Kolehmainen Niina, Ramsay Craig, McKee Lorna, Missiuna Cheryl, Owen Christine, Francis Jill
N. Kolehmainen, PhD, Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX United Kingdom.
C. Ramsay, PhD, Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
Phys Ther. 2015 Oct;95(10):1374-86. doi: 10.2522/ptj.20140404. Epub 2015 May 21.
Participation in physical play/leisure (PPP) is an important therapy goal of children with motor impairments. Evidence for interventions promoting PPP in these children is scarce. The first step is to identify modifiable, clinically meaningful predictors of PPP for targeting by interventions.
The study objective was to identify, in children with motor impairments, body function and structure, activity, environmental, and personal factors related to PPP and modifiable by therapists.
This was a mixed-methods, intervention development study. The World Health Organization framework International Classification of Functioning, Disability and Health was used.
Participants were children (6-8 years old) with motor impairments, mobilizing independently with or without equipment and seen by physical therapists or occupational therapists in 6 regions in the United Kingdom, and their parents. Self-reported PPP was assessed with the Children's Assessment of Participation and Enjoyment. Modifiable-factor data were collected with therapists' observations, parent questionnaires, and child-friendly interviews. The Children's Assessment of Participation and Enjoyment, therapist, and parent data were analyzed using descriptive statistics and linear regression. Interview data were analyzed for emerging themes.
Children's (n=195) PPP (X=18 times per week, interquartile range=11-25) was mainly 'recreational' (eg, pretend play, playing with pets) rather than 'active physical' (eg, riding a bike/scooter). Parents (n=152) reported positive beliefs about children's PPP but various levels of family PPP. Therapists reported 23 unique impairments (eg, muscle tone), 16 activity limitations (eg, walking), and 3 personal factors (eg, child's PPP confidence). Children interviewed (n=17) reported a strong preference for active play but indicated that adults regulated their PPP. Family PPP and impairment in the child's movement-related body structures explained 18% of the variation in PPP. Family PPP explained most of the variation.
It is likely that the study had a degree of self-selection bias, and caution must be taken in generalizing the results to children whose parents have less positive views about PPP.
The results converge with wider literature about the child's social context as a PPP intervention target. In addition, the results question therapists' observations in explaining PPP.
参与体育游戏/休闲活动（PPP）是运动障碍儿童的一项重要治疗目标。关于促进这些儿童参与PPP的干预措施的证据很少。第一步是确定PPP的可改变的、具有临床意义的预测因素，以便作为干预目标。
本研究的目的是在运动障碍儿童中确定与PPP相关且可由治疗师改变的身体功能和结构、活动、环境及个人因素。
这是一项混合方法的干预开发研究。使用了世界卫生组织的《国际功能、残疾和健康分类》框架。
参与者为运动障碍儿童（6至8岁），他们在英国6个地区由物理治疗师或职业治疗师诊治，可独立或借助设备进行活动，参与者还包括他们的父母。使用《儿童参与和享受评估量表》对自我报告的PPP进行评估。通过治疗师的观察、家长问卷和儿童友好访谈收集可改变因素的数据。使用描述性统计和线性回归分析《儿童参与和享受评估量表》、治疗师及家长的数据。对访谈数据进行分析以找出新出现的主题。
儿童（n = 195）的PPP（每周X = 18次，四分位距 = 11 - 25）主要是“娱乐性的”（如假装游戏、与宠物玩耍），而非“积极体育性的”（如骑自行车/踏板车）。家长（n = 152）对儿童的PPP持积极态度，但家庭PPP水平各不相同。治疗师报告了23种独特的损伤（如肌张力）、16种活动受限（如行走）和3种个人因素（如儿童的PPP信心）。接受访谈的儿童（n = 17）表示强烈偏好积极的游戏，但指出成年人会对他们的PPP进行监管。家庭PPP和儿童与运动相关的身体结构损伤解释了PPP变异的18%。家庭PPP解释了大部分变异。
该研究可能存在一定程度的自我选择偏差，在将结果推广到其父母对PPP看法不那么积极的儿童时必须谨慎。
研究结果与将儿童社会环境作为PPP干预目标的更广泛文献一致。此外，研究结果对治疗师在解释PPP方面的观察提出了质疑。
