Data-Driven Decision Making (DDDM) from the perspective of Ayres Sensory Integration®

Rolim, Amanda Fernandes; Liider, Loysi Crystine Marchi; Omairi, Claudia

doi:10.1590/2526-8910.ctoRE271635412

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• Cad. Bras. Ter. Ocup. 31 • 2023 • https://doi.org/10.1590/2526-8910.ctoRE271635412 copy

Data-Driven Decision Making (DDDM) from the perspective of Ayres Sensory Integration®

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

The Ayres Sensory Integration® (ASI) method has been standing out within Occupational Therapy when implementing its evidence-based practice and, for this reason, it has had great notoriety in Brazil and in the world. To ensure the quality of the services provided, Ayres Sensory Integration® training programs follow some minimum standards, including the use of the Fidelity Measure© and the interpretation of evaluation data to inform clinical reasoning, which can be carried out through the Data-Driven Decision Making (DDDM).

Objective

Since DDDM is a tool that is still little discussed in Brazil, it is proposed to present its main contributions to the clinical and professional reasoning of occupational therapists and to the generation of evidence.

Method

This is an integrative and narrative literature review with a quali-quantitative approach, the sample period being the years from 2012 to March 2022. Among the 22 titles found, 13 scientific articles were included in this Review.

Results

DDDM proved to be a safe and viable tool for use in clinical practice in ASI®, with several contributions such as: client-centered practice, generation of hypotheses, development of personalized activities and intervention, elaboration of appropriate goals for each case and quantification of intervention effectiveness.

Conclusion

It is a tool that supports evidence-based practice as well as guides the clinical reasoning of occupational therapists through a focus on the use of data-based decision making.

Keywords:
Occupational Therapy; Mental Processing; Clinical Decision-Making

Article identification	Title	Author(s)	Year	Emphasis
A1	Case Report: ASI intervention on a child with autism in Saudi Arabia	Alkhalifah et al.	2022	The 8 steps of Data-Driven Decision Making (DDDM) were used to apply the intervention in ASI®. The article states that the use of the distal and proximal results were helpful in demonstrating the link between underlying sensory integration challenges to occupations and ADLs. They also state that the use of DDDM was relevant for the formulation of hypotheses.
A2	Effectiveness of occupational therapy using a sensory integration approach: A multiple-baseline design study	Andelin et al.	2021	The article highlights the relevance of using the DDDM to generate hypotheses about the processing and sensory integration factors that affect the child's motor performance. The hypotheses helped in the development of sensorimotor activities individually adapted to address these factors.
A3	Occupational Therapy Interventions for Children and Youth With Challenges in Sensory Integration and Sensory Processing: A Clinic-Based Practice Case Example	Parham et al.	2019	The DDDM allows a comprehensive assessment of sensory processing and integration to be performed. The use of evaluative data contributes to raising hypotheses about the factors that affect occupational performance and participation. It contributes to setting goals, being relevant for measuring results and monitoring progress.
A4	Efficacy of occupational therapy using Ayres Sensory Integration®: A systematic review	Schaaf et al.	2018	This research demonstrated that the use of replicable measures and intervention protocols encourage evidence-based practice and greater fidelity to the ASI® Therapy, contributing to the advancement of best practices for children with ASD with sensory processing difficulties.
A5	Identifying and Measuring Outcomes in Ayres Sensory Integration	May-Benson et al.	2018	This article discusses the use of DDDM to identify and measure distal and proximal results in ASI®. It emphasizes that identifying and measuring the results of participation and performance of occupations is an important component in the occupational therapy process. It highlights that in the ASI® intervention, changes in proximal factors, such as sensory and motor skills, are seen as a means of improving functioning in distal factors, such as: occupational performance, quality of life and participation. As with most occupational therapy interventions, distal outcomes based on participation are of primary importance. It also highlights the importance of a careful selection of outcome measures for advancing existing evidence and practices within the ASI®.
A6	The Development of a Measurement Tool Evaluating Knowledge Related to Sensory Processing among Graduate Occupational Therapy Students: A Process Description	Gee et al.	2017	The article describes that although there are resources available for occupational therapists to guide their interventions within the ASI®, such as the DDDM, this process has not been widely reported in the literature. And, although occupational therapy has placed greater emphasis on generating evidence, at undergraduate level there is little focus on how to teach students about a formalized process that determines when and how to use evidence-based interventions, highlighting the need for continuing education.
A7	Application of data-driven decision making using Ayres Sensory Integration® With a child with autism	Faller et al.	2016	The article points out that the structured format of the DDDM facilitated the use of the systematic process by the occupational therapist and provided a method for describing the reasoning process, including a data-based rationale for treatment decisions. The process allowed the occupational therapist to engage in a client-centered practice, individualizing the intervention to target specific underlying sensorimotor factors identified through the collection and analysis of assessment data. The DDDM allows the occupational therapist to systematically and clearly document the results and is useful to inform parents about the progress made with the ASI® intervention, increasing the evidence regarding the effectiveness of this method.
A8	Linking sensory factors to participation: establishing intervention goals with parents for children with autism spectrum disorder	Schaaf et al.	2015	According to this article, the DDDM is a structured process that helps occupational therapists link identified parent priorities to underlying factors (proximal) that may be affecting occupational performance and participation (distal). Once these factors are related, they guide the design and selection of intervention strategies that target priority areas. The DDDM makes it possible to identify the family's goals, strengths, and challenges of child participation, through a systematic assessment to formulate the hypothetical factors that affect participation. From this, the professional formulates targeted goals that link the factors identified in the assessment process to the goal areas identified by the parents. The process, therefore, creates evidence through practice, which is evidence-based.
A9	Creating Evidence for Practice Using Data-Driven Decision Making	Schaaf	2015	The main implication of DDDM in occupational therapy, according to the article, is the scientific validation of the profession, since DDDM is a mechanism for generating evidence through practice and the use of data. It also points out that, although the TO literature presents the importance of an evidence-based, systematic and data-oriented practice, professionals do not use these mechanisms to guide and measure their interventions. Among some identified barriers are: lack of time, knowledge and skills, and the belief that evidence may limit their ability to provide client - or family-centered care.
A10	An intervention for sensory difficulties in children with autism: A randomized trial.	Schaaf et al.	2014	The article demonstrates that the use of the DDDM allows for the individual customization of treatment activities through evaluative data and the formulation of hypotheses about the sensorimotor factors that affect the child's functional behaviors. The results of the article provide preliminary support for the effectiveness of a manual intervention designed to address sensory information processing and integration difficulties for children with ASD.
A11	Occupational therapy based on Ayres Sensory Integration in the treatment of retentive fecal incontinence in a 3-year-old boy	Bellefeuill et al.	2013	It presents the intervention process based on DDDM, showing that it can be used with children with diagnoses other than ASD. The case study demonstrates the use of systematic reasoning systems using the DDDM as an example for generating evidence during clinical practice. Emphasizes proximal and distal results and hypotheses.
A12	Occupational therapy and sensory integration for children with autism: a feasibility, safety, acceptability and fidelity study.	Schaaf et al.	2012	The data-driven intervention process was extremely valuable to the occupational therapists, allowing them to implement the intervention with high fidelity. In addition, the manual protocol provided guidance to the therapist throughout the process, maintaining fidelity to the principles and practices described in the ASI® Fidelity Measure©. The scaled, standardized method of documenting the individual's progress toward goals was helpful in identifying changes in performance and participation linked to sensory integration and processing. The protocol, therefore, proved to be safe, acceptable, and feasible to be administered with children with autism.
A13	Emerging as Leaders in Autism Research and Practice: Using the Data-Driven Intervention Process	Schaaf & Blanche	2012	The study identified that the data-driven intervention process allows occupational therapists to systematically identify and test their clinical reasoning by providing data on intervention effects. Ultimately, this process allows therapists to validate occupational therapy interventions.

Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
E-mail: cadto@ufscar.br

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[1] Amanda Fernandes Rolim e-mail: toamandafernandes@gmail.com; amandarolim@ufpr.br