Efficacy of a participation-focused therapy intervention on participation in physical activities, health-related quality of life, and behavioural barriers to participation in children with cerebral palsy

Abstract

Background and Objective(s): To compare the efficacy of a participation-focused intervention (ParticiPAte CP) to usual care, on child-perceived performance of active physical leisure participation goals, condition-specific quality of life, and reduction in barriers to participation in children with cerebral palsy (CP). Study Design: Randomized controlled trial. Study Participants & Setting: Seventeen children with spastic (n=14) and other types (n=3) of CP (males n=9; mean age 9y8m±1y6m; range 8-12y; GMFCS I-III) were recruited. The intervention was delivered in the home. Materials/Methods: Participants were randomly allocated via concealed, stratified randomization (GMFCS I-II vs. III; male vs. female) to receive either ParticiPAte CP (one 60min session/ week for eight weeks) immediately, or a usual care waitlist control group. ParticiPAte CP consisted of an individually- tailored, goal-directed intervention, utilising a toolbox of strategies (e.g. goal-setting, barrier identification, strategy creation, and motivational interviewing). Evidence-based activityfocused (e.g. skills practice) and context-focused strategies were used in response to identified barriers. The primary outcome was perceived performance of and satisfaction with active physical leisure participation goals on the Canadian Occupational Performance Measure (COPM). Secondary outcomes included: (i) Cerebral Palsy Quality of Life Questionnaire - Child (CPQOL-Child), (ii) Barriers to Participation in Physical Activities Questionnaire (BPPA-Q), (iii) Participation and Environment Measure - Child and Youth (PEM-CY). Generalised Estimating Equations were used to compare groups post-intervention (8wks), adjusting for baseline differences (Stata 14.2). Results: Nine children were allocated to immediate treatment and eight to the wait-list group. There was 100% retention to the 8-week follow-up. Six participants completed all eight sessions and the remaining three completed seven. The immediate group demonstrated clinically meaningful and significantly greater performance of attendance and/or involvement in active physical leisure participation goals on the COPM (estimated mean difference [MD] 3.47, 95%CI 1.43-5.52, p=0.001) compared to wait-list. The intervention group also demonstrated significant improvements in COPM Satisfaction (MD 3.26, 95%CI 1.16-5.36, p=0.002), CPQOL-Child Social Wellbeing and Acceptance Domain (MD 12.3, 95%CI 0.50- 24.0, p=0.041) and BPPA-Q total score, indicating fewer barriers to participation (MD 26.0, 95%CI 19.3-32.6, p<0.001). There was no significant effect for all other secondary outcomes. Conclusions/Significance: These pilot data suggest ParticiPAte CP is an effective intervention to improve child-perceived performance of and satisfaction with active physical leisure participation goals. The intervention also appeared to reduce the impact of parent-reported barriers to their child's participation. The small sample size may have limited ability to detect differences on secondary outcomes.L6184697352017-09-29 <br />