This is a prospective cross-sectional observation and survey study conducted with institutional ethics review board approval (SingHealth CIRB 2017/3127) and informed consent between April 2018 to November 2019. The study complies with the standards, guidelines and regulations for clinical research.
Specialized design Mobility equipment
A specialized mobility system (I-MOVE) is developed as a CONCEPT CHILD-KIND MOBILITY DEVICE to interest children and initiate child-machine interaction that includes sitting on it in the ‘chair mode’, self-application of the restraint module and assisted ambulation . See Figure 1. This was developed as a collaboration between investigators from the paediatric anaesthesia department and biomedical engineers with input from parents with ASD children as well as multi-disciplinary healthcare professionals with experience in the care of children with ASD . The mobility system is a multi-position configuration mobile chair-bed system with a restraining module [12, 13]. These positions are ‘sitting’ for preoperative sedation and induction of anaesthesia, ‘supine’ for airway management and transfer, ‘lateral tilt’ to aid lateral transfer onto the OT table, ‘Trendelenburg’ for oropharyngeal suctioning as part of airway protection . These movements were activated via hand-held remote. In the resting position, it resembles a racing car chair, transformation to supine position resembles a reclining massage chair, all of which are different forms of chairs children are familiar with.
The restraint module is a key feature and comes in 3 options ; an over the hip adjustable restraint (like an airplane seat belt), an overhead restraint (‘amusement park restraint-like’) or a combination of the two with the strap traversing through the overhead restraint. The amusement park design adds to the contextual fun-based approach to I-MOVE. This reduces manpower and physical restraint used to move patients into the OR, patient handling and lifting transferring.
Survey participants and method
Survey participants include healthcare providers (HCP), parents and children. The inclusion criteria are HCP with experience in the perioperative care of ASD children in the operating theatre. The inclusion criteria for parents are those with children diagnosed with ASD. The exclusion criteria were permanent staff of paediatric anaesthesia department to avoid conflict of interest.
The inclusion criteria for children participants are neurotypical children or ASD children between 6 to 16 years old and whom parents have confidence of ability to complete the survey independently. Exclusion criteria are children with uncontrolled disruptive behaviour.
Informed consent was obtained from HCP and parents. Parental consent was obtained for children with further assent obtained from children as deemed appropriate.
Parents and children were introduced to the operating theatre waiting area and the hospital trolley. The rest of the study was performed in a dedicated hospital room where I-MOVE was located and participants were informed about the motivation for development of the I-MOVE. The stage of Proof of concept of I-MOVE was emphasized. For the children, I-MOVE was introduced as a ‘special chair concept’ to help children move around in the hospital and to ‘go to sleep’. This was followed by a demonstration of the operation and function of I-MOVE in all configurations. HCP and parents were instructed to examine and operate the system. Children were invited to explore the I-move such as sit on it and putting on the restraint module. This is followed by a survey.
In the survey, HCP and parents answered eight closed ended 7-points Likert questions which evaluate their acceptance of multiple functions of I-move on anxious and uncooperative ASD children based on their work experience (HCP) and personal experience (parents). Parents and children rated their general experience of the special chair using 5 points Likert scale and explained their likes and dislikes.
Parents were asked on their opinion on the suitability of use of I-move and restraint in various situations. Children indicated the situations in which they would use the I-move.
Frequency was presented as numbers and percentage. For data analysis, methods used were t test for continuous data and chi square test for dichotomous data using SPSS version 19 (Inc Chicago IL, US). A p value of less than 0.05 was considered statistical significance.
In a previous observation survey, we found that 25% of parents would use the traditional hospital mobility device such as hospital trolley and wheelchairs. Parental opinion was used in the sample size calculation as parents of ASD children are the best resource to create a successful experience for their children . We hypothesize that if the specially designed mobility device could garner a 75% agreement for use as a perioperative special mobility device, at a power of 0.9, 23 participants were needed for the parent expert group. Hence a minimum of 23 was recruited for the parent and expert groups.