Peer-reviewed article
Using Ecological Momentary Assessment to Document and Investigate Caregiver Practices Between Pediatric Therapy Sessions: Prospective Pilot Cohort Study.
James JK, Shotwell MP, Jensen HM, James SA ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This pilot study tested a method called Ecological Momentary Assessment (EMA) to track what caregivers actually do at home to support children receiving therapy services like occupational, physical, or speech therapy between sessions. The researchers found that caregivers remembered doing much more practice (71 minutes per day) than what they actually recorded in real-time (23 minutes per day), showing that memory-based reports are unreliable. Caregivers said they fit practice into daily routines in short sessions when children were engaged and they remembered the therapist's strategies.
Key points
- Caregivers who filled out daily logs reported 23 minutes of practice per day, while the same caregivers remembered doing 71 minutes per day when asked to recall
- EMA logging had high dropout: only 5 out of 34 survey participants completed the 30-day monitoring period, indicating significant participation barriers
- When caregivers did practice, they did it in short, frequent sessions (averaging 5 bouts per day) embedded within existing daily routines rather than as separate structured sessions
- Key factors that helped caregivers practice were: fitting therapy into daily routines, the child being engaged, and caregivers remembering the strategies the therapist showed them
- Overall completion rate for daily logs was 55% (82 out of 150 days), with most missing entries occurring on days when no practice happened
Limitations
The study is a small pilot with only 5 participants who completed the full monitoring period, so results may not generalise to other caregivers or settings. The document does not report which countries the study took place in or whether findings differ by type of therapy or child disability.
Abstract
Background Determining the appropriate dosage of pediatric occupational therapy, physical therapy, and speech-language pathology services is important when supporting families of children with disabilities. However, therapy dosage is inconsistently reported, and caregiver-delivered practice between sessions is rarely documented. Ecological momentary assessment (EMA) offers a method to capture caregiver practice in real time and to examine factors that influence it. Objective This study aims to pilot the use of EMA to measure caregiver practices between therapy sessions and to compare EMA-reported practices with caregiver recall. Methods This pilot prospective cohort study used convenience sampling to recruit caregivers of children receiving therapy services. During September 2024, participants completed a confidential baseline Qualtrics survey in their homes, which included recall of home practice from the previous week. Participants were then invited to complete 30 days of EMA logging of daily practice. Five participants enrolled in the EMA phase, which began 24 to 72 hours after baseline survey completion and took place during October and November 2024. Semistructured follow-up interviews were conducted immediately after the 30-day EMA period. Results Of the 34 survey participants, 5 continued to the EMA phase, contributing 150 days of data, with 82 completed entries (82/150, 55%). Caregivers primarily completed EMA logs on days when practice occurred; missing entries were coded as zero practice based on caregiver reports. Recalled practice averaged 4.5 (SD 5.65) bouts/day and 11.6 (SD 6.35) minutes/bout, totaling 71.2 (SD 121.02) minutes/day. EMA-reported practice across all days (n=150) averaged 2.7 (SD 4.39) bouts/day and 6.5 (SD 6.45) minutes/bout, totaling 23.2 (SD 14.12) minutes/day, which was substantially lower than recalled estimates. On days when practice was reported (n=82), EMA-documented practice averaged 5.2 (SD 3.28) bouts/day and 6.5 (SD 6.45) minutes/bout, totaling 23.9 (SD 14.72) minutes/day. Variability in recalled practice was high (mean 71.19, SD 121.02 min/d). Caregivers described practice as occurring in short, frequent bouts embedded within daily routines, with routine integration, child engagement, and recall of therapist strategies identified as key facilitators. Conclusions Caregiver-delivered practice occurred in short, frequent bouts integrated into daily routines. EMA-reported practice was substantially lower than caregiver recall, suggesting that retrospective recall and prospectively reported EMA data may differ substantially. These findings highlight the importance of teaching strategies that are brief, engaging, and easily incorporated into daily routines. Despite the small sample, EMA was acceptable to a subset of caregivers who completed participation; however, substantial attrition between survey enrollment and EMA initiation suggests significant feasibility and participation barriers that warrant further investigation.