Miller Laura, Ziviani Jenny, Ware Robert S, Boyd Roslyn N
Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
Dev Med Child Neurol. 2014 Oct;56(10):976-83. doi: 10.1111/dmcn.12471. Epub 2014 Apr 26.
To determine the extent to which children's mastery motivation predicts occupational performance outcomes following upper limb intervention (ULI).
In this cohort study, participants received 45 hours of ULI, either in an intensive group-based or distributed individualized model. The Dimensions of Mastery Questionnaire (DMQ) measured mastery motivation at baseline. Occupational performance outcomes were assessed at baseline and 13 weeks' post-intervention using the Canadian Occupational Performance Measure (COPM). Multivariable models determined the contribution of mastery motivation to COPM outcome irrespective of group membership.
Forty-two children with congenital hemiplegia (29 males, 13 females; mean age 7y 8mo [SD 2y 2mo]; range 5y 1mo-12y 8mo; Manual Ability Classification System [MACS] I=20 and II=22; predominant motor type unilateral spastic n=41) participated in the study. Significant gains were seen in COPM performance and satisfaction scores (p<0.001) post-intervention with no between group differences. Children who had greater persistence with object-oriented tasks (p=0.02) and better manual ability (p=0.03) achieved higher COPM performance scores at 13 weeks. Children's persistence on object-oriented tasks was the strongest predictor of COPM satisfaction (p=0.01).
Children's persistence with object-oriented tasks as well as manual abilities needs to be considered when undertaking ULI. Predetermining children's motivational predispositions can assist clinicians to tailor therapy sessions individually based on children's strengths, contributing to effective engagement in ULI.
确定儿童的掌握动机在多大程度上能够预测上肢干预（ULI）后的职业表现结果。
在这项队列研究中，参与者接受了45小时的上肢干预，干预模式分为强化小组式或分散个体化式。掌握问卷维度（DMQ）在基线时测量掌握动机。使用加拿大职业表现测量量表（COPM）在基线和干预后13周评估职业表现结果。多变量模型确定了掌握动机对COPM结果的贡献，而不考虑分组情况。
42名先天性偏瘫儿童（男29名，女13名；平均年龄7岁8个月[标准差2岁2个月]；范围5岁1个月至12岁8个月；手动能力分类系统[MACS]I级=20名，II级=22名；主要运动类型为单侧痉挛型n=41名）参与了研究。干预后COPM表现和满意度得分有显著提高（p<0.001），组间无差异。在面向对象任务中具有更强坚持性（p=0.02）和更好手动能力（p=0.03）的儿童在13周时获得了更高的COPM表现得分。儿童在面向对象任务上的坚持性是COPM满意度的最强预测因素（p=0.01）。
在进行上肢干预时，需要考虑儿童在面向对象任务上的坚持性以及手动能力。预先确定儿童的动机倾向可以帮助临床医生根据儿童的优势进行个性化的治疗安排，有助于儿童有效参与上肢干预。
