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Participation predictors for leisure-time physical activity intervention in children with cerebral palsy
Sarah E Reedman1, Roslyn N Boyd1, Jenny Ziviani2
1Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Insights
Physical activity interventions for children with cerebral palsy (CP) are more effective when barriers are overcome and intrinsic motivation is present. Older age and autism spectrum disorder (ASD) may reduce therapy effectiveness.
Area of Science:
- Pediatric Rehabilitation
- Physical Therapy
- Behavioral Science
Background:
- Children with cerebral palsy (CP) often face challenges in participating in leisure-time physical activities.
- Understanding factors influencing participation is crucial for effective interventions.
Purpose of the Study:
- To identify predictors of change in participation and performance in children with CP undergoing a physical activity intervention.
- To explore factors influencing outcomes like occupational performance, satisfaction, self-competence, and physical activity levels.
Main Methods:
- A wait-list randomized trial involving 33 children (aged 8-12 years) with CP.
- Assessed predictors including age, Gross Motor Function Classification System level, autism spectrum disorder (ASD), and various motivation and behavior scales.
- Utilized multivariable models selected via Bayesian information criterion.
Main Results:
- Overcoming participation barriers, age, and comorbid ASD predicted changes in occupational performance (49% variance).
- Intrinsic motivation and age predicted changes in satisfaction (32% variance).
- Extrinsic motivation predicted changes in self-competence (24% variance), while parental support, barriers, motivation, and baseline activity predicted changes in moderate-to-vigorous physical activity (MVPA) (59% variance).
Conclusions:
- Findings support a behavioral approach to physical activity in children with CP.
- Meeting goals, intrinsic motivation, and addressing barriers enhance participation.
- Older age and ASD may moderate intervention effectiveness.
Aim:
To determine the predictors of magnitude of change in response to a participation-focused leisure-time physical activity intervention in children with cerebral palsy (CP) using the ParticiPAte CP protocol.
Method:
We included 33 children (16 males, 17 females) aged 8 to 12 years (mean age=10y, SD=1y 6mo) with CP with pre/postintervention data from a wait-list randomized trial. The hypothesized linear predictors of change in primary outcomes (Canadian Occupational Performance Measure [COPM]-performance and COPM-satisfaction, Belief in Goal Self-Competence Scale (BiGSS), and minutes per day moderate-to-vigorous physical activity [MVPA]) were: age; Gross Motor Function Classification System level; comorbid autism spectrum disorder (ASD); Goal Attainment Scaling T score; Problems in Schools Questionnaire; Physical Activity Climate Questionnaire; Motives for Physical Activities Measure-Revised; and stage of behaviour change. Multivariable models were selected using the Bayesian information criterion.
Results:
Overcoming barriers to participation, age, and comorbid ASD explained 49% of the variance in change in COPM-performance. Being motivated by interest and/or enjoyment and age explained 32% of the variance in change in COPM-satisfaction. Being motivated by physical activity competence or appearance (extrinsic motivation) explained 24% of the variance in change in BiGSS. Parental autonomy supportiveness, overcoming barriers to participation, appearance motivation, and baseline MVPA explained 59% of the variance in change in MVPA.
Interpretation:
These findings support a behaviour paradigm for conceptualizing physical activity in children with CP.
What This Paper Adds:
Children who met their treatment goals showed a greater increase in physical activity participation. Children who were more intrinsically motivated by physical activity at baseline improved more. Being older and having a comorbid diagnosis of autism spectrum disorder were associated with an attenuated effect of the therapy.
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