Online Occupational Therapy on Occupational Balance, Well-being and Quality of Life in Syrian Refugee Children
Condition: Occupational Balance; Well-being; Quality of Life; Occupational Therapy; Refugee; Children
Study type: Interventional

Summary: 
      Cognitive and learning difficulties created by traumatic events related to difficulties and
      trauma experienced during the Syrian civil war and resettlement period in Turkey might have
      been complicated by the limitations of the COVID19 pandemic. Thus, it is of utmost importance
      to find out and implement effective and feasible ways of intervention to ameliorate adverse
      effects of the refugee experience and COVID19 pandemic on cognitive functions, well-being,
      quality of life, and occupational balance in these children. Thus, this research was designed
      a randomized controlled trial in which examining the effects of a customized online
      occupational training program encompassing various activities on the aforementioned aspects
      of refugee children resettled in Turkey.

      The present study was designed as a randomized controlled study, including pre-post testing.
      Occupational balance, well-being and health-related quality of life were evaluated via the
      Occupational Balance Questionnaire (OBQ11), Well Star Scale (WSS) and the Pediatric Quality
      of Life Inventory (PedsQL). The intervention group attended online occupational therapy
      classes. Online classes were carried out as 5 sessions per week, each session lasting 1 hour,
      for 3 weeks. Questionnaires performed at the outset of the study and following the training
      program. Overall, 52 refugee children were randomized into intervention and control groups,
      each including 26 children. The mean WSS, PedsQL and OBQ11 scores significantly improved in
      the intervention group than in the control group. This was the first study investigating the
      effects of a customized online training course on well-being, occupational balance and
      quality of life in Syrian refugee children, also affected unfavorably by COVID19 lockdown.
      The results showed significant improvements in all study scales that we used to quantify the
      alterations in the aforementioned traits.
    

Detailed description: 
      Occupational Balance Questionnaire (OBQ11), Well Star Scale (WSS), and the Pediatric Quality
      of Life Inventory (PedsQL) were administered to the children before and after the
      intervention, and the results were compared.

      Occupational Balance Questionnaire (revised version, OBQ11) This questionnaire is used to
      assess the activity-role balance according to the level of contention and to define the
      variety of the activities and occupational balance based on the results of obtained data. A
      reliability and validity study of the Turkish version was conducted by Gunal et al. Each item
      in the OBQ is scored between zero (strongly disagree) and 3 (strongly agree). The total score
      varies between 0 and 33 points. Higher scores indicate better occupational balance.

      The Well-Star Scale The Well Star Scale developed by Korkut-Owen et al. consists of 24 items
      and 5 dimensions. In its broadest meaning, well-being is a concept that means to be well in a
      number of dimensions of life and is explained by a series of models. This scale evaluates an
      individual's well-being state, making sense of life, and being target-oriented in the context
      of cognitive, emotional, physical, and social dimensions. The scores that can be obtained
      from the scale ranges between 24 and 120. Higher scores indicate that an individual view
      their well-being favorably. Subscores of this scale can be calculated in various dimensions
      as well.

      Pediatric Quality of Life Inventory (PedsQL) The Pediatric Quality of Life Inventory is used
      to assess the health-related quality of life of the subjects. The reliability and validity
      study of the Turkish version was performed by Memik el al. Physical, emotional, social, and
      school functioning are among the key scales included in this survey. This inventory is a
      useful tool for assessing the health-related quality of life of healthy children and
      adolescents, as well as those with acute and chronic illnesses, in big groups such as schools
      and hospitals. The PedsQL inventory consists of 23 items that are scored between 0 and 100.
      When a question is answered as "never", 100 points are given. "Almost never," "sometimes,"
      "often," and "almost always" answers are given 75, 50, 25, and 0 points, respectively. The
      items of the PedsQL cover school functioning and core dimensions of health described by the
      WHO, including consists of physical health, emotional functioning and social functioning.
      Three summary scales are scored based on the answers given to inventory questions: total
      scale score (TSS), physical health summary score (PHSS), and psychosocial health summary
      score (PsHSS). Psychosocial health summary score is composed of scores obtained from the
      scales of emotional (EFS), social (SFS), and school functioning (ScFS). Higher PedsQL scores
      indicate the better health-related quality of life. Brevity, easy applicability, and scoring
      by the investigator and the short time needed to complete are important advantages of the
      inventory. Total PedsQL score=Arithmetic averages of PHSS and PHSS (PHSS= averages of EFS,
      SFS, and ScFS).

      52 refugee children were randomized into intervention and control groups, each including 26
      children. All study participants (52 refugee children) continued taking classes from the EBA
      program as part of their routine education plan. Only children in the intervention group
      attended web-based occupational therapy classes. Online classes were carried out as 5
      sessions per week, each session lasting 1 hour, for 3 weeks. In total, 15 sessions were
      performed during the study period. Group activities were performed through the Zoom
      application by means of a video camera. Online group activities included painting and cake
      making together, sports activities to be performed simultaneously with the movements shown by
      the researcher, memory games, and games that can be played with the group, such as the
      categories game.

      At the same time, children were asked to interpret idioms and proverbs and to express what
      they understood from the book they needed to read daily by choosing a different person in the
      group every day. Sports activities comprised the movements demonstrated by researcher through
      online Zoom meeting performed simultaneously with all group members. These sports activities
      were performed in the last 15 minutes of group activities, 5 days a week, in order to
      increase the physical activity level of children whose physical activities decreased during
      the lockdown period at home.

      Apart from the web-based training to be held with the group, an occupational balance program
      chart was created for individuals and applied through a single-person online session to
      organize daily routines and occupations and to perform activities in a balanced way. This
      chart comprised what children did hour by hour from waking up to bedtime. The children were
      asked to apply this chart 6 days a week while Sunday was considered as a resting day. The
      routine daily chart included test solving (50 questions a day), reading a book, learning an
      idiom and a proverb, and playing 10 games from the Mental Up application. The child played 10
      games from this application for 3 weeks, 6 days a week, and sent the score they got to the
      researcher via the WhatsApp application on a daily basis. The winner of the day was announced
      in the WhatsApp group in which all the children were involved to create a competitive
      environment and to ensure their motivation.
    

Intervention name(s): Occupational Therapy
Intervention type(s): Behavioral
Intervention description(s): online occupational therapy sessions are based on the activity training
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This prospective studies that measure the effectiveness of occupational therapy intervention. Randomized controlled trials (RCT) are prospective studies that measure the effectiveness of a new intervention or treatment. Participants are recruited and randomly assigned to either the intervention or the comparator group. It is important to ensure that at the time of recruitment there is no knowledge of which group the participant will be allocated to; this is known as concealment. It is examined whether there is any difference in the results of the study intervention and also the intervention and control group are compared.
Masking: Single (Investigator)
Primary purpose: Treatment