Volume 27, Issue 4 (In press 2026)
Arch Rehabil 2026, 27(4): 0-0 |
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Ethics code: IR.USWR.REC.1402.181
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Khazaeli K, Hosseini S A, Mirzaie H, Shirvani A, Nobakht Z. Adaptation of Occupational Therapy Clinical Recommendations for Sensory-Motor Skills in Children with Autism: The Iranian Context. Arch Rehabil 2026; 27 (4)
URL: http://rehabilitationj.uswr.ac.ir/article-1-3815-en.html
URL: http://rehabilitationj.uswr.ac.ir/article-1-3815-en.html
1- Department of Occupational Therapy, School of Rehabilitation Sciences, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, kh.khazaeli@yahoo.com
2- Department of Occupational Therapy, School of Rehabilitation Sciences, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, alihosse@gmail.com
3- Department of Occupational Therapy, School of Rehabilitation Sciences, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran ,hooshang_mirzaie@yahoo.com
4- National center for health vocational training Ministry of Health, Tehran, Iran, arm.shirvani@gmail.com
5- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, nobakht.zahra@gmail.com
2- Department of Occupational Therapy, School of Rehabilitation Sciences, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, alihosse@gmail.com
3- Department of Occupational Therapy, School of Rehabilitation Sciences, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran ,
4- National center for health vocational training Ministry of Health, Tehran, Iran, arm.shirvani@gmail.com
5- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, nobakht.zahra@gmail.com
Abstract: (14 Views)
Objective: Children with autism spectrum disorder (ASD) frequently experience sensory-motor deficits that affect participation, independence, and daily living activities. Although international clinical guidelines are available, cultural, structural, and implementation-related differences limit their direct applicability in Iran. This study aimed to localize and develop occupational therapy clinical recommendations for sensory-motor skills in children with ASD, adapted to the Iranian healthcare context.
Materials & Methods: This methodological mixed-methods study was conducted based on the National Model for the Adaptation of Clinical Practice Guidelines in Iran. After establishing a technical committee and a 13-member expert panel and formulating the study questions, systematic searches were performed in national and international databases to identify eligible guidelines and extract key recommendations. A supplementary search was then conducted to strengthen the evidence base. Retrieved studies were analyzed using a standardized framework, including Sackett levels of evidence and statistical outcome indicators. Based on this process, 11 preliminary clinical scenarios were developed.
The scenarios were evaluated by the panel using the RAND/UCLA Appropriateness Method (RAM), with ratings on a 9-point scale across four dimensions: accessibility, cost, acceptability, feasibility. Scenarios meeting standard RAM agreement criteria in the first round were retained, while the remaining scenarios proceeded to a second round of discussion and review. Finally, a Gestalt approach was used to adapt the recommendations to the Iranian health system, resulting in six final recommendations.
Results: Of 116 sources identified in the guideline search, 37 clinical guidelines remained after screening. Full-text review identified sensory-motor recommendations in three guidelines. After reviewing the supporting evidence and supplementary-search findings, 11 preliminary clinical scenarios were developed and evaluated through two RAM consensus rounds. This process resulted in six final clinical recommendations. Applied Behavior Analysis (ABA), music therapy, the Qigong sensory program, and Ayres Sensory Integration (ASI) were prioritized according to age group and functional need and were considered compatible with the Iranian healthcare context.
Conclusion: By integrating international evidence with local priorities, this study produced six occupational therapy recommendations for improving sensory-motor skills in children with ASD in Iran. ABA and music therapy were prioritized for toddlers and preschool-aged children, the Qigong sensory program for preschool-aged children, and ASI for school-aged children. These recommendations reflect a balance between scientific effectiveness and implementation factors, including cost, accessibility, and acceptability. Rather than a fixed protocol, the adapted guideline offers occupational therapists a practical framework for selecting age- and function-appropriate interventions to support participation in daily life activities.
Materials & Methods: This methodological mixed-methods study was conducted based on the National Model for the Adaptation of Clinical Practice Guidelines in Iran. After establishing a technical committee and a 13-member expert panel and formulating the study questions, systematic searches were performed in national and international databases to identify eligible guidelines and extract key recommendations. A supplementary search was then conducted to strengthen the evidence base. Retrieved studies were analyzed using a standardized framework, including Sackett levels of evidence and statistical outcome indicators. Based on this process, 11 preliminary clinical scenarios were developed.
The scenarios were evaluated by the panel using the RAND/UCLA Appropriateness Method (RAM), with ratings on a 9-point scale across four dimensions: accessibility, cost, acceptability, feasibility. Scenarios meeting standard RAM agreement criteria in the first round were retained, while the remaining scenarios proceeded to a second round of discussion and review. Finally, a Gestalt approach was used to adapt the recommendations to the Iranian health system, resulting in six final recommendations.
Results: Of 116 sources identified in the guideline search, 37 clinical guidelines remained after screening. Full-text review identified sensory-motor recommendations in three guidelines. After reviewing the supporting evidence and supplementary-search findings, 11 preliminary clinical scenarios were developed and evaluated through two RAM consensus rounds. This process resulted in six final clinical recommendations. Applied Behavior Analysis (ABA), music therapy, the Qigong sensory program, and Ayres Sensory Integration (ASI) were prioritized according to age group and functional need and were considered compatible with the Iranian healthcare context.
Conclusion: By integrating international evidence with local priorities, this study produced six occupational therapy recommendations for improving sensory-motor skills in children with ASD in Iran. ABA and music therapy were prioritized for toddlers and preschool-aged children, the Qigong sensory program for preschool-aged children, and ASI for school-aged children. These recommendations reflect a balance between scientific effectiveness and implementation factors, including cost, accessibility, and acceptability. Rather than a fixed protocol, the adapted guideline offers occupational therapists a practical framework for selecting age- and function-appropriate interventions to support participation in daily life activities.
Keywords: Autism Spectrum Disorder, Occupational Therapy, Sensory-Motor Skills, Adaptation, Clinical Recommendations
Type of Study: Original |
Subject:
Occupational Therapy
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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 (CC-By-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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