Enhancing Physically Active Leisure Participation for Children With Cerebral Palsy: A Randomized Controlled Trial.

Abstract

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). 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). 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. 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.