Manzoor, 2017; Bailes et al., 2010; Martins et al., 2017).

OT Outcome Measures

It has been difficult for OTs to distinct their unique role in UEU therapy using assessment

tools. Evidence has shown that the Gross Motor Function Measure (GMFM) is commonly used

by PTs to evaluate gross measure changes from UEU intervention (Christy et al., 2012; Martins

et al., 2015; Trahan and Malouin, 2002). Few studies indicate the use of objective OT outcome

measures for intensive therapy; however, one potential area of OT evaluation includes trunk

control. Characterizing proximal control can indicate the quality of distal mobility, and

ultimately the ability to perform functional tasks and occupations (Fabrizio & Rafols, 2014). The

Trunk Control Measurement Scale (TCMS) is a valid and reliable tool that measures static and

dynamic trunk control in sitting positions (Heyrman et al., 2011). This tool was developed

specifically for individuals with CP, so characteristics of neuromotor impairments are taken into

consideration within evaluation and scoring procedures (Heyrman et al., 2011). Likewise, the

Sitting Assessment test for Children with Neuromotor Dysfunction (SACND) assesses trunk tone

and stability when performing both static and reaching tasks (Knox, 2022). This valid and
7
INCREASING CONFIDENCE & COMPETENCE OF OT

reliable measure was found to be effective in assessing change within a child’s performance after

two weeks of intensive therapeutic intervention (Knox, 2022).

While this is not an objective measure, another tool that has been used with participants

in brief intensive therapy programs is the Pediatric Evaluation Disability Inventory (PEDI)

(Bailes et al., 2010; Bailes et al., 2011; Martins et al., 2015). This parent-report questionnaire

evaluates motor, social, and self-care function of children, and can be used to gather

supplemental information about occupational performance skills (Bailes et al., 2011).

Home Programs

Many intensive therapy programs include supplemental home protocols during treatment

periods and after discharge to promote carryover of established skills (Bailes et al., 2010; Christy

et al., 2012; Martins et al., 2015). Before providing family education and assigning home

protocols, several considerations must be made regarding parents and guardians’ schedules, as

well as comfort levels and knowledge regarding the techniques they are expected to perform

(Segal & Beyer, 2006). Additionally, due to its rigorous demands, intensive therapy programs

can be stressful for families (Christy et al., 2012). Strategies identified by OTs to reduce family

stress and promote compliance to home programs include providing education about program

effectiveness, utilizing a chart system to track completion, and conducting home program trial

periods before establishing their feasibility (Segal & Beyer, 2006).

Staff Training

Research has identified several training design components that are effective in

improving competence and confidence levels of OTs. The use of a blended learning model with

online and face-to-face components has been proven to improve participant learning outcomes

(Pizzi, 2014). Furthermore, scheduling dispersed training sessions allow therapists to have
8
INCREASING CONFIDENCE & COMPETENCE OF OT

opportunities to practice newly learned skills within the clinical setting (Doyle & Bennet, 2014).

Additionally, the involvement of real children and families within a pediatric therapist training

promotes practice-based learning and skill reinforcement (Bakuwa et al., 2020). Specific

educational methods that were found to increase therapists’ confidence and knowledge include

didactive presentations, role plays, review questions, practical treatments, group discussions,

self-reflection exercises, individual learning activities, and case studies (Bakuwa et al., 2020;

Brangan et al., 2015; Buchanan et al., 2014; Doyle & Bennett, 2014; Flink et al, 2016; Fortune et

al., 2019; Roberts et al., 2017).

Several studies also outlined therapists’ preferences when it comes to receiving

continuing education. Both online modules and small, face-to-face workshops are favored

methods of training (Piernik-Yoder & Beck, 2012; van Vuuren & Nel, 2013). Additionally,

evidence has shown that therapists like having opportunities for hands-on practice, receiving

demonstrations, and using supplemental print resources (books, manuals, etc.) when learning

new concepts (Piernik Yoder & beck, 2012; van Vuuren & Nel, 2013).

Conclusion

While the literature has outlined the variability of UEU intensive therapy, credibility of

multiple outcome measures, strategies for home program use, and efficacy of multi-modal staff

education methods, there is room to investigate effective training methods for OTs regarding

evaluation, intervention, and discharge procedures in an intensive pediatric therapy program.

Description of the Project

Target Population and Setting

The population of this Doctoral Capstone Experience (DCE) program includes OTs

involved with the Intensive Strength Clinic at the Center Township and Robinson Township
9
INCREASING CONFIDENCE & COMPETENCE OF OT

Reach for Speech locations. There are currently 2 individuals within this group, but it expected

that another OT will be hired within the program in the before this training is implemented.

Key Data from Needs Assessment

A needs assessment was conducted over a 2-week period at the Center Township and

Robinson Township Reach for Speech Locations. Data was gathered through observations, semi-

structured interviews, electronic surveys, and document reviews. Several stakeholders were

interviewed including 2 OTs and 2 PTs who run the Intensive Strength Clinic, a speech-language

pathologist (SLP) who had prior experience pushing into UEU sessions, and a parent of the child

who was enrolled in the clinic during that time. Additionally, surveys were sent to 9 families

who previously completed the intensive program. Towards the end of the need assessment, a

follow-up survey was sent to the 2 OTs and 2 PTs who provide Intensive Strength Clinic services

in order to prioritize the areas of need identified through interviews and observations.

Data reflected that staff had more prevalent areas of need compared to clients and their

families. 100% of OTs working in the Intensive Strength Clinic identified that increased

education about specialized techniques and the use of objective OT outcome measures were the

first and second-most prioritized need respectively. Additionally, 50% of therapists who run the

program reported development and consistent distribution of home programs as another need.

Goals and Objectives of the Project

The following goals and objectives outline how the desired overarching outcomes of the

Intensive Strength Clinic staff training program will be achieved:

I. By the end of the DCE, OTs will demonstrate increased competency with administering at

least one new outcome measure for clients in the Intensive Strength Clinic.
10
INCREASING CONFIDENCE & COMPETENCE OF OT

a. Upon completion of the asynchronous online training module within the evaluation-

focused learning unit, OTs will correctly answer at least 75% of knowledge check

questions with no more than 1 visual prompt.

b. After 2 in-person training sessions, 66% of OTs will be able to demonstrate scoring

on at least 1 new assessment of choice with no more than 2 verbal prompts.

II. In 14 weeks, OTs will have increased confidence with providing evidence-based and client-

centered interventions as demonstrated by scores improvements of at least 10% on the post-

intervention confidence scale.

a. After the first in-person training session of the intervention-focused learning unit,

OTs will be able to role-play at least 1 new treatment technique given a client

scenario with less than 3 verbal cues.

b. In 10 weeks, OTs will demonstrate achievement of at least 1 personal confidence goal

written at the beginning of the training as indicated by a self-reflection exercise.

Project Design, Description, and Structure

Through the establishment of a formal staff training program for OTs, this project will

enhance the current Intensive Strength Clinic at Reach for Speech. Therefore, this capstone

project can be described as quality improvement with a repeated measures design (DeIuliis &

Bednarski, 2019; Mattila et al., 2019). To utilize a repeated measures design, participants’

knowledge and confidence levels will be measured three times throughout the duration of the

training program (Mattila et al., 2019). A knowledge check quiz will be administered at the end

of each of the three learning units to gather data about participants’ competency levels over the

course of the program. Similarly, a confidence scale will be administered pre-, mid-, and post-

training to assess changes in participants’ confidence levels as they complete the training.
11
INCREASING CONFIDENCE & COMPETENCE OF OT

The Plan-Do-Study-Act framework will be used to support quality improvement within

the repeated measures design (Taylor et al., 2014). This model provides opportunities to

continually analyze participants’ performance, then modify the training program to best meet

their needs—ultimately improving the overarching quality of the program (Taylor et al., 2014).

The training program itself will take place over 8 weeks through synchronous and

asynchronous components. It will consist of 3 learning units, each focusing on different

components of the therapeutic process including evaluation, intervention, and discharge. Every

unit will include an online learning module and at least 1 face-to-face training session. There will

be 2 weeks dedicated to each learning unit, with 1-week breaks taking place between each one.

Project Implementation

Weeks 1-4 of the doctoral capstone experience will focus on training preparation. During

this time, collaboration with on-site staff will take place in order to select new OT outcome

measures and to identify appropriate activities for home programs. Also, during weeks 1-4,

content will begin to be gathered and organized for the first learning unit.

Weeks 5-13 is when training implementation takes place. Each learning unit will have 1

full week dedicated to preparation, and 2 weeks for implementation. Unit 1 learning materials

will be created during week 5, then implemented in 6-7. Likewise, unit 2 will be planned during

week 8, and implemented in 9-10. Finally, unit 3 will be organized during week 11, and

implemented in 12-13. Time permitting, preparation of learning materials may overlap with

implementation phases. For example, content for unit 2 may begin to be planned during weeks 6-

7 while the first unit is being implemented, and likewise for unit 3 during weeks 9-10.

Conclusion of the project will consist of compiling and organizing training materials for

program sustainability during week 14. The OTD candidate will work with on-site staff to plan
12
INCREASING CONFIDENCE & COMPETENCE OF OT

logistics regarding program continuity and to ensure the site is well-equipped to run the program

with future new hires. See Appendix D for a visual representation of project implementation.

Outcome Measures

All outcome measures will be created by the OTD candidate with reference to

standardized tools and published literature. See Appendix E for an outline of these measures.

Participants will complete a 9-item demographic questionnaire (see Appendix F)

consisting of multiple-choice and open-response questions on Qualtrics at the beginning of the

training program (Forsyth & Kviz, 2017). This will be used to gather information about

participants’ prior work and educational experiences (Hovick & Provident, 2018).

A confidence scale will be administered to participants at the beginning, middle, and end

of the training using Qualtrics (Axboe et al., 2016; Brangan et al., 2015; Hovick & Provident,

2018). This tool will be used to assess changes in staff confidence levels regarding the provision

of services within the Intensive Strength Clinic as they complete the training. The confidence

scale is in progress, as items will be finalized once specific training components are determined.

Knowledge check quizzes will be conducted with participants at the end of each learning

unit through Nearpod (Bakuwa et al., 2020; Buchanan et al., 2014). Scores will be monitored to

assess staff competence regarding evaluation, intervention, and discharge topics. The knowledge

quizzes are in progress, as items will be finalized once learning modules have been developed.

Satisfaction surveys consisting Likert-scale and open-ended items will be administered

through Qualtrics at the middle and end of the training (Brangan et al., 2015; Forsyth & Kyiz,

2017; Myers, 2019). Feedback from the mid-training survey (see Appendix G) will be used to

enhance remaining training activities, while feedback from the post-training survey (see

Appendix H) will inform resources left at the site for future program implementation.
13
INCREASING CONFIDENCE & COMPETENCE OF OT

Data Collection Plan

Data collection will occur through various mediums during several points of the training

(Flecky et al., 2020). See Appendix I for a visual representation of data collection procedures.

To gather pre-training data, a demographic questionnaire and confidence scale will be

emailed to participants during Week 4 of the DCE experience. During the training program,

knowledge checks will be administered during weeks 7, 10, and 13 through Nearpod. A mid-

training satisfaction survey and confidence scale will be emailed to participants during week 8.

To gather post-training data, a post-training satisfaction survey and a final confidence scale will

be emailed to participants upon completion of all learning units.

During the training, document reviews of completed learning activities will take place to

track participation (Flecky et al., 2020). Throughout the entire DCE, observations will be

completed during Intensive Strength Unit sessions to evaluate how training materials are being

used in clinical practice (Flecky et al., 2020). Additionally, informal interviews will be

conducted with on-site staff and families enrolled in the Intensive Strength Clinic to understand

their perceptions of the training program and integrate feedback as needed (Flecky et al., 2020).

Data Management and Analysis Plan

All collected data will be stored electronically and organized by date as well as category

(Finlayson & Denend, 2017). Descriptive statistics will be used to analyze quantitative data

(Taylor, 2017). Frequencies of Likert scale items will be compared on the demographic and

satisfaction questionnaires, and means of confidence scale scores and knowledge quiz scores will

be compared to assess improvements in each area over time (Taylor, 2017). Qualitative data

relating to staff feedback and demographic questionnaires will be analyzed through the use of

thematic coding using a codebook to identify overarching themes (Peacock & Paul-Ward, 2017).
14
INCREASING CONFIDENCE & COMPETENCE OF OT

Dissemination Goals and Scholarly Products

Several dissemination products can arise through the completion of this quality

improvement project. Results may be presented at local or national conferences such as those

hosted annually by the Pennsylvania Occupational Therapy Association (POTA) and American

Occupational Therapy Association (AOTA). Additionally, through the development of training

modules, UEU treatment protocols and family education materials will be created for future use.

The curriculum used in this program can also be used to develop a staff training handbook and

checklist for the site to utilize when training future new hires.
15
INCREASING CONFIDENCE & COMPETENCE OF OT

References

Afzal, F., & Manzoor, S. (2017). Universal exercise unit therapy has effects on social and motor

function of 8 years old hyperactive boy with Autism Spectrum Disorder. Journal of

University Medical & Dental College, 8(1), 60-64.

https://www.jumdc.com/index.php/jumdc/article/view/110

Afzal, F., Ahmed, H.I., Asim, H.M., Rasul, A., & Islam, A. (2015). Effects of Universal Exercise

Unit combined with conventional combination therapy on gross motor and functional

skills in spastic and athetoid cerebral palsy children. Int J Med Appl Health, 3(1), 28-24.

American Occupational Therapy Association. (2022). Evidence-based practice & knowledge

translation. https://www.aota.org/practice/practice-essentials/evidencebased-

practiceknowledge-translation

Axboe, M. K., Christensen, K. S., Kofoed, P. E., & Ammentorp, J. (2016). Development and

validation of a self-efficacy questionnaire (SE-12) measuring the clinical communication

skills of health care professionals. BioMed Central Medical Education, 16(1), 1-10.

https://doi.org/10.1186/s12909-016-0798-7

Azab, A. S. R., & Hamed, S. A. (2014). Effect of suit therapy on back geometry in spastic

Diplegic cerebral palsied children. Journal of American Science, 10(10), 245-51.

https://doi.org/10.13140/RG.2.1.3806.2161

Bailes, A. F., Greve, K., Burch, C. K., Reder, R., Lin, L., & Huth, M. M. (2011). The effect of

suit wear during an intensive therapy program in children with cerebral palsy. Pediatric

Physical Therapy, 23(2), 136-142. https://doi.org//10.1097/PEP.0b013e318218ef58

16
INCREASING CONFIDENCE & COMPETENCE OF OT

Bailes, A.F., Greve, K., & Schmitt, L.C. (2010). Changes in two children with cerebral palsy

after intensive suit therapy: A case report. Pediatric Physical Therapy, 22(1), 76-85.

https://doi.org/10.1097/PEP.0b013e3181cbf224

Bakuwa, T.C., Pilusa, S., & Salojee, G. (2020). The value of a short practical training course for

newly qualified therapists working with children with cerebral palsy in South Africa.

African Journal of Disability 9(0), e1-e12.

https://doaj.org/article/5da8df0559394153be1af807f8756028 

Barthel, K. (2010). A frame of reference for Neuro-Developmental Treatment. In P. Kramer & J.

Hinojosa (Eds.) Frames of reference for pediatric occupational therapy (3rd ed., pp. 187-

233). Lippincott, Williams, & Wilkins.

Brangan, J., Quinn, S., & Spirtos, M. (2015). Impact of an evidence-based practice course on

occupational therapist’s confidence levels and goals. Occupational Therapy in Health

Care, 29(1), 27-38. https://doi.org/10.3109/07380577.2014.968943

Buchanan, H., Siegfried, N., Jelsma, J., & Lombard, C. (2014). Comparison of an interactive

with a didactic educational intervention for improving the evidence-based practice

knowledge of occupational therapists in the public health sector in South Africa: a

randomised controlled trial. Trials, 15(216), 1-11.

https://doi.org/10.1186/1745-6215-15-216

Christy, J. B., Chapman, C. G., & Murphy, P. (2012). The effect of intense physical therapy for

children with cerebral palsy. Journal of Pediatric Rehabilitation Medicine, 5(3), 159-170.

https://doi.org/10.3233/PRM-2012-0208
17
INCREASING CONFIDENCE & COMPETENCE OF OT

Damiano, D. L. (2009). Rehabilitative therapies in cerebral palsy: The good, the not as good, and

the possible. Journal of child neurology, 24(9), 1200-1204.

https://doi.org/10.1177/0883073809337919

DeIuliis, E.D., & Bednarski, J.A. (2019). Understanding the ACOTE areas of focus for the

capstone. In E. D. DeIuliis & J. A. Bednarksi (Eds.), The entry level occupational

therapy doctorate capstone: A framework for the experience and project (pp. 38-58).

SLACK.

Döpp, C. M., Steultjens, E. M., & Radel, J. (2012). A survey of evidence‐based practise among

Dutch occupational therapists. Occupational Therapy International, 19(1), 17-27.

https://doi.org/10.1002/oti.324

Doyle, S.D., & Bennett, S. (2014). Feasibility and effect of a professional education workshop

for occupational therapists’ management of upper-limb poststroke sensory impairment.

American Journal of Occupational Therapy, 68(3), e74– e83.

http://dx.doi.org/10.5014/ajot.2014.009019

Fabrizio, A., & Rafols, J. (2014). Optimizing abilities and capacities: Range of motion, strength,

and endurance. In M. V. Radomski & C. A. Trombly- Latham (Eds.), Occupational

therapy for physical dysfunction (7th ed., pp. 589-613). Lippincott Williams & Wilkins.

Finlayson, M., & Denend, T.V. (2017). Entering, storing, and managing data. In R.R. Taylor &

G. Kielhofner (Eds.), Research in occupational therapy: Methods of inquiry for

enhancing practice (pp.  313-329). F.A. Davis Company.

Flecky, K., Doll, J.D., & Scaffa, M.E. (2020). Program planning and needs assessment. In M.E.

Scaffa & S.R. Reitz (Eds.), Occupational therapy in community and population health

practice (pp. 74-93). F.A. Davis Company.

18
INCREASING CONFIDENCE & COMPETENCE OF OT

Flink, M., Bertilsson, A. S., Johansson, U., Guidetti, S., Tham, K., & Von Koch, L. (2016).

Training in client-centeredness enhances occupational therapist documentation on goal

setting and client participation in goal setting in the medical records of people with

stroke. Clinical Rehabilitation, 30(12), 1200-1210.

https://doi.org/10.1177/0269215515620256

Fortune, J., Breckon, J., Norris, M., Eva, G., & Frater, T. (2019). Motivational interviewing

training for physiotherapy and occupational therapy students: effect on confidence,

knowledge and skills. Patient education and counseling, 102(4), 694-700.

https://doi.org/10.1016/j.pec.2018.11.014

Forsyth, K., & Kviz F.J. (2017). Survey research. In R.R. Taylor & G. Kielhofner

(Eds.), Research in occupational therapy: Methods of inquiry for enhancing

practice (pp.  375-394). F.A. Davis Company.

Genius 4 Kids. (n.d.). Universal Exercise Unit. http://www.genius4kids.com/Main/5-UEU-

E1.htm

Heyrman, L., Molenaers, G., Desloovere, K., Verheyden, G., De Cat, J., Monbaliu, E., & Feys,

H. (2011). A clinical tool to measure trunk control in children with cerebral palsy: The

trunk control measurement scale. Research in Developmental Disabilities, 32(2011),

2624-2635. https://doi.org/10.1016/j.ridd.2011.06.012

Hovick, S., & Provident, I. (2018). Increasing Rehabilitation Therapists’ Confidence Utilizing

Evidence-Based Interventions: Pilot Study. The Internet Journal of Allied Health

Sciences and Practice, 16(4), 1-8. https://doi.org/10.46743/1540-580X/2018.1759

Kids Reach 4 Speech. (2022a). Intensive Clinics & Specialty Programs.

https://www.kidsreach4speech.com/intensive-clinics-specialty-programs/
19
INCREASING CONFIDENCE & COMPETENCE OF OT

Kids Reach 4 Speech. (2022b). Reach for Speech. https://www.kidsreach4speech.com/

Knox, V. (2002). Evaluation of the sitting assessment test for children with neuromotor

dysfunction as a measurement tool in cerebral palsy. Physiotherapy, 88(9), 534-541.

https://doi.org//10.1016/S0031-9406(05)60136-8

Koscielny, R. (2004, March). Cerebral Palsy Magazine. 2(1), 12-14.

Martins E., Cordovil R., Oliveira R., Pinho J., & Vaz J.R. (2017). The immediate effects of

Therasuit® on the gait pattern of a child with unilateral spastic cerebral palsy. Journal of

Pediatric Neurological Disorders 3(1), 1-4.

https://doi.org/10.4172/2572- 4983.1000S1011

Martins, E., Cordovil, R., Oliveira, R., Letras, S., Lourenço, S., Pereira, I., Ferro, A., Lopes, I.,

Silva, C.R., & Marques, M. (2015). Efficacy of suit therapy on functioning in children

and adolescents with cerebral palsy: A systematic review and meta-

analysis. Developmental medicine & child neurology, 58(4), 348-360.

https://doi.org/10.1111/dmcn.12988

Mattila, A. M., Donoso Brown, E. V., & Blaskowitz, M. (2019). Supporting sustainability of the

capstone project through program evaluation. In E. D. DeIuliis & J. A. Bednarksi

(Eds.), The entry level occupational therapy doctorate capstone: A framework for the

experience and project (pp. 155-175). SLACK.

Myers, C. (2019). Occupational therapists’ perceptions of online competence assessment and

evidence-based resources. American Journal of Occupational Therapy, 73(2), 1-8.

https://doi.org/10.5014/ajot.2019.029322
20
INCREASING CONFIDENCE & COMPETENCE OF OT

O’Brien, J.C., & Kuhaneck, H. (2020). Using occupational therapy models and frames of

reference with children and youth. In J.C. O’Brien & H. Kuhaneck (Eds.), Occupational

therapy for children and adolescents (8th ed., pp. 18-45). Elsevier.

Peacock, N., & Paul-Ward, A. (2017). Contemporary tools for managing and analyzing

qualitative data. In R.R. Taylor & G. Kielhofner (Eds.), Research in occupational

therapy: Methods of inquiry for enhancing practice (pp.  214-227). F.A. Davis Company.

Piernik-Yoder, B., & Beck, A. (2012). The use of standardized assessments in occupational

therapy in the United States. Occupational Therapy in Health Care, 26(2-3), 97-108.

https://doi.org/10.3109/07380577.2012.695103

Pizzi, M. A. (2014). Blended learning pedagogy: The time is now!. Occupational therapy in

health care, 28(3), 333-338. https://doi.org/10.3109/07380577.2014.908479

Roberts, M. J., Fitzgerald, D., & Molineux, M. (2017). Educating occupational therapists in the

use of theory and evidence to enhance supervision practice. The Open Journal of

Occupational Therapy, 5(4), 1-8. https://doi.org/10.15453/2168-6408.1356

Segal, R., & Beyer, C. (2006). Integration and application of a home treatment program: A study

of parents and occupational therapists. American Journal of Occupational Therapy, 6(5),

500–510. https://doi.org/10.5014/ajot.60.5.500

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic

review of the application of the plan–do–study–act method to improve quality in

healthcare. BMJ Quality & Safety, 23(4), 290-298. http://dx.doi.org/10.1136/bmjqs-2013-

001862
21
INCREASING CONFIDENCE & COMPETENCE OF OT

Taylor, R.R. (2017). Deciding on an approach to data analysis. In R.R. Taylor & G. Kielhofner

(Eds.), Research in occupational therapy: Methods of inquiry for enhancing

practice (pp.  330-341). F.A. Davis Company.

Trahan, J., & Malouin, F. (2002). Intermittent intensive physiotherapy in children with cerebral

palsy: A pilot study. Developmental Medicine and Child Neurology, 44(4), 233-239.

https://www.cambridge.org/core/journals/developmental-medicine-and-child-

neurology/article/intermittent-intensive-physiotherapy-in-children-with-cerebral-palsy-a-

pilot-study/4E9183C0D0CE09E95E5E4B710C2293DC

Upton, D., Stephens, D., Williams, B., & Scurlock-Evans, L. (2014). Occupational Therapists'

attitudes, knowledge, and implementation of evidence-based practice: a systematic

review of published research. British Journal of Occupational Therapy, 77(1), 24-38.

https://doi.org/10.4276/030802214X13887685335544

van Vuuren, S., & Nel, M. (2013). A clinical skills unit: Addressing the need for continued

professional development (CPD) in allied health professions. South African Journal of

Occupational Therapy, 43(3), 41-46. http://www.scielo.org.za/scielo.php?pid=S2310-

38332013000300007&script=sci_arttext&tlng=es
22
INCREASING CONFIDENCE & COMPETENCE OF OT

Appendix A

Evidence Table A: Relevant Quantitative Studies

First Research Question Research Population Measures Relevant Findings Lev

author/date Design Evid
Afzal What are the effects of UEU Quasi- 25 children between 3- GMFM, Canadian Significant improvements in gross Lev
(2015) treatment on gross motor and experimental 14 years old with Occupational motor and functional skills were seen
functional skills of children study spastic or athetoid CP Performance Measure after 3 months of UEU therapy (5 days
with CP? in Pakistan (COPM) a week, 1 hour per day).
Afzal What is the effect of UEU Case Study 8-year-old male with PEDI UEU combined with “social skills Lev
(2017) therapy on social and motor autism in Pakistan training, attending skills training, and
function of an 8-year old male adaptive sports activities can change
with autism? motor function, self-help function and
social function of a child with autism”
(p. 60)
Axboe What are the psychometric Cross- 292 Danish Self-Efficacy The SE-12 established acceptable Leve
(2016) properties of a new self- Sectional physicians, nurses, Questionnaire (SE-12) reliability and validity, but tool
efficacy questionnaire (SE-12) Study PTs, OTs, midwives, adjustment and further testing is
that evaluates Danish *not provided by and health assistance necessary.
authors
healthcare workers’
communication skills?
Azab What is the effect of suit Randomized 30 children between 7- Formetric instrument Suit therapy in conjunction with Lev
(2014) therapy on back geometry in Controlled 9 years old with system regular PT is effective in “improving
children with spastic diplegic Trial spastic diplegia the back geometry” (p. 250) and
CP? “posture reactions, trunk muscle
strength, trunk control, and…motor
and sensory awareness” (p.250).
Bailes What are the “effects of Case Report 2 children with spastic PEDI, GMFM, 3-D gait A 3-week Intensive OT & PT program Lev
(2010) intensive suit therapy on gait, diplegic CP analysis (4 hours a day for 5 days a week) using
functional skills, caregiver the Therasuit Method was found to
assistance, and gross motor cause minimal improvements in gross
ability in children with CP” (p. motor skills, self-care function, and
76)? gait patterns.
Bailes What are the effects of Randomized 20 children with CP PEDI Significant differences were not found Lev
23
INCREASING CONFIDENCE & COMPETENCE OF OT
(2011) TheraSuit wear during
intensive occupational and
physical therapy of 20 children
with CP?
Bakuwa How does a 6-day continuing
(2020) education training about
pediatric CP affect self-
perceived knowledge,
attitudes, and behaviors of
OTs, PTs, and SLPs in South
Africa?
Brangan How does a 1 day evidence-
(2015) based practice (EBP) course
influence confidence levels of
Irish OTs?
Buchanan What are the differences
(2014) between interactive and
didactive EBP trainings on
knowledge, attitudes, and
behavior of OTs in South
Africa?
Christy How does an intensive PT
(2012) program affect “gross motor
function, community walking
and participation in children
with CP” (p. 159)?
Döpp What are Dutch OTs’
(2012) perceptions and experiences of
EBP?
Controlled between groups, but children who
Trial wore TheraSuits during an intensive
therapy program had significant
within-group improvements in motor
and self-care functions.
Secondary Pediatric OTs, PTs, & Researcher-created The practice-based training resulted in Leve
Analysis SLPs in South Africa General Information significant changes in knowledge and
Form, Knowledge positive impacts on attitudes and
Questionnaire, behavior of participants.
Evaluation Form
Single group 137 OTs in Ireland Evidence-Based Practice Participants displayed significant Lev
Pretest- who were members of Confidence Scale (EPIC improvements in confidence levels
Posttest the Association of scale) after the training.
Design Occupational
*not provided by Therapists of Ireland
authors
Randomized 98 OTs in South Shortened Adapted Both interactive and didactive training Lev
Controlled Africa Fresno Test of methods are effective for causing
Trial Competence in EBP significant improvements in
(SAFT), Modified knowledge for OTs.
version of Knowledge,
attitude, and behavior
questionnaire (KABQ)
Single group 17 children with CP GMFM, COPM, Step The 3-week intensive program (four Lev
Pretest- Watch Activity Monitor hours a day for 5 days a week) was
Posttest (SAM), Pediatric found to have significant immediate
Design Outcomes Data effects on motor function, goal
Collection Instrument performance, and perceived health, but
(PODCI) improvements in walking were not
detected.
Descriptive 100 Dutch OTs who Online survey including - 53% of OTs reported that Leve
Study were members of the rating-scale items and incorporating evidence is too time-
*not provided by Dutch Association of demographic questions demanding and effortful
authors
Occupational Therapy
24
INCREASING CONFIDENCE & COMPETENCE OF OT
Doyle How does an 8-hour training
(2014) about post-stroke sensory
deficits affect the perceived
behavior, knowledge, and
attitudes of OTs?
Flink How does a training about
(2016) client-centered practice affect
documentation and goal-
writing produced by OTs
working in inpatient
rehabilitation hospitals in
Sweden?
Fortune How does a 3-day training
(2019) about motivational
interviewing affect knowledge
and confidence of OT & PT
students?
Heyrman What are the psychometric
(2011) qualities of the Trunk
Controlled Measurement Scale
(TCMS)?
Hovick How does a 6-week EBP
(2018) training influence confidence
levels of rehabilitation
therapists at a SNF?
Knox What is the applicability of the
(2022) Sitting Assessment test for
- 67.4% of OTs reported that
determining the quality of evidence
is the most present barrier to using
EBP
Quasi- 19 OTs who work Researcher-designed Participants demonstrated statistically Lev
Experimental with stroke patients questionnaire, Patient- significant changes in attitudes,
Study with a Practitioner Orientation confidence, & knowledge regarding
Single-Group Scale (PPOS) post-stroke impairment.
Pretest-
Posttest
Design
Randomized 133 Swedish OTs Analysis of Training participants were found to Lev
Controlled working in inpatient documentation written document significantly greater
Trial rehabilitation for 279 clients using a amounts about goal progression and
researcher-developed client participation.
protocol
Prospective 25 OT & PT students Motivational The training significantly improved Lev
Quasi- Interviewing Knowledge confidence levels and skillset of
Experimental and Attitudes Test participants, but knowledge levels
Design (MIKAT), Motivational remained constant after intervention.
Interviewing Treatment
Integrity Scoring tool
(MITI)
Cross- 26 children with CP TCMS The TCMS is a valid and reliable. tool Leve
Sectional and 30 children with that can be used to assess static and
Study typical development dynamic trunk control in children with
*not provided by CP.
authors
Pilot Study 11 SNF rehabilitation Evidence-Based Practice The training improved participants’ Lev
therapists (OTs, Profile Questionnaire understanding of EBP, but not their
OTAs, PTs, PTAs, (EBPPQ) confidence levels.
SLPs)
Case Study 4-year-old female with SACND The SACND is a valid and reliable Lev
spastic diplegic CP tool that was effective in assessing
25
INCREASING CONFIDENCE & COMPETENCE OF OT
Children with Neuromotor
Dysfunction (SACND) to a
child with CP?
Martins What are the immediate effects
(2017) of TherSuit on the gait of a
child with left spastic
hemiplegia?
Myers What are OTs’ perceptions of
(2019) NBCOT Navigator?
Piernik- How are standardized
Yoder assessments used in OT
(2012) practice?
Trahan What are the effectives of a
(2002) program “combining intensive
therapy periods with periods
without therapy” (p. 233) and
what are the effects of
intensive therapy on motor
function of children with CP?
van What are the continuing
Vuuren professional development
(2013) needs of allied health
professionals in South Africa?
trunk tone and stability during resting
and reaching activities for a child with
CP.
Single-Case 5-year-old female with GMFM, Functional TheraSuit had positive influences on Lev
Quasi- left spastic hemiplegia Mobility Scale, Range of gait patterns, but additional research
Experimental Motion (ROM), with larger samples are necessary.
Study Observational Gait
Analysis
Cross 266 OTs Researcher-Created - 93% of OTs reported that evidence- Leve
Sectional Survey (administered via based resources were helpful
Study Qualtrics) - An online competence assessment
can benefit practitioners’ clinical
skills.
- survey feedback can be used to
modify educational materials
according to participants’ needs.
Descriptive 794 OTs across 10 Modified version of Pediatric OTs use standardized Leve
Study practice settings Clinicians Experiences assessments more frequently than other
*not provided by with Clinical Measures settings; several barriers influence the
authors
survey ability to use standardized assessments
in practice
Multiple- 5 children with GMFM - 4 -week periods of intensive therapy Lev
Baseline spastic, athetoid, or mixed with 8-week periods without
Design Pilot ataxic CP therapy is tolerable and can be
Study effective in maintaining
improvements in motor function.
- Improvements in motor function
were seen after each intensive period.
Descriptive, 127 allied health Researcher-developed - 85% of professionals prefer learning Leve
Comparative professionals (OTs, questionnaire through demonstrations and hands-on
Study PTs, qualified practice
dieticians) in South - Professionals favor receiving training
Africa form individuals in their own field
26
INCREASING CONFIDENCE & COMPETENCE OF OT
First Research Question
author/date
Pizzi (2014) What are the benefits of
utilizing a blended learning
model in academia?
Roberts What are effective planning
(2017) and implementation
procedures of a training to
enhance supervisory
procedures within an OT
department of a hospital
system?
Segal (2006) What are therapist and
parent perceptions
regarding the strategies and
barriers of completing
brushing home protocol?
Appendix B
Evidence Table B: Relevant Qualitative Studies
Research Design
Exploratory Study
*not provided by authors
Exploratory Study
*not provided by authors
Phenomenology
*not provided by authors
Population Data Gathering Relevant Findings
28 OT & PT Online survey (pre-, mid-, and A blended learning model
students post-course) (consisting of several online and
face-to-face activities) can enhan
student learning and outcomes.
48 OTs receiving Manchester Clinical Using a mixture of educational
and providing Supervision Scale & semi- methods (online, face-to-face,
supervisory services structured interviews used to worksheets, videos, etc.) can be
within the Gold gather perceptions about beneficial to participant learning
Coast Hospital supervisory procedures and
system needs prior to intervention
design
8 OTs & 6 parents Semi-Structured Interviews - Parent-identified barriers to ho
or guardians of program adherence include ch
children with special discomfort, transition difficult
needs challenging behaviors, and bus
schedules.
- OT-identified strategies for ho
program compliance include
increased education, tracking
systems, and trial periods.
27
INCREASING CONFIDENCE & COMPETENCE OF OT

Appendix C

Evidence Table C: Relevant Systematic Reviews (SR), Meta-Analyses (MA) or Scoping Reviews

First author/date Formulated Research Number/Type of Studies Key Characteristics Summary of Evidence, & Conclusions
Question Design in Review
Damiano (2009) What are positives Scoping 34 qualitative and - Participants include children with - The repetitive nature of intensive
and negatives of Review quantitative studies CP therapy can promote neural
current PT *not provided by - Topics include previous and new advancement.
treatment authors PT treatment approaches - Brain plasticity can promote the
techniques for development of adaptive changes in
children with CP? children with CP.
Martins (2015) What are the Systematic 4 Randomized - Interventions included any type - Intensive suit therapy has positive
effects of suit Review & Controlled Trials of suit therapy (TheraSuit, Adeli effects on motor performance and
therapy for Meta- suit, Bungy suit, etc.) function, but they are not significant
children with CP? Analysis - Participants included children 0- - Limited evidence is available regardin
18 years old with CP the efficacy of suit therapy.
- Primary outcome measures
included the GMFM & PEDI
Taylor (2014) How has the Plan- Systematic 73 studies using the - Interventions included isolated - The PDSA framework can support QI
Do-Study-Act Review PDSA framework and iterative PDSA cycles in healthcare settings.
(PDSA) - QI took place in acute care, - PDSA has been interpreted and utilize
framework been community-based, and inconsistently among studies.
used in quality organizational settings
improvement
studies about
healthcare?
Upton (2014) What are OTs’ Systematic 32 studies (including - Topics included attitudes, - Several barriers prevent OTs from
perceived Review 23 quantitative, 8 knowledge, and barriers of EBP integrating evidence into practice
knowledge, qualitative, & 1 mixed- - Participants included OTs from - OTs generally have positive attitudes
attitudes, and methods design) multiple countries; some studies about EBP
barriers of EBP? also included other allied health - OTs have limited confidence regardin
professionals their ability to use EBP
28
INCREASING CONFIDENCE & COMPETENCE OF OT

Appendix D

Program Implementation Graphic

29
INCREASING CONFIDENCE & COMPETENCE OF OT
30
INCREASING CONFIDENCE & COMPETENCE OF OT

Appendix E

Outcome & Analysis Table

Project Outcomes Instrument Analysis Methods Literature

Competence Levels - Knowledge Check - Descriptive - Bakuwa et al.

Quiz Statistics (2020)
- Demographic - Buchanan et al.
Questionnaire (2014)

Confidence Levels - Confidence Scale - Descriptive - Axboe et al.

- Demographic Statistics (2016)
Questionnaire - T-tests - Brangan et al.
(2015)
- Hovick &
Provident (2018)

Participant Satisfaction - Mid-Training - Descriptive - Brangan et al.

Satisfaction Statistics (2015)
Survey - T-tests - Myers (2019)
- Post-Training - Thematic Coding
Satisfaction
Survey
 31
INCREASING CONFIDENCE & COMPETENCE OF OT

Appendix F

Demographic Survey

Demographic Survey

Please complete the following questions about your prior work and educational experiences before
participating in the Intensive Strength Clinic training program.

1. Name:

2. What is your position at Reach for Speech?

3. What is your work schedule?

 Full-Time
 Part-Time
 Other

4. Which Reach for Speech locations do you work at? (Select all that apply)
 Center Township
 Robinson Township
 Moon Township

5. Highest Level of Occupational Therapy Education Earned:

 Bachelors
 Masters
 Doctorate

6. Years of experience as an occupational therapist:

 Less than 1 year
 1-5 years
 6-10 years
 11+ years

7. Years of experience in the Intensive Strength Clinic:

 Less than 1 year
 1-5 years
 6-10 years
 11+ years

8. Have you received prior training about the Intensive Strength Clinic?
 Yes
 No

9. If you answered “yes” to the question above, please describe your prior training
experience(s).

This survey was designed with reference to Hovick & Provident (2018)
32
INCREASING CONFIDENCE & COMPETENCE OF OT

Appendix G

Mid-Training Satisfaction Survey

Mid-Training Satisfaction Survey

Please complete the following questions to describe your satisfaction with the training program so
far. Your feedback will be integrated into the remainder of the training
Mark your response for each of the following statements:
1. The training content is helpful for my learning.
 Strongly  Somewhat  Neither agree  Somewhat  Strongly 2.
disagree disagree nor disagree agree agree 2.
2.
In person activities are scheduled at appropriate times.
 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

3. I have sufficient time to complete asynchronous learning activities.

 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

4. The training workload is realistic for my schedule.

 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

5. The trainer is available to answer questions about training content.

 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

Please rate your satisfaction with each of the following learning methods:
1. Nearpod Lessons
 Extremely  Somewhat  Neither satisfied  Somewhat  Extremely
dissatisfie dissatisfied nor dissatisfied satisfied satisfied 2.
d 2.
Role Plays
 Extremely  Somewhat  Neither satisfied  Somewhat  Extremely
dissatisfie dissatisfied nor dissatisfied satisfied satisfied 3.
d 3.
Video Analysis Activities
 Extremely  Somewhat  Neither satisfied  Somewhat  Extremely
dissatisfie dissatisfied nor dissatisfied satisfied satisfied 4.
d 4.
Group Discussions
33
INCREASING CONFIDENCE & COMPETENCE OF OT

 Extremely  Somewhat  Neither satisfied  Somewhat  Extremely

dissatisfie dissatisfied nor dissatisfied satisfied satisfied
d
Keep, Stop, Start
Type your responses to the following questions:

1. What parts of the training should the instructor keep doing?

2. What parts of the training should the instructor stop doing?

3. What should the instructor start doing in the training?

 34
INCREASING CONFIDENCE & COMPETENCE OF OT

This survey was designed with reference to Brangan et al. (2015) & Myers (2019)
35
INCREASING CONFIDENCE & COMPETENCE OF OT

Appendix H

Post-Training Satisfaction Survey

Post-Training Satisfaction Survey

Please complete the following questions to describe your satisfaction with the training program so
far. Your feedback will be integrated into the remainder of the training

Mark your response for each of the following statements:

1. The training content was helpful for my learning.
 Strongly  Somewhat  Neither agree  Somewhat  Strongly 2.
disagree disagree nor disagree agree agree 2.
2.
In person activities were scheduled at appropriate times.
 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

3. I had sufficient time to complete asynchronous learning activities.

 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

4. The training workload was realistic for my schedule.

 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

5. The instructor was available to answer questions about training content.

 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

6. The mid-training feedback I provided was applied to the rest of the training.
 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

7. Material taught in the training can be integrated into the Intensive Strength Clinic.
 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree

8. I would recommend this training program to a co-worker.

 Strongly  Somewhat  Neither agree  Somewhat  Strongly
disagree disagree nor disagree agree agree
 36
INCREASING CONFIDENCE & COMPETENCE OF OT

Type your responses to the following questions:

9. What parts of the training program did you find to be effective?

10. What parts of the training were ineffective and should not be used in the future?

11. Please provide any additional feedback about the training (optional).

This survey was designed with reference to Brangan et al. (2015) & Myers (2019)
37
INCREASING CONFIDENCE & COMPETENCE OF OT

Appendix I

Data Collection Graphic