Motor learning in children with movement difficulties: A modified Delphi study of influencing factors

ObjectiveTo identify key factors influencing motor learning in children with motor difficulties and to examine the level of agreement and disagreement among paediatric physiotherapists regarding these factors within contemporary and conventional paradigms.DesignA three-round modified Delphi study using online questionnaires.ParticipantsThe study included 16 experienced paediatric physiotherapists in the first round, of whom 14 (87.5%) completed all three rounds.Main MeasuresIn Round 1, experts identified factors via open-ended questions. In Rounds 2 and 3, participants rated their agreement on a 5-point Likert scale. Consensus was defined using mean scores (mean ≥ 4.0), coefficient of variation (≤ 30%) and percentage agreement (≥ 70%). Kendall's coefficient of concordance (W) was used to assess inter-rater agreement on prioritisation.ResultsFrom an initial 646 items, 251 factors reached consensus by Round 3. High levels of agreement were observed for factors aligned with contemporary motor learning paradigms (e.g. child motivation, goal-directed activity, family involvement). However, experts simultaneously reached consensus on conventional, impairment-based strategies (e.g. normalisation of tone, restriction of atypical movement). Despite high agreement on item importance, Kendall's W (0.244) indicated weak agreement on the relative prioritisation of these factors.ConclusionsThe participating experts endorsed a dual-consensus, valuing both active motor learning principles and traditional impairment-based normalisation. This coexistence highlights an apparent translational gap between current theoretical evidence and clinical practice. The identified framework has the potential to inform curriculum development to bridge conventional approaches and contemporary evidence-based paediatric rehabilitation.