Physiotherapy - Research Publications
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ItemNo Preview AvailableAcceptability of Dance PREEMIE (a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age) from the perspectives of families and dancer teachers: a reflexive thematic analysis(TAYLOR & FRANCIS INC, 2023-06-03)BACKGROUND: Physical activity (PA) participation is important for children born extremely preterm or extremely low birthweight as it provides opportunities to improve motor skills and cardiovascular fitness; however there is little evidence on interventions promoting PA participation for this group, particularly at preschool age. OBJECTIVE: This study aims to explore the acceptability, a critical component of intervention feasibility, of a novel dance participation intervention. METHODS: Semi-structured interviews explored the acceptability of Dance PREEMIE, a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age (trial registration ACTRN12619001266156), from the perspectives of dance teachers delivering the intervention (n = 6), and parents of participating children (n = 6). Data were analyzed using reflexive thematic analysis. RESULTS: Five themes were developed: 1) placing the child center-stage: a shared motivation to promote child wellbeing and development; 2) Dance PREEMIE as a catalyst for participation; 3) child development takes time, practice and exposure; 4) the value of being informed; and 5) dance teachers as architects of the learning environment. CONCLUSION: Dance PREEMIE was acceptable to both parents of participating children and dance teachers. Findings from this study may inform future interventions aiming to improve PA participation for children with motor impairment at preschool age.
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ItemNo Preview AvailableSpatiotemporal gait variables and step-to-step variability in preschool-aged children born < 30 weeks' gestation and at term in preferred speed, dual-task paradigm, and tandem walking(ELSEVIER IRELAND LTD, 2022-02)BACKGROUND: Children born very preterm (< 32 weeks' gestation) are at greater risk of motor impairment and executive/attentional dysfunctions than term-born children; however, little is known about how functional tasks, including walking, may be affected by very preterm birth. RESEARCH QUESTION: How does the gait pattern of preschool-age children born < 30 weeks compare with term-born controls under a variety of walking conditions? METHODS: In this prospective cohort study, children born < 30 weeks and at term were assessed at 4.5-5 years' corrected age, blinded to birth group. Four walking conditions were assessed using the GAITRite® system: preferred speed, cognitive dual-task, motor dual-task, and tandem walking. Gait variables analysed included speed, cadence, step length, step time, base of support (BOS), and single and double support time. Spatiotemporal variables were compared between groups using linear regression, adjusting for lower-limb length, corrected age at assessment, and number of trials. RESULTS: 224 children (112 < 30 weeks and 112 term-born) were assessed. Gait variables of children born < 30 weeks did not differ from their term-born peers when walking at their preferred speed, except for higher BOS variability (mean difference [MD] = 0.19 cm, 95% confidence interval [CI] 0.10, 0.27, p < 0.001). Under the motor dual-task condition, children born < 30 weeks walked faster (MD= 3.06 cm/s, 95% CI 0.14, 5.97, p = 0.040), with a longer step length (MD= 1.10 cm, 95%CI 0.19, 2.01, p = 0.018), and a wider BOS (MD= 0.37 cm, 95%CI 0.06, 0.67, p = 0.019). In cognitive dual-task and tandem conditions, children born < 30 weeks walked with a wider BOS compared with term-born peers (MD= 0.43 cm, 95%CI 0.05, 0.81, p = 0.028; and MD= 0.30 cm, 95%CI 0.09, 0.51, p = 0.005, respectively). SIGNIFICANCE: This research highlights the need to consider the walking performance of preschool-age children born < 30 weeks under challenging conditions, such as dual-task or tandem walking, when assessing gait patterns and planning interventions.
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ItemBarriers and facilitators to community participation for preschool age children born very preterm: a prospective cohort study(WILEY, 2021-06)AIM: We compared preschool age children born very preterm with term-born controls to: (1) understand the association between very preterm birth and community participation, (2) determine if motor impairment or social risk affect participation differently between groups, and (3) understand environmental barriers and supports to participation for parents. METHOD: Forty-eight children born very preterm (<30wks' gestation; 22 males, 26 females) and 96 controls (47 males, 49 females) were assessed at 4 to 5 years' corrected age for community participation using the Young Children's Participation and Environment Measure. Motor skills were assessed using the Movement Assessment Battery for Children, Second Edition and the Little Developmental Coordination Disorder Questionnaire. RESULTS: Children born very preterm participated less frequently than term-born children (difference in means=-0.28, 95% confidence interval [CI] -0.54 to -0.03, p=0.029). Social risk was associated with lower frequency (interaction p<0.001) and involvement (interaction p=0.05) in community activities for children in the very preterm group only. Parents of children born very preterm perceived more barriers (odds ratio=4.32, 95% CI 1.46-12.77, p=0.008) and environmental factors to be less supportive of participation than parents of controls (difference in medians=-6.21, 95% CI -11.42 to -1.00, p=0.02). INTERPRETATION: Children born very preterm may benefit from ongoing support to promote participation, especially in families of higher social risk.
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ItemMovement-based interventions for preschool-age children with, or at risk of, motor impairment: a systematic review(WILEY, 2020-03)AIM: To explore the efficacy of movement-based interventions to improve motor skills in preschool-age children with, or at risk of, motor impairment, including those with a diagnosis of cerebral palsy, autism spectrum disorder, and developmental coordination disorder. METHOD: Relevant electronic databases were searched for randomized or quasi-randomized controlled trials. Outcomes were classified using domains of the International Classification of Functioning, Disability and Health: Children & Youth version. Quality was assessed using the Physiotherapy Evidence Database scale. Risk of bias was assessed using the Cochrane Risk of Bias tool. Effect sizes were calculated using Cohen's d. RESULTS: Seventeen articles exploring a heterogeneity of intervention types, population groups, and outcome measures met the inclusion criteria. Movement-based interventions did not significantly improve outcomes in either the body structure and function or activity domains in most studies. No studies used a participation outcome measure. INTERPRETATION: There is a paucity of evidence exploring movement-based interventions in the preschool-age group. Although movement-based interventions showed potential for improving body structure and function and activity outcomes for children with motor impairment, results were mostly not significant. Small sample sizes, variable study quality, and risk of bias limit confidence in the results. WHAT THIS PAPER ADDS: The evidence is inconclusive to support movement-based interventions in this group. No studies used outcome measures assessing participation. Variability in intervention type and study quality limit confidence in results.
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ItemBike skills training for children with cerebral palsy: protocol for a randomised controlled trial(BMJ PUBLISHING GROUP, 2018-05)INTRODUCTION: Two-wheel bike riding can be a goal for children with cerebral palsy (CP) and a means of participating in physical activity. It is possible for some children with CP to ride a two-wheel bike; however, currently far fewer can ride compared with their typically developing peers. Evidence supports training targeted towards goals of the child with CP and their family; yet there is little evidence to guide best-practice bike skills training. Task-specific training may lead to attainment of two-wheel bike-specific goals. This study aims to determine if a novel task-specific approach to training two-wheel bike skills is more effective than a parent-led home programme for attaining individualised two-wheel bike-specific goals in independently ambulant children with CP aged 6-15 years. METHODS AND ANALYSIS: Sixty eligible children with CP (Gross Motor Function Classification System levels I-II) aged 6-15 years with goals relating to riding a two-wheel bike will be randomised to either a novel task-specific centre-based group programme (intervention) or a parent-led home-based programme (comparison), both involving a 1-week intervention period. The primary outcome is goal attainment in the week following the intervention period (T1). Secondary outcomes include: goal attainment and participation in physical activity at 3 months postintervention (T2) and bike skills, attendance and involvement in bike riding, self-perception and functional skills at T1 and T2. Economic appraisal will involve cost-effectiveness and cost-utility analyses. Adherence of clinicians and parents to the intervention and comparison protocols will be assessed. Linear and logistic regression will be used to assess the effect of the intervention, adjusted for site as used in the randomisation process. ETHICS AND DISSEMINATION: This study was approved by the Human Research and Ethics Committees at The Royal Children's Hospital (#36209). Results will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT03003026; Pre-results.
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ItemTask-specific gross motor skills training for ambulant school-aged children with cerebral palsy: a systematic review(BMJ PUBLISHING GROUP, 2017-08)OBJECTIVES: The primary objective is to systematically evaluate the evidence for the effectiveness of task-specific training (TST) of gross motor skills for improving activity and/or participation outcomes in ambulant school-aged children with cerebral palsy (CP). The secondary objective is to identify motor learning strategies reported within TST and assess relationship to outcome. DESIGN: Systematic review. METHOD: Relevant databases were searched for studies including: children with CP (mean age >4 years and >60% of the sample ambulant); TST targeting gross motor skills and activity (skill performance, gross motor function and functional skills) and/or participation-related outcomes. Quality of included studies was assessed using standardised tools for risk of bias, study design and quality of evidence across outcomes. Continuous data were summarised for each study using standardised mean difference (SMD) and 95% CIs. RESULTS: Thirteen studies met inclusion criteria: eight randomised controlled trials (RCTs), three comparative studies, one repeated-measures study and one single-subject design study. Risk of bias was moderate across studies. Components of TST varied and were often poorly reported. Within-group effects of TST were positive across all outcomes of interest in 11 studies. In RCTs, between-group effects were conflicting for skill performance and functional skills, positive for participation-related outcomes (one study: Life-HABITS performance SMD=1.19, 95% CI 0.3 to 2.07, p<0.001; Life-HABITS satisfaction SMD=1.29, 95% CI 0.40 to 2.18, p=0.001), while no difference or negative effects were found for gross motor function. The quality of evidence was low-to-moderate overall. Variability and poor reporting of motor learning strategies limited assessment of relationship to outcome. CONCLUSIONS: Limited evidence for TST for gross motor skills in ambulant children with CP exists for improving activity and participation-related outcomes and recommendations for use over other interventions are limited by poor study methodology and heterogeneous interventions. REGISTRATION: PROSPERO ID42016036727.
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ItemDance PREEMIE, a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age: an Australian feasibility trial protocol(BMJ PUBLISHING GROUP, 2020-01)INTRODUCTION: Children born extremely preterm (EP: <28 weeks gestation) and/or extremely low birth weight (ELBW: <1000 g) are at increased risk of motor impairment compared with children born at term. Children with motor impairment have lower rates of physical activity (PA) participation compared with their typically developing peers. PA participation is an important outcome for children with motor impairment, however, there is limited evidence available to support interventions that improve PA participation in this population. The aim of this study is to assess the feasibility, including the recruitment and retention, acceptability and fidelity, of a preschool dance participation intervention for children born EP/EBLW with motor impairment called Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age. METHODS AND ANALYSIS: This feasibility case series trial will recruit EP/ELBW children with motor impairment (n=10) from the Victorian Infant Collaborative Study 2016/2017 cohort, a prospective longitudinal cohort study. Up to 10 community-based dance teachers will be recruited and provided with physiotherapy-led training and support to facilitate the participation of EP/ELBW children in community dance classes. A mixed-methods approach (quantitative and qualitative) will be used to analyse the primary aim, to determine the feasibility of the intervention from the perspectives of families and dance teachers. ETHICS AND DISSEMINATION: This study is approved by the Human Research Ethics Committees of The Royal Children's Hospital and The Royal Women's Hospital, Melbourne. Study outcomes will be disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER: ACTRN12619001266156.
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ItemTask-specific training for bicycle-riding goals in ambulant children with cerebral palsy: a randomized controlled trial(WILEY, 2022-02)AIM: To determine whether a task-specific physiotherapist-led training approach is more effective than a non-specific parent-led home programme for attaining bicycle-riding goals in ambulant children with cerebral palsy (CP). METHOD: Sixty-two ambulant children with CP aged 6 to 15 years (33 males, 29 females, mean age 9y 6mo) with bicycle-riding goals participated in this multi-centre, assessor-blind, parallel-group, superiority randomized controlled trial. Children in the task-specific group participated in a physiotherapist-led, group-based, intensive training programme. Children in the parent-led home group were provided with a practice schedule, generic written information, and telephone support. Both programmes involved a 1-week training period. The primary outcome was goal attainment at 1 week after training measured using the Goal Attainment Scale. Secondary outcomes included bicycle skills, participation in bicycle riding, functional skills, self-perception, physical activity, and health-related quality of life at 1 week and 3 months after training. RESULTS: Children in the task-specific training group had greater odds of goal attainment than those in the parent-led home programme at 1 week after intervention (odds ratio [OR] 10.4, 95% confidence interval [CI] 2.8-38.6), with evidence for superiority retained at 3 months (OR 4.0, 95% CI 1.3-12.5). INTERPRETATION: The task-specific physiotherapist-led training approach was more effective for attaining bicycle-riding goals than a non-specific parent-led home programme in ambulant children with CP.