Predictors of physical activity levels in children and adolescents with cerebral palsy: clinical cohort study protocol

Christina Esmann Fonvig, Jens Troelsen, Ulrike Dunkhase-Heinl, Jens Martin Lauritsen, Anders Holsgaard-Larsen, Christina Esmann Fonvig, Jens Troelsen, Ulrike Dunkhase-Heinl, Jens Martin Lauritsen, Anders Holsgaard-Larsen

Abstract

Introduction: Children and adolescents with cerebral palsy may be trapped in a vicious circle of low physical fitness, resulting in deconditioning that causes a further decrease in physical activity (PA), a lower quality of life and an increased risk of developing non-communicable diseases. Therefore, establishing a healthy and active lifestyle during childhood is even more important for individuals with a disability. However, the factors that influence habitual PA in children and adolescents with cerebral palsy remain unknown.The present protocol outlines a prospective cohort study with the aim of investigating potential predictors of habitual PA in children and adolescents with cerebral palsy in order to provide evidence for optimising PA levels and associated overall health.

Methods and analysis: This prospective cohort study will enrol participants with cerebral palsy between the ages of 8 and 15 years at Gross Motor Function Classification System levels I-III. Using a modified version of the International Classification of Functioning, Disability and Health model as a conceptual analytical framework, the analysis will be divided into six components and will provide predictors for habitual PA measured by accelerometry. The potential predictive variables are registry data on physical function (Danish Cerebral Palsy Follow-Up Programme); validated proxy-reported questionnaires on quality of life (Paediatric Quality of Life Inventory), overall health, pain and participation in daily activities (Paediatric Outcomes Data Collection Instrument) and supplementary questions regarding sleep, screen time and socioeconomic status.

Ethics and dissemination: The project is approved by the Danish Data Protection Agency (19/16396) and has been declared not notifiable by the Regional Committee on Health Research Ethics, cf. Committee Act Art. 14, paragraph 1 (S-20192000-23). The study results will be published in international peer-reviewed journals, presented at international conferences, and published in a PhD dissertation.

Trial registration number: NCT04614207.

Keywords: developmental neurology & neurodisability; epidemiology; musculoskeletal disorders.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram. GMFCS, Gross Motor Function Classification System.
Figure 2
Figure 2
Included predictive variables sorted into components according to the modified ICF model, including data collection timeline in months. Variables derived from the following: aCPUP registry, bParent-Reported Questionnaire, cPODCI questionnaire, dPedsQLquestionnaire. BMI, body mass index; CP, cerebral palsy; CPUP, Cerebral Palsy Follow-Up Programme; GMFCS, Gross Motor Function Classification System; ICF, International Classification of Functioning, Disability and Health; PedsQL, Paediatric Quality of Life Inventory; PODCI, Paediatric Outcomes Data Collection Instrument; PedsQL, Paediatric Quality of Life Inventory.

References

    1. Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lancet 2004;363:1619–31. 10.1016/S0140-6736(04)16207-7
    1. Oskoui M, Coutinho F, Dykeman J, et al. . An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2013;55:509–19. 10.1111/dmcn.12080
    1. Frøslev-Friis C, Dunkhase-Heinl U, Andersen JDH, et al. . Epidemiology of cerebral palsy in southern Denmark. Dan Med J 2015;62:A4990.
    1. Bax M, Goldstein M, Rosenbaum P, et al. . Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2005;47:571–6. 10.1017/S001216220500112X
    1. Bell KJ, Ounpuu S, DeLuca PA, et al. . Natural progression of gait in children with cerebral palsy. J Pediatr Orthop 2002;22:677–82. 10.1097/01241398-200209000-00020
    1. Global Recommendations on Physical Activity for Health . WHO guidelines Approved by the guidelines review Committee. Geneva: WHO, 2010.
    1. Carlon SL, Taylor NF, Dodd KJ, et al. . Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing Peers: a systematic review. Disabil Rehabil 2013;35:647–55. 10.3109/09638288.2012.715721
    1. Bjornson KF, Belza B, Kartin D, et al. . Ambulatory physical activity performance in youth with cerebral palsy and youth who are developing typically. Phys Ther 2007;87:248–57. 10.2522/ptj.20060157
    1. Durstine JL, Painter P, Franklin BA, et al. . Physical activity for the chronically ill and disabled. Sports Med 2000;30:207–19. 10.2165/00007256-200030030-00005
    1. Murray CJL, Vos T, Lozano R, et al. . Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet 2012;380:2197–223. 10.1016/S0140-6736(12)61689-4
    1. Morgan P, McGinley J. Gait function and decline in adults with cerebral palsy: a systematic review. Disabil Rehabil 2014;36:1–9. 10.3109/09638288.2013.775359
    1. Fowler EG, Kolobe TH, Damiano DL, et al. . Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research Summit proceedings. Phys Ther 2007;87:1495–510. 10.2522/ptj.20060116
    1. Strong WB, Malina RM, Blimkie CJR, et al. . Evidence based physical activity for school-age youth. J Pediatr 2005;146:732–7. 10.1016/j.jpeds.2005.01.055
    1. Rasmussen HM, Nordbye-Nielsen K, Møller-Madsen B, et al. . The Danish cerebral palsy follow-up program. Clin Epidemiol 2016;8:457–60. 10.2147/CLEP.S99474
    1. Alriksson-Schmidt A, Hägglund G, Rodby-Bousquet E, et al. . Follow-Up of individuals with cerebral palsy through the transition years and description of adult life: the Swedish experience. J Pediatr Rehabil Med 2014;7:53–61. 10.3233/PRM-140273
    1. SST . National Klinisk Retningslinje for fysioterapi/ergoterapi TIL børn Med cerebral parese. Available:
    1. Vandenbroucke JP, et al. . Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Ann Intern Med 2007;147:W–W-94. 10.7326/0003-4819-147-8-200710160-00010-w1
    1. Harris PA, Taylor R, Thielke R, et al. . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81. 10.1016/j.jbi.2008.08.010
    1. Arvidsson D, Fridolfsson J, Börjesson M. Measurement of physical activity in clinical practice using accelerometers. J Intern Med 2019;286:137–53. 10.1111/joim.12908
    1. Gorter JW, Noorduyn SG, Obeid J. Accelerometry: a feasible method to quantify physical activity in ambulatory and nonambulatory adolescents with cerebral palsy. Int J Pediatr 2012;2012:6. 10.1155/2012/329284
    1. Rasmussen MGB, Pedersen J, Olesen LG, et al. . Short-Term efficacy of reducing screen media use on physical activity, sleep, and physiological stress in families with children aged 4-14: study protocol for the screens randomized controlled trial. BMC Public Health 2020;20:380. 10.1186/s12889-020-8458-6
    1. Trost SG, Fragala-Pinkham M, Lennon N, et al. . Decision trees for detection of activity intensity in youth with cerebral palsy. Med Sci Sports Exerc 2016;48:958–66. 10.1249/MSS.0000000000000842
    1. Ishikawa S, Kang M, Bjornson KF, et al. . Reliably measuring ambulatory activity levels of children and adolescents with cerebral palsy. Arch Phys Med Rehabil 2013;94:132–7. 10.1016/j.apmr.2012.07.027
    1. Cain KL, Sallis JF, Conway TL, et al. . Using accelerometers in youth physical activity studies: a review of methods. J Phys Act Health 2013;10:437–50. 10.1123/jpah.10.3.437
    1. Brønd JC, Andersen LB, Arvidsson D. Generating ActiGraph counts from raw acceleration recorded by an alternative monitor. Med Sci Sports Exerc 2017;49:2351–60. 10.1249/MSS.0000000000001344
    1. Stahlhut M, Wong CTK, Taudorf K. Oversættelse af PedQL [in Danish]. Fag Og Forskning 2010;4.
    1. Carlon S, Shields N, Yong K, et al. . A systematic review of the psychometric properties of quality of life measures for school aged children with cerebral palsy. BMC Pediatr 2010;10:81. 10.1186/1471-2431-10-81
    1. Varni JW, Burwinkle TM, Berrin SJ, et al. . The PedsQL in pediatric cerebral palsy: reliability, validity, and sensitivity of the generic core scales and cerebral palsy module. Dev Med Child Neurol 2006;48:442. 10.1017/S001216220600096X
    1. McCarthy ML, Silberstein CE, Atkins EA, et al. . Comparing reliability and validity of pediatric instruments for measuring health and well-being of children with spastic cerebral palsy. Dev Med Child Neurol 2002;44:468–76. 10.1111/j.1469-8749.2002.tb00308.x
    1. Harvey A, Robin J, Morris ME, et al. . A systematic review of measures of activity limitation for children with cerebral palsy. Dev Med Child Neurol 2008;50:190–8. 10.1111/j.1469-8749.2008.02027.x
    1. Pedersen NH, Koch S, Larsen KT, et al. . Protocol for evaluating the impact of a national school policy on physical activity levels in Danish children and adolescents: the PHASAR study - a natural experiment. BMC Public Health 2018;18:1245. 10.1186/s12889-018-6144-8
    1. HMea R. CPOP manual for physiotherapy protocol, 2014. Available:
    1. Graham HK, Harvey A, Rodda J, et al. . The functional mobility scale (FMS). J Pediatr Orthop 2004;24:514–20. 10.1097/01241398-200409000-00011
    1. Rosenbaum P. Family and quality of life: key elements in intervention in children with cerebral palsy. Dev Med Child Neurol 2011;53 Suppl 4:68–70. 10.1111/j.1469-8749.2011.04068.x
    1. McDougall J, Wright V, Rosenbaum P. The ICF model of functioning and disability: incorporating quality of life and human development. Dev Neurorehabil 2010;13:204–11. 10.3109/17518421003620525
    1. Shmueli G. To explain or to predict? Statistical Science 2011;25.
    1. Harrell FE, Strategies MM. Multivariable Modeling Strategies. In: Regression modeling strategies. Springer series in statistics. New York, NY: Springer, 2001.
    1. Austin PC, Steyerberg EW. Events per variable (EPV) and the relative performance of different strategies for estimating the out-of-sample validity of logistic regression models. Stat Methods Med Res 2017;26:796–808. 10.1177/0962280214558972
    1. Schomaker M, Heumann C. Bootstrap inference when using multiple imputation. Stat Med 2018;37:2252–66. 10.1002/sim.7654
    1. Schiariti V, Klassen AF, Cieza A, et al. . Comparing contents of outcome measures in cerebral palsy using the International classification of functioning (ICF-CY): a systematic review. Eur J Paediatr Neurol 2014;18:1–12. 10.1016/j.ejpn.2013.08.001
    1. Germain N, Aballéa S, Toumi M. Measuring the health-related quality of life in young children: how far have we come? J Mark Access Health Policy 2019;7:1618661. 10.1080/20016689.2019.1618661
    1. Schneller MB, Bentsen P, Nielsen G, et al. . Measuring children's physical activity: compliance using Skin-Taped Accelerometers. Med Sci Sports Exerc 2017;49:1261–9. 10.1249/MSS.0000000000001222
    1. Stewart T, Narayanan A, Hedayatrad L, et al. . A Dual-Accelerometer system for classifying physical activity in children and adults. Med Sci Sports Exerc 2018;50:2595–602. 10.1249/MSS.0000000000001717

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren