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Enhancing Physically Active Leisure Participation for Children With Cerebral Palsy: A Randomized Controlled Trial
Leanne Sakzewski1,2, Sarah Reedman3, Catherine Elliott4,5
1School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia.
Objectives:
To determine if a participation-focused therapy (Participate-CP) was more effective than usual care to improve participation in physically active leisure and physical activity for children with cerebral palsy (CP).
Methods:
This prospective, multisite waitlist randomized controlled trial included children with CP, aged 8 to 14 years, classified in Gross Motor Function Classification System (GMFCS) levels I-IV. Participate-CP comprised weekly, 60-minute sessions over 12 weeks using motivational interviewing and a toolbox of evidence-based therapy strategies targeting modifiable barriers to participation. Primary outcomes were the Canadian Occupational Performance Measure (COPM) and time spent in moderate-to-vigorous physical activity. Secondary outcomes were the Barriers to Participation in Physical Activities Questionnaire, Participation and Environment Measure for Children and Youth (PEM-CY), Motives for Physical Activities Measure, and Physical Activity Climate Questionnaire and Goal Attainment Scale (GAS).
Results:
A total of 110 children (mean age 10.4 years [SD, 1.6 years]; 60% boys; and GMFCS I = 58, II = 30, III = 8, and IV = 14) were assigned to Participate-CP (n = 56) or usual care (n = 54). There were no relevant baseline differences between groups. Participate-CP led to greater changes in perceived performance of participation goals (COPM: mean difference [MD], 2.75; 95% CI, 2.08-3.42; P < .001), greater average movement intensity (MD, 4.66; 95% CI, 0.50-8.82; P = .03), fewer barriers to participation (MD, 13.42; 95% CI, 1.69-25.14; P = .03), and greater frequency of community participation (PEM-CY: MD, 0.35; 95% CI, 0.02-0.68; P = .04) and expected goal attainment (GAS T score mean, 53.7; SD, 9.9). There were no differences between groups in the remaining measures.
Conclusion:
Participate-CP was confirmed as effective to improve the performance of physically active leisure goals, average movement intensity, frequency of community participation, and reduced barriers to participation.
