Comparing quality of life and habitual physical activity in children with cerebral palsy.
Purpose: This study examined the association between ambulatory status, based on the Gross Motor Function Classification System (GMFCS), Habitual Physical Activity (HPA), and Quality of Life (QOL) in children with Cerebral Palsy (CP) at the age of 5.
Study Population: This study used children with CP at the age of 5. Participants could not have lesions that were progression or neurodegenerative.
Methods, Outcome Measures, and Intervention: Participants were assessed based on Gross Motor Function Measure (GMFM) 66 item, as well as placed into ambulatory categories based on the GMFCS in five groups, Level I independent walking without restrictions, Level II independent walking with limited on uneven surfaces, Level III walking with an assistive device, Level IV limited self-mobility or use power mobility, Level V severely limited self-mobility and used wheeled mobility. HPA was determined by placing an ActiGraph triaxial accelerometer around the lower back of the child for a period of three days. Activity diaries were created to log when the ActiGraph was put on and taken off to accurately measure HPA. The parents of the children were given the parent proxy Cerebral Palsy Quality of Life questionnaire for Children to assess QOL.
Results: The study began with 132 participants and ended with 58 after 74 children were excluded because they were unable to complete the 3 day physical activity monitoring. QOL was found to be significantly better in ambulatory children (GMFCS Levels I – III) than non-ambulatory children (Levels IV & V) in the categories of functioning, participation and physical health, and emotional wellbeing and self-esteem. When HPA was compared to QOL, with motor function (based on the GMFM) controlled for, there was no significance.
Strengths: The use of the ActiGraph gives more objective data on how much physical activity a child is able to get, compared to using subjective measures. Since the ActiGraph is placed around the trunk the activity data that was gathered was not affected by asymmetric movement patterns. This study includes a large number of participants for a specific age.
Limitations: This study had a large number of dropouts due to the inability of many children to tolerate wearing the ActiGraph, potentially skewing data. The ActiGraph also has its own limitations, as it is unable to be worn during water-based activities, and it does not detect activities where the trunk does not move, such as bike riding. There were also 47 participants that were considered ambulatory based on the GMFCS compared to only 11 Non-ambulatory, ideally both categories would have similar amounts of patients. All participants were the age of 5, future research should include a wider range of ages.
Clinical Application: This article shows that what is important for children with CP is their ambulatory status, not so much the amount of activity that they are getting. This may narrow the focus of PT goals to help improve the ability of children with CP to ambulate, but not necessarily their amount of activity, in order to improve parent reported QOL.
Reference: Piyapa Keawutan, Kristie L. Bell, Stina Oftedal, Peter S.W. Davies, Robert S. Ware, Roslyn N. Boyd. Quality of life and habitual physical activity in children with cerebral palsy aged 5 years: A cross-sectional study. Research in Developmental Disabilities. Volume 74, March 2018, pg 139-145
2 responses to “Comparing quality of life and habitual physical activity in children with cerebral palsy.”
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Darrin,
Thank you for summarizing this article concisely and clearly. I’m curious about the conclusions that the authors drew between the quality of life and functional status. Since the QOL survey was completed by parents, would you consider this to be a fair conclusion to draw? I imagine that there are many limitations to determining the quality of life of a 5-year-old. Did you happen to look into the validity of this outcome measure for young children with CP?
Thanks,
Kailey
Thank you for you questions Kailey! I do believe that the CP QOL-Child is a valid and reliable measure of a child’s QOL from the response of a parent, based on the research that I have cited below. While a parent proxy is not the ideal method of data collection it can be difficult to find a true QOL measure in this population when they are so young. Hope this helps!
Reference: Waters, E., Davis, E., Boyd, R., Reddihough, D., Mackinnon, A., Graham, H. K., et al. (2013). Cerebral palsy quality of life questionnaire for children (CP QOL-child) manual. Melbourne: University of Melbourne.