Methods
Design and participants
In this cross-sectional study, 88participants were selected from autism school, autism rehabilitation centers and occupational therapy centers in Arak, Iran, 2020. These centers are referral centers for autistic patients in Arak, who refer to these centers for education and rehabilitation cares.
Inclusion criteria including diagnosis of autism by a neurologist and psychiatrist, ages 3 to 18, and autistic children whose main caregiver was their mothers. Mothers who did not want to continue the study and answering all the questions were excluded from the study.
After obtaining a written informed consent from the mothers, the historical and demographic information related to the child and mother was measured. Then the Canadian Occupational Performance Measure (COPM) [19] were filled through a semi-structured interview with the mothers. In addition, the parent version of Quality of Life in Autism Questionnaire (QoLA-P) [20] was also given to the mothers and they were asked to complete it.
The Canadian Occupational Performance Measure (COPM)
COPM is a unique tool designed for occupational therapists to use over time to change the perception of the client (self-client) in their work performance and in the area of work performance and in the areas of self-care, productivity and play a game. Activities are written in the interview guide and within the appropriate COPM domain, after which the individual rates the importance of each activity on a ten-point visual analog scale, ratings range from 1 to 10. According to the manual, the participants select the five activities that are most important and ranks them based on the degree of priority. The person's self-perception of performance and satisfaction is then ranked from 1 to 10.
Dehghan et al. [21] in their study suggested that the Persian version of COPM has acceptable validity and reliability in Iranian mothers of children with cerebral palsy and in their study, the correlation coefficient of test–retest score for performance and satisfaction are reported to be 0.84 and 0.87, respectively.
Quality of Life in Autism Questionnaire-parent version (QoLA-P)
The quality of life questionnaire for parents with ASD children has two parts, the first part (part-A) is related to the quality of life and the second part (part-B) is related to the problems that these children have and are related to the parents or their caregivers. The reliability and validity of Persian version of QoLA-P was assessed by the authors and the results showed that it is a valid questionnaire to assess the QoL of Iranian Parents of children with ASD (two subscales revealed good internal validity with Cronbach’s alpha of 0.899 and 0.950 for Part-A and Part-B, respectively).
Part-A (caregivers’ quality of life subscale)
The part A contains 28 items to measure parents’ overall perception of their quality of life. Each item is measured by a 5-point LIKERT scoring scale. Therefore, the scores of Section A vary from 28 to 140, higher scores indicate better QoL.
Part-B (difficulties children with ASD can experience)
This section is designed to examine parents' views on how autistic disorders are problematic in their lives. Here is a list of 20 items that children with ASD experience. Part B scoring is from 1 to 5. Therefore, the scores of part B vary from 20 to 100, and higher scores indicate less problems for parents with their children’s ASD-related behaviors. Based on Eapen V et al. study [20], internal consistency coefficients for the QoLA were 0.94 and 0.92 for Part A and B, respectively.
Sample size
To determine the sample size, the amount of type 1 error was considered 5% and the study power 80%. Since no similar study was found, assuming an expected correlation coefficient of 0.3, the minimum sample size required for this study was estimated at 85 ASD children.
Data analysis
To analyze the data, two independent T-test, likelihood ratio chi-square and correlation coefficient were used. Significance level was considered < 0.05. Version 14 of the Stata software is used for analysis of the data.