- Investigator/s:
- Carol Maher, Marie Williams, Tim Olds, Alison Lane, Susan Gibson
- ICF Classifications:
- Activities
- Participation
What are the questions?
- What are the physical and sedentary activity patterns of adolescents with cerebral palsy?
- How do these patterns relate to quality of life and health issues?
- How do the physical and sedentary activity patterns of adolescents with cerebral palsy compare with those of non-disabled adolescents?
Background
Physical activity has many psychological and health benefits, such as improved well-being and reduced risk of diabetes, heart disease and colon cancer.
Little is currently known about physical activity levels in adolescents with cerebral palsy. The little that is known would suggest that they are insufficiently physically active to achieve substantial health benefits. However existing data are relatively outdated and are based on overseas populations.
This study aimed to determine current physical activity patterns amongst South Australian adolescents with cerebral palsy.
Context
The project consists of three discrete, but related studies:
Study 1 - concerned with determining current patterns of physical activity in adolescents with cerebral palsy (completed).
Study 2 - involves the development, and user testing, of an internet-based intervention aimed at increasing levels of physical activity amongst ambulant adolescents with cerebral palsy (currently underway - user testing is currently underway).
Study 3 - will test the efficacy of the internet-based physical activity intervention using a randomised controlled trial (planned for 2007).
This progress report is focussed on the Study 1.
How was the project carried out?
Participants
Novita clients aged 11-17 years with a principal diagnosis of cerebral palsy.
Data collection - Study 1 (completed)
Data collection was undertaken using a postal survey comprising two existing survey tools:
- The Adolescent Questionnaire from the Health of Young Victorians Study (a major longitudinal study currently underway in Victoria) - this questionnaire examines health status and quality of life.
- The Physical Activity Questionnaire for Adolescents (PAQ-A), a well recognised questionnaire that examines physical activity over the past seven days.
Some purpose-designed questions were also added to record demographic details, level of impairment (based upon the Gross Motor Function Classification System), and time spent undertaking sedentary activities.
The survey was piloted with 20 young people with cerebral palsy on two occasions, separated by a week, to confirm the wording of the purpose-designed items and to determine reliability (test-retest).
Concurrent validity was examined by comparing PAQ-A scores with pedometer/accelerometer step/displacement counts over one week, and by comparing the sedentary behaviours questionnaire responses with a self-completed screen-time logbook.
Reliability of the two instruments was confirmed (ICC=0.51-0.99 (individual PAQ-A items); 0.90 (overall physical activity score); 0.30-0.95 (sedentary activities items); 0.84 (total weekly sedentary time)).
Validity was determined using Pearson’s correlation coefficient; r=0.24 (overall PAQ-A score/ pedometer step count); r=-0.21 (overall PAQ-A score/accelerometer displacement counts); r=-0.03 to 0.51 (survey sedentary behaviour questions/logbook); and r=0.38 (survey total weekly screen-time/logbook total weekly screen-time).
Surveys were collated into individually-coded packages (including personalized covering letter and reply-paid envelopes) for each family identified as being eligible from the Novita database. A cinema voucher was provided to participants who returned the survey, irrespective of whether it was completed.
Surveys were coded to permit repeat mail-outs to non-responders at four and eight weeks and to allow identification of non-responders’ characteristics in order to estimate representativeness of the sample and identify non-responder bias.
Participants were instructed that it was preferable for the young person with cerebral palsy to complete the survey independently. For participants whose physical or intellectual disability prevented them from completing the surveys independently, their parent/guardian was instructed to read the survey to them and document their responses. In the case of participants with severe intellectual disability, the parent/guardian was asked to complete the survey on their behalf.
Data analysis
- Categorical data were analysed in terms of frequency of responses and percentages of the total sample.
- Ratio data were descriptively analysed using medians and ranges, means and standard deviations.
- ANCOVA was used to identify relationships between participants’ characteristics and physical and sedentary activity patterns.
- Comparative normative data were obtained from two recent studies conducted with 7018, 11-17 year old Australian school children.
- Since activity patterns in the general adolescent population are known to vary by age and gender, a proportional number of participants without cerebral palsy were selected from the comparative dataset for each age and gender. Comparisons were then made with the matched dataset.
The findings
The survey was sent to 229 potential participants and 118 responded (response rate 51.5%, age range 11-17 years, males n=76).
Key findings were that:
- adolescents with cerebral palsy were less physically active than their non-disabled peers
- physical activity level was related to GMFCS (Gross Motor Function Classification System) functional ability
- adolescents with cerebral palsy participated in lower intensity and more solitary activities than non-disabled adolescents
- sedentary activity patterns were similar between adolescents with and without cerebral palsy.
Preliminary analyses are currently underway for the quality of life and health issues data.
What are the potential implications?
For children, their families
While adolescents with cerebral palsy are participating in a range of physical activities, there is a tendency towards participation in low-intensity, relatively solitary activities. Thus, the vast majority of adolescents with cerebral palsy are unlikely to be participating in sufficient physical activity to achieve the health, social and psychological benefits that regular moderate to vigorous physical activity offers.
For therapists
The study emphasises the importance of considering the various aspects of physical activity such as enjoyment, opportunity for socialisation and physiological benefits, such as intensity, frequency and duration for young people with cerebral palsy. The ongoing challenge is assisting such people to participate in physical activity that is not only enjoyable, but also of sufficient intensity to achieve the physiological benefits of regular physical activity, while maximizing opportunities for socialisation.
For managers
The study raises the possibility of Novita regions running physical activity programs for adolescent clients with cerebral palsy.
Project details
Start date: July 2005
Completion dates:
Study 1 - analysis completed.
Study 2 - currently underway.
Study 3 - to be undertaken in 2007.
Funding sources: Australian Postgraduate Aware PhD scholarship; University of South Australia, School of Health Sciences stipend.
Research team
Chief investigator
Carol Maher
Doctoral student
University of South Australia and Novita
PhD supervisors
Marie Williams
Tim Olds
Dr Alison Lane
University of South Australia
Novita liaison
Susan Gibson
Research Senior Physiotherapist
Contact person
Carol Maher
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Note: Role and organisation are listed as at the time of the project.