Running head: EVIDENCE SYNTHESIS PAPER

Evidence Synthesis Paper

Tonya DeDera and Jesse Vallera
Touro University Nevada

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Research Question

During the course of fieldwork at a treatment facility that focused on fine and performing
arts with young adults, a client having difficulties with fine motor skills and a lack of
coordination was observed. The client participated in all of the fine and performing art activities
and was extremely excited about performing in them. The client had a diagnosis of dyspraxia,
which explained the reason behind her coordination difficulties. However, this led to exploring
our research question: Does participating in fine and performing art activities improve fine motor
skills in young adults with developmental coordination disorder (DCD)?
How does this study relate to your research question?
This qualitative research study was chosen because it addresses young adults having
significant coordination difficulties. The research question asked if fine motor skills can be
improved through the fine and performing art activities, and the article was titled: Life
Experiences of Young Adults Who Have Coordination Difficulties was written about young
adults that used various coping strategies to manage their coordination difficulties. The article
provided information collected from college students through two in-depth interviews and a
DCD-Q, a standardized questionnaire that rates coordination difficulties that provided some
insight related to the research question.
What is the purpose of the study?
The purpose of the study was to explore the effects of DCD on the lives of nine young
adult college students and investigate the effects of the disorder on their life domains. The
questions for the interviews were broad, asking the students to tell their stories, including the
successes and the challenges they had faced (Missiuna, Moll, King, Stewart, & Macdonald,
2008, p. 159). This study helps to expand the knowledge that the disorder has on an individual as

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they progress into adulthood since very little research is known. This study was designed to
interview the college students and collect information from their questionnaires on the impact of
the disorder.
Were research questions asked? If so, what are the research questions?
This research study did not asked any questions, but rather it was an exploratory study
and thus the researchers identified two objectives. The first objective is to gather detailed
information about the experiences of young adults who had these difficulties, and the second
objective was to, identify the specific factor that support or hinder development and
participation in education, employment, leisure, and social spheres of life (Missiuna et al., 2008,
p.158). The authors felt that this study could enlighten certain life domains about a specific
population.
What is the study design/ type of qualitative research?
The authors stated in the article that they utilized a retrospective qualitative study
approach, the participants in the study recalled situations that the authors then categorized as
themes. The authors also stated that they used a phenomenological approach that typically uses a
sample size of ten; however, in this study the research team felt that they had achieved
theoretical saturation (i.e., no new themes emerged) after nine participants had been interviewed.
The phenomenological study consisted of two in-depths interviews in a private office for 1-2
hours. The participants had to recall their life experiences with coordination difficulties. The
participants were given an incentive of 25 dollars per interview and were provided with free
parking. The participants recalled specific experiences that they encountered as key informants,
which allowed the researchers to gain knowledge through complex processes that enable better
understanding in the participants meaning of everyday life (Missiuna et al., 2008).

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What is the theoretical perspective of the researcher for this study?

The researchers wanted to explore aspects in life domains beyond the limited scope of
pediatrics. The authors stated, Significantly less is known about what happens to these children
when they enter high school or about their progression into adulthood...it is important to
understand the factors that may contribute to difficulties or successes through this phase of life.
(Missiuna et al., 2008, pp. 157-158). The authors explain that the DCD population experiences
academic, social, and emotional problems with development and intended to present awareness
for other avenues or alternatives.
How were the participants recruited and selected?
The participants of the study were recruited from a population of a local college and
university community (Missiuna et al., 2008). This population-based strategy was utilized
because DCD then was somewhat a recent diagnosis and the young adults had no medical record
of the disorder. The recruitment posters asked for volunteers between the ages of 19 and 26 years
old. Another criterion of the participants was to have had experiences with being awkward and or
having a lack of coordination in their youth (Missiuna et al., 2008).
How many participants were in the study?
As stated previously, the phenomenological study usually uses a sample size of 10
participants. However, the researchers of this study felt that the theoretical saturation was
achieved with nine participants since no new themes had emerged following the interviews
(Missiuna et al., 2008).
How are the participants described?
As stated previously, the participants were all college students 19-to-26 years of age.
They were all single and came from diverse cultural backgrounds, however, they were
predominantly Canadian-born and spoke English as their main language. The participants

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reported a wide range of coordination abilities ranging from impairments in eye-hand

coordination for specific activities to severe difficulties that contributed to injuries and impaired
functioning in everyday activities (Missiuna et al., 2008).
The participants had an immense transformation from adolescents to young adults. For
these activities with fine and performing arts, the participants enjoyed active engagement to
increase self-acceptance and self-confidence through accomplishment. One participant felt that
additional practice is essential with improved skill and reports, "I think you can do it with
practice. I don't think there's anything you can't do; if you're bad at it, you just have to try a little
bit more than someone who gets it right away. Another participant stated there are strengths
and weaknesses for every individual, and reported, I slowly learned through trial and error what
I was good at, what I wasnt good at. What I was good at, I kept doing and what I wasnt good at,
I stopped doing. Then I started being more confident in everything I did because everything I did
I could do. This was an evolution of difference to understand that domains of life is constantly
changing. Now the problems have been adapted into the participants way of life, and one
explains, Most of my coordination problems are almost completely theyre not gone, but Ive
grown accustomed to them. Ive learned to adapt to them (Missiuna et al., 2008, p. 163).
What is the relationship of the researcher to the participants?
The authors did not reference in any particular way that they had a relationship with the
participants of this research study. The authors were extremely grateful to the participants for
their willingness to share their viewpoints or perceptions and life experiences so candidly
(Missiuna et al., 2008).

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What are the sources for data?

As previously stated, the sources used for data were two in-depth interviews where each
participant gave their perspectives on the impact of coordination difficulties on functioning in
activities of daily living (ADL) and instrumental activities of daily living (IADL) from
adolescence to young adults (Missiuna et al., 2008). The interviews took place on the university
campus within a private room over an estimated time of one to two hours. Following the
interviews, the participants were asked to complete four short questionnaires (DCD-Q) to
collected personal information, developmental history, and coordination difficulties that affected
their functioning abilities as a child and a young adult in areas of life such as education, work,
leisure, and social relationships. The authors of the questionnaire gave the researchers
authorization to use the instrument as a retrospective screening tool to ratify the presence of
coordination difficulties as a child (Missiuna et al., 2008).
Besides the questionnaires, the participants received mailed transcripts of the first
interview to examine. The second interview followed to address particular issues that emerged
from the first interview and DCD-Qs. According to the authors, all interviews were audio-taped,
transcribed verbatim, and reviewed for accuracy by the interviewers and participants (Missiuna
et al., 2008).
How are the findings reported?
The findings were reported through a member checking process. The findings of the
participants were put into category format to ensure that the information was correct. The
participants were asked to reiterate the findings of the study and then they were interviewed
individually over the phone and in person. This process confirmed the findings of the research
(Missiuna et al., 2008).

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What are the findings?

For the nine participants, none of them have had occupational therapy in their
youth. Some participants have had various problems including, attention, learning, or emotional
difficulties at some point. According to the developmental history questionnaire Table 2, the
categories that were most severe were the following: motor skills (e.g., throwing and catching a
ball, riding a bicycle, jumping, etc.), and mathematic skills were charted as very delayed
(Missiuna et al., 2008). Fine motor skills showed somewhat delay in the highest number of
participants, but several individuals show remarkable improvement.
How do the findings relate to previous research as described in the literature review?
The previous study reported within this literature review discussed the longitudinal
studies on the academic and educational results of children with DCD. The findings of this study
relates to the outcome of the previous study only in the subject of Mathematics as being very
delayed (Missiuna et al., 2008). Other than that, the participants were highly advanced in
academics. With that said, the studies reported within this literature review showed very few
findings and were based on limited sample sizes. This affected the results about the impact of
coordination disorders on the life domains of these individuals.
Does the author state any clinical implications for the findings?
The clinical implications for this study is to identify clients with DCD and to have
occupational therapists facilitate creative adaptation to have meaning in their lives. The authors
assert, If adolescents with DCD are aware of their differences but optimize their strengths, an
occupational therapist can work with them to find suitable tasks and environments that will meet
their desire to participate (Missiuna, 2008, p. 165). The authors always mention the occupation
therapists would be beneficial to share any development for children and their families so they
can create strategies as soon as they emerge.

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What are the limitations that the author identifies?

The authors had various limitations that made an impact on the current study. The
sample was small with only nine students. Moreover, the sample was homogeneous and all nine
students were well educated, attending post-secondary institutions. Another limitation was that
all of the participants reflected on past experiences that may or may not be accurate to recall
vivid recollection (Missiuna et al., 2008).
Does the author discuss implications for future research?
The authors discussed possible future research opportunities based on the current
limitations. Further exploration on participants who are persistently struggling in adulthood with
emotional health problems would be extremely informative. Given the perceptions of the
participants past experiences that may or may not be accurate, the authors presented a
longitudinal, prospective study to have more solid evidence for the reflections of the participants
(Missiuna et al., 2008).
What are potential sources of bias on the part of the researcher? Did the researcher
describe methods for avoiding bias?
The authors did not address any bias for the study. The researchers demonstrated
resources to ensure accurate data was collected by organizing a team of diverse viewpoints to the
study based on their different backgrounds (Missiuna et al., 2008).
Is there a rationale for the participant selection? Are the participants credible
(believable)?
The selection criterion was that each of the participants had to have significant
coordination difficulties during childhood and adolescence that could have inhibited academic
and functional activities. The participants will be excluded for any chronic or degenerative
conditions that affect neuromuscular or developmental problems (e.g., cerebral palsy or multiple

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sclerosis), and the participants had to demonstrate normal intellectual abilities for the
questionnaires and for the two interviews (Missiuna et al., 2008).
How does the researcher use methods to establish trustworthiness of the data? Do these
methods seem adequate?
To establish trustworthiness of the study, the researchers screened the participants to
identify their potential as key informants capable of both reflecting on and sharing their
experiences (Missiuna, 2008, p. 159). In addition, the criterion included an age range so that
they were past adolescence but could still reflect on recalling their experiences (Missiuna et al.,
2008).
Are the themes presented consistent with the data presented? Do the conclusions make
sense to you or do you think the researcher was reading into the findings (or trying to find
what he/she wanted to find)?
There were three themes that emerged in the qualitative analysis. The first was to
understand coordination differences in context; the second was the participants strategies used
to manage their differences; and the third was how the differences evolved over time. The data
presented was to explain past and present experiences of the participants. The participants
provided statements that supported the overarching themes and the authors elaborated with
rationales for each of the themes (Missiuna et al., 2008). We concurred that the study supporting
with data for each themes. Participants now have positive strategies to manage their motor skills
through social participation and physical performance.

Was the researcher flexible in the data collection process? Did he/she allow the data to
guide the process?
The researchers had a variety of different methods to utilize the screening and the data
collection process. The prospective participants had to complete the DCD-Q, which as a
retrospective screening tool, an initial interview and a follow-up interview. The methods present

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in each interview were audio-taped, transcribed verbatim, and review for accuracy with the
interviewer and the participants. Furthermore, every interview contributed data analysis for each
author. The authors extracted relevant information and presented it in such a way that
highlighted the activities and then categorized them under each theme.
How would you use this article as a therapist?
We would use this article for a specific population of adolescents or young adults that
have the potential to improve in many domains. Now that we are aware of the DCD population
and can find certain activities (e.g. fine and performing arts) to promote social participation
through fine/gross motor skills, language skills, self-help, and cognitive ability. We could utilize
a different approach if the population was for early intervention or geriatrics with the same
diagnosis.
How does this article support/not support participation in occupation and the field of
occupational therapy?
This article does indeed support the field of occupational therapy; however, the authors
challenge the field to move beyond the traditional medical-based interventions and try a more
holistic perspective to the DCD population. The authors assert, Occupational Therapists
approaches to more ecological or environmental interventions that facilitate social and
community participation, helping young clients, instead, to manage their difficulties (Missiuna,
2008, p. 165). We agree with this challenge as occupational therapy students, and not be limited
to only remediation interventions but rather embrace other alternatives of social integration in
communities so that clients have the optimal quality of life possible. If these clients have
increased engagement in several aspects of their environments, then their environments will
influence them in various domains such as fine motor skills, language skills and cognitive ability.

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References

Missiuna, C., Moll, S., King, G., Stewart, D., & Macdonald, K. (2008). Life experiences of
young adults who have coordination difficulties. Canadian Journal of Occupational
Therapy, 75(3), 157-166.