Abstract
Background Participation in physical play/leisure (PPP) is an important therapy goal of children with motor impairments. Evidence for interventions promoting PPP in these children is scarce. The first step is to identify modifiable, clinically meaningful predictors of PPP for targeting by interventions.
Objective The study objective was to identify, in children with motor impairments, body function and structure, activity, environmental, and personal factors related to PPP and modifiable by therapists.
Design This was a mixed-methods, intervention development study. The World Health Organization framework International Classification of Functioning, Disability and Health was used.
Methods Participants were children (6–8 years old) with motor impairments, mobilizing independently with or without equipment and seen by physical therapists or occupational therapists in 6 regions in the United Kingdom, and their parents. Self-reported PPP was assessed with the Children's Assessment of Participation and Enjoyment. Modifiable-factor data were collected with therapists' observations, parent questionnaires, and child-friendly interviews. The Children's Assessment of Participation and Enjoyment, therapist, and parent data were analyzed using descriptive statistics and linear regression. Interview data were analyzed for emerging themes.
Results Children's (n=195) PPP (X̅=18 times per week, interquartile range=11–25) was mainly ‘recreational’ (eg, pretend play, playing with pets) rather than ‘active physical’ (eg, riding a bike/scooter). Parents (n=152) reported positive beliefs about children's PPP but various levels of family PPP. Therapists reported 23 unique impairments (eg, muscle tone), 16 activity limitations (eg, walking), and 3 personal factors (eg, child's PPP confidence). Children interviewed (n=17) reported a strong preference for active play but indicated that adults regulated their PPP. Family PPP and impairment in the child's movement-related body structures explained 18% of the variation in PPP. Family PPP explained most of the variation.
Limitations It is likely that the study had a degree of self-selection bias, and caution must be taken in generalizing the results to children whose parents have less positive views about PPP.
Conclusions The results converge with wider literature about the child's social context as a PPP intervention target. In addition, the results question therapists' observations in explaining PPP.
Footnotes
Dr Kolehmainen proposed the research idea and refined it further with all coauthors. Dr Kolehmainen, Professor Ramsay, Professor McKee, Professor Missiuna, and Professor Francis developed the research design. Dr Kolehmainen led the writing of the manuscript; all other coauthors provided critical comments throughout the manuscript. Dr Kolehmainen collected and analyzed all data; the coauthors provided expertise on the methods (Professor Ramsay, Professor McKee, and Professor Francis) and the topic content (Professor Missiuna, Ms Owen, and Professor Francis). Professor Missiuna also analyzed the child interviews. Dr Kolehmainen led fund procurement, project management, and institutional liaisons. All authors provided consultation (including review of manuscript before submission).
The authors thank the therapists for supporting data collection; the child and parent advisors for contributing to the data collection materials and interpretation of the results; Ms Heather Angilley (Mid-Yorkshire NHS), Ms Jennifer McAnuff (Leeds NHS), and Dr Olaf Verschuren (de Hoogstraat Revalidatie) for clinical expertise; Dr Marjolijn Ketelaar (de Hoogstraat Revalidatie) and Professors Peter Rosenbaum (McMaster University), Allan Colver (Newcastle University), and Marie Johnston (University of Aberdeen) for scientific advice; and Dr Nora Fayed (McMaster University) and Dr Olaf Kraus de Camargo (McMaster University) for advice on the use of the International Classification of Functioning, Disability and Health for Children and Youth.
The study was approved by a National Health Service Research Ethics Committee (ref: 11/S0801/2).
The study was funded by the UK Medical Research Council (ref: G0902129). Professor McKee and Professor Ramsay are funded by the Chief Scientist Office of the Scottish Government Health Directorates.
- Received September 18, 2014.
- Accepted April 2, 2015.
