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Efficacy of participation-focused therapy on performance of physical activity participation goals and habitual physical activity in children with cerebral palsy: a randomized controlled trial
Reedman SE, Boyd RN, Trost SG, Elliott C, Sakzewski L
Archives of Physical Medicine and Rehabilitation 2019 Apr;100(4):676-686
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To determine the efficacy of a participation-focused therapy (ParticiPAte CP) on leisure-time physical activity goal performance and satisfaction and habitual physical activity (HPA) in children with cerebral palsy (CP). DESIGN: Randomized waitlist-controlled trial. SETTING: Home and community. PARTICIPANTS: Thirty-seven children Gross Motor Function Classification System (GMFCS) I to III were recruited (18 males, mean age 10 y 0 mo (SD 1 y 5 mo)) from a population-based register. INTERVENTIONS: Participants were randomized to ParticiPAte CP (an 8-week goal-directed, individualized, participation-focused therapy delivered by a physical therapist) or waitlist usual care. MAIN OUTCOME MEASURES: The primary outcome was Canadian Occupational Performance Measure (COPM). Accelerometers were worn for objective measurement of HPA (min/day) moderate to vigorous physical activity, MVPA, and sedentary time). Barriers to participation, community participation, and quality of life outcomes were also collected. Data were analysed by intention-to-treat using generalized estimating equations. RESULTS: ParticiPAte CP led to significant improvements in goal performance (MD 3.58, 95% CI 2.19 to 4.97, p < 0.001), satisfaction (MD 1.87, 95% CI 0.37 to 3.36, p = 0.014), and barriers to participation (MD 26.39, 95% CI 6.13 to 46.67, p = 0.011) compared with usual care at eight weeks. There were no between group differences on min/day MVPA at eight weeks (MD 1.17, 95% CI -13.27 to 15.61, p = 0.874). There was a significant difference in response to intervention between participants who were versus were not meeting HPA guidelines at baseline (MD 15.85, 95% CI 3.80 to 27.89, p < 0.0061). Following ParticiPAte CP, low active participants had increased average MVPA by 5.98 (SD 12.16) min/day. CONCLUSION: ParticiPAte CP was effective at increasing perceived performance of leisure-time physical activity goals in children with CP GMFCS I to III by reducing modifiable barriers to participation. This did not translate into change in HPA on average, however low active children may have a clinically meaningful response.

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