Move it to improve it: Using a web-based therapy program to increase physical activity in children and adolescents with congenital hemiplegia

Abstract

Background/Objectives: Move it to improve it (Mitii™) is a webbased therapy program which combines upper-limb and cognitive training with physical activity. This study examines whether MitiiTM training can increase physical activity capacity and performance in independently ambulant children with congenital hemiplegia. Design: Randomised waitlist controlled trial. Participants and setting: Children and adolescents with congenital hemiplegia (n=82; 42 males; age 11y 6mo [2y 5mo]) classified at GMFCS levels I=39 and II=43 completed MitiiTM in their home environments. Methods: Participants were matched in pairs and randomly allocated to receive 20 weeks of 20 to 30 minutes of daily Mitii™ training (Mitii), or waitlisted receiving usual care (Control). Each Mitii™ program comprised 40% gross-motor activities, including sit-to-stands, squats, lunges, and balance exercises. Physical activity was assessed using the MobQues28, 6 minute walk test (6MWT), functional strength tests (maximal repetitions of sit to stand, lateral step up, half-kneel to stand in 30- s), and 4 day ActiGraph®GT3X+ accelerometer records at baseline and 20 weeks. Independent t-tests and linear regression were calculated by intention to treat with last observation carried forward. Data are mean±1SD, α=0.05. Results: Groups were similar on all characteristics at baseline (p>0.05). At 20 week, 38 (93%) participants in Mitii and 35 (85%) participants remained in Control. Mitii participants completed 28.0 (14.6) hours of Mitii™ training (60% potential dose; range 3.6-54.5h) on 72 (34) days. Control participants received Physiotherapy monthly (n=6), once (n=8) or not at all (n=21), total dose 1.3 (1.4) hours. Mitii participants demonstrated significant improvements in functional strength (19 combined reps, 95% CI=10-28, p<0.001) and 6MWT (33m, 95% CI=14-52, p=0.001) compared to Control at 20 weeks. There were no differences in MobQues28 scores (-4 points, 95% CI=-8 to 1, p=0.13) or physical activity (6 counts/min, 95% CI=-87 to 100, p=0.89). Results were consistent across GMFCS levels. Mitii™ training dose did not predict the size of change demonstrated in functional strength (R2=0.03, p=0.40), MobQues28 (R2=0.30, p=0.37), or physical activity counts/minute (R2=0.28, p=0.22), but 6MWT demonstrated a trend (R2=0.28, p=0.07). Mitii™ group allocation significantly predicted improvements in functional strength (R2=0.41, p<0.001) and 6MWT (R2=0.20, p=0.001), but not MobQues28 (R2=0.27, p=0.16), or physical activity counts/minute (R2=0.17, p=0.96). Conclusions: Mitii™ training can improve physical activity capacity though not performance in independently ambulant children with congenital hemiplegia. There was no change in activity limitations though this may reflect ceiling effects with the MobQues28. This study suggests that the web-based training program Mitii™ can be used to train activity capacity but interventions targeting an increase in habitual physical activity may need to attend to environmental and motivational aspects of behavior change.L717463352015-02-03 <br />