Mary Khetani - Academia.edu (original) (raw)

Papers by Mary Khetani

Pediatric Critical Care Medicine, 2015

To determine the feasibility of conducting a longitudinal prospective study to evaluate functiona... more To determine the feasibility of conducting a longitudinal prospective study to evaluate functional recovery and predictors of impaired functional recovery in critically ill children. Prospective pilot study. Single-center PICU at McMaster Children's Hospital, Hamilton, Canada. Children aged 12 months to 17 years, with at least one organ dysfunction, limited mobility or bed rest during the first 48 hours of PICU admission, and a minimum 48-hour PICU length of stay, were eligible. Patients transferred from a neonatal ICU prior to ever being discharged home, already mobilizing well or at baseline functional status at time of screening, with an English language barrier, and prior enrollment into this study, were excluded. None. The primary outcome was feasibility, as defined by the ability to screen, enroll eligible patients, and execute the study procedures and measurements on participants. Secondary outcomes included functional status at baseline, 3 and 6 months, PICU morbidity, and mortality. Functional status was measured using the Pediatric Evaluation of Disability Inventory and the Participation and Environment Measure for Children and Youth. Thirty-three patients were enrolled between October 2012 and April 2013. Consent rate was 85%, and follow-up rates were 93% at 3 months and 71% at 6 months. We were able to execute the study procedures and measurements, demonstrating feasibility of conducting a future longitudinal study. Functional status deteriorated following critical illness. Recovery appears to be influenced by baseline health or functional status and severity of illness. Longitudinal research is needed to understand how children recover after a critical illness. Our results suggest factors that may influence the recovery trajectory and were used to inform the methodology, outcomes of interest, and appropriate sample size of a larger multicenter study evaluating functional recovery in this population.

Physical & Occupational Therapy in Pediatrics, 2014

Aims: The purpose of this study was to explore the utility of the Participation and Environment M... more Aims: The purpose of this study was to explore the utility of the Participation and Environment Measure for Children and Youth (PEM-CY) for collaborative care planning with parents of children with disabilities. Methods: An explanatory sequential mixed methods approach was employed to examine how community-based service providers interpret and apply PEM-CY case results to set goals and formulate care plans with parents. We used two distinct, interactive phases that included collection and summary of PEM-CY data in Phase One (quantitative) and sequential collection and analysis of interview data during Phase Two (qualitative). Twenty-three parents of children with disabilities (mean age = 10.7 years) completed the PEM-CY community section during Phase One (quan). Four PEM-CY case reports were used with seven providers who were interviewed during Phase Two (QUAL). Results: Providers identified a four-step decisional support algorithm for leveraging PEM-CY case results in care planning: (1) parent rank orders activities in which change is desired, (2) child preferences are incorporated, (3) provider clarifies parent and child goals, and (4) activityspecific supports, barriers, and strategies are identified. Conclusions: Further validation and refinement of the decisional support algorithm with parents and children when applied to PEM-CY home and school reports is discussed.

Journal of Developmental & Behavioral Pediatrics, 2013

Disability & Rehabilitation, 2008

Purpose. The aim of this paper is to examine conceptual issues that challenge development of vali... more Purpose. The aim of this paper is to examine conceptual issues that challenge development of valid and useful measures of children's participation. Method. Ambiguities in the current definition of participation in the International Classification of Functioning, Disability and Health (ICF) are examined along with their implications for developing valid measures for children and youth. Results. Developers of new measures must address three key issues that will affect the ultimate meaning of participation data obtained from these instruments: uncertain criteria to distinguish activity from participation; lack of consensus on whether measures should address objective or subjective aspects of participation or both; and appropriate choice of respondent when children are the focus. Variations in how the participation construct is operationalized challenge one's ability to develop a coherent body of knowledge about children's participation and the factors that influence it. Conclusion. Given current variations in how participation is being defined, both developers and users of measures of participation need to be explicit about the definition of participation that a particular measure represents and the inferences that can be drawn from the scores.

Disability and Rehabilitation, 2012

The purpose of this paper is to describe the conceptual foundation of a new parent-report measure... more The purpose of this paper is to describe the conceptual foundation of a new parent-report measure of the participation and environment of children and youth: the Participation and Environment Measure - Children and Youth version (PEM-CY). The ICF-CY provided an initial conceptual framework. Results from a qualitative study to obtain parent perspectives and in-depth review of the literature were used to identify relevant dimensions, items and rating scales for measurement. Life situations, defined as sets of activity categories, were identified for three settings: home, school and community. Participation was operationalized as a multidimensional construct with three measurement dimensions: frequency, extent of involvement and desire for change. Parallel sets of items examining environmental factors that are perceived to help or facilitate participation were defined in relation to the typical activities of each setting. The PEM-CY provides a new measure of participation and environment that reflects the perspectives of parents of children and youth. The instrument will facilitate research and professional practice to understand and support the participation of children and youth with and without disabilities.

Disability and Health Journal, 2014

Background: Participation in home, school, and community activities is an important indicator of ... more Background: Participation in home, school, and community activities is an important indicator of child health and well-being. Evaluating environmental influences on children's participation can inform efforts to develop sustainable built environments, but few validated measures exist.

Developmental Medicine & Child Neurology, 2011

AIM The aim of this study was to examine the psychometric properties (reliability and validity) o... more AIM The aim of this study was to examine the psychometric properties (reliability and validity) of the Participation and Environment Measure for Children and Youth (PEM-CY).

The British Journal of Occupational Therapy, 2013

British Journal of Haematology, 2005

Archives of Physical Medicine and Rehabilitation, 2011

Bedell GM, Khetani MA, Cousins MA, Coster WJ, Law MC. Parent perspectives to inform development o... more Bedell GM, Khetani MA, Cousins MA, Coster WJ, Law MC. Parent perspectives to inform development of measures of children's participation and environment. Arch Phys Med Rehabil 2011;92:765-73. Objective: To obtain parents' perspectives on children's participation and environment to inform the development of new measures.

Archives of Physical Medicine and Rehabilitation

Pediatric Critical Care Medicine, 2015

To determine the feasibility of conducting a longitudinal prospective study to evaluate functiona... more To determine the feasibility of conducting a longitudinal prospective study to evaluate functional recovery and predictors of impaired functional recovery in critically ill children. Prospective pilot study. Single-center PICU at McMaster Children's Hospital, Hamilton, Canada. Children aged 12 months to 17 years, with at least one organ dysfunction, limited mobility or bed rest during the first 48 hours of PICU admission, and a minimum 48-hour PICU length of stay, were eligible. Patients transferred from a neonatal ICU prior to ever being discharged home, already mobilizing well or at baseline functional status at time of screening, with an English language barrier, and prior enrollment into this study, were excluded. None. The primary outcome was feasibility, as defined by the ability to screen, enroll eligible patients, and execute the study procedures and measurements on participants. Secondary outcomes included functional status at baseline, 3 and 6 months, PICU morbidity, and mortality. Functional status was measured using the Pediatric Evaluation of Disability Inventory and the Participation and Environment Measure for Children and Youth. Thirty-three patients were enrolled between October 2012 and April 2013. Consent rate was 85%, and follow-up rates were 93% at 3 months and 71% at 6 months. We were able to execute the study procedures and measurements, demonstrating feasibility of conducting a future longitudinal study. Functional status deteriorated following critical illness. Recovery appears to be influenced by baseline health or functional status and severity of illness. Longitudinal research is needed to understand how children recover after a critical illness. Our results suggest factors that may influence the recovery trajectory and were used to inform the methodology, outcomes of interest, and appropriate sample size of a larger multicenter study evaluating functional recovery in this population.

Physical & Occupational Therapy in Pediatrics, 2014

Aims: The purpose of this study was to explore the utility of the Participation and Environment M... more Aims: The purpose of this study was to explore the utility of the Participation and Environment Measure for Children and Youth (PEM-CY) for collaborative care planning with parents of children with disabilities. Methods: An explanatory sequential mixed methods approach was employed to examine how community-based service providers interpret and apply PEM-CY case results to set goals and formulate care plans with parents. We used two distinct, interactive phases that included collection and summary of PEM-CY data in Phase One (quantitative) and sequential collection and analysis of interview data during Phase Two (qualitative). Twenty-three parents of children with disabilities (mean age = 10.7 years) completed the PEM-CY community section during Phase One (quan). Four PEM-CY case reports were used with seven providers who were interviewed during Phase Two (QUAL). Results: Providers identified a four-step decisional support algorithm for leveraging PEM-CY case results in care planning: (1) parent rank orders activities in which change is desired, (2) child preferences are incorporated, (3) provider clarifies parent and child goals, and (4) activityspecific supports, barriers, and strategies are identified. Conclusions: Further validation and refinement of the decisional support algorithm with parents and children when applied to PEM-CY home and school reports is discussed.

Journal of Developmental & Behavioral Pediatrics, 2013

Disability & Rehabilitation, 2008

Purpose. The aim of this paper is to examine conceptual issues that challenge development of vali... more Purpose. The aim of this paper is to examine conceptual issues that challenge development of valid and useful measures of children's participation. Method. Ambiguities in the current definition of participation in the International Classification of Functioning, Disability and Health (ICF) are examined along with their implications for developing valid measures for children and youth. Results. Developers of new measures must address three key issues that will affect the ultimate meaning of participation data obtained from these instruments: uncertain criteria to distinguish activity from participation; lack of consensus on whether measures should address objective or subjective aspects of participation or both; and appropriate choice of respondent when children are the focus. Variations in how the participation construct is operationalized challenge one's ability to develop a coherent body of knowledge about children's participation and the factors that influence it. Conclusion. Given current variations in how participation is being defined, both developers and users of measures of participation need to be explicit about the definition of participation that a particular measure represents and the inferences that can be drawn from the scores.

Disability and Rehabilitation, 2012

The purpose of this paper is to describe the conceptual foundation of a new parent-report measure... more The purpose of this paper is to describe the conceptual foundation of a new parent-report measure of the participation and environment of children and youth: the Participation and Environment Measure - Children and Youth version (PEM-CY). The ICF-CY provided an initial conceptual framework. Results from a qualitative study to obtain parent perspectives and in-depth review of the literature were used to identify relevant dimensions, items and rating scales for measurement. Life situations, defined as sets of activity categories, were identified for three settings: home, school and community. Participation was operationalized as a multidimensional construct with three measurement dimensions: frequency, extent of involvement and desire for change. Parallel sets of items examining environmental factors that are perceived to help or facilitate participation were defined in relation to the typical activities of each setting. The PEM-CY provides a new measure of participation and environment that reflects the perspectives of parents of children and youth. The instrument will facilitate research and professional practice to understand and support the participation of children and youth with and without disabilities.

Disability and Health Journal, 2014

Background: Participation in home, school, and community activities is an important indicator of ... more Background: Participation in home, school, and community activities is an important indicator of child health and well-being. Evaluating environmental influences on children's participation can inform efforts to develop sustainable built environments, but few validated measures exist.

Developmental Medicine & Child Neurology, 2011

AIM The aim of this study was to examine the psychometric properties (reliability and validity) o... more AIM The aim of this study was to examine the psychometric properties (reliability and validity) of the Participation and Environment Measure for Children and Youth (PEM-CY).

The British Journal of Occupational Therapy, 2013

British Journal of Haematology, 2005

Archives of Physical Medicine and Rehabilitation, 2011

Bedell GM, Khetani MA, Cousins MA, Coster WJ, Law MC. Parent perspectives to inform development o... more Bedell GM, Khetani MA, Cousins MA, Coster WJ, Law MC. Parent perspectives to inform development of measures of children's participation and environment. Arch Phys Med Rehabil 2011;92:765-73. Objective: To obtain parents' perspectives on children's participation and environment to inform the development of new measures.

Archives of Physical Medicine and Rehabilitation