Physical activity and walking performance: Influence on quality of life in ambulatory children with cerebral palsy (CP) Kilby Yarbrough, MD 1, Kristie.

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Presentation transcript:

Physical activity and walking performance: Influence on quality of life in ambulatory children with cerebral palsy (CP) Kilby Yarbrough, MD 1, Kristie F. Bjornson PT, PhD 2 1 Department of Rehabilitation Medicine, University of Washington, Seattle, WA 2 Seattle Children’s Research Institute, Pediatrics, University of Washington, Seattle METHODS Design: A secondary analysis of a cross-sectional cohort Individual multivariate regression models developed for PedsQL domains Total QOL Physical QOL Psychosocial QOL Covariates: frequency and level of participation in daily life, age, satisfaction with participation, walking capacity, communication, and topography of CP. Setting: Regional tertiary care children’s hospital Participants: 128 ambulatory children with CP, ages 2-9 years Gross Motor Function Classification System, Levels I=44, II= 54, and III=30 Diplegia=46, Hemiplegia=63, Quadriplegia=12, Triplegia=6, Monoplegia=1 Main Outcome Measures: Parental report of QOL (PedsQL) and Physical activity (PA) PA- Activities Scale for Kids (ASKp) walking performance - ankle worn accelerometry (StepWatch) average # strides/day > 30 strides/min. Participation – Life-H Total Score Frequency of Participation-CAPE frequency Satisfaction with participation in daily life- LIFE-H satisfaction PURPOSE OF CURRENT STUDY To examine the influence of physical activity and walking performance to parental report of QOL in ambulatory children with CP. Propose a conceptual model examining the relationships of the ICF to QOL for ambulatory children with CP. PA and walking performance were associated with physical QOL (56% variance explained) but not psychosocial QOL (38% variance explained). Frequency and total participation in daily life was also associated with psychosocial QOL (p= ). REFERENCES 1 Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B. A report: the definition and classification of cerebral palsy April Dev Med Child Neurol. 2007, 109: WHO. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 1995; 41: WHO. International Classification of Functioning, Disability and Health (ICF). World Health Organization; Geneva: Varni JW, Limbers CA, Burwinkle TM. Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes 2007, 5:43. RESULTS PedsQL-Overall QOL domain averaged 56.5(16.4) with physical and psychosocial domains 52.2(21.4) and 60.9(14.7) respectively. Only PA was associated with overall QOL (p<.001.) CONCLUSIONS QOL in ambulatory children with CP appears lower than healthy children. Physical activity, walking performance, frequency and level of participation in daily life are associated with varying domains of QOL. Future work should explore the effect of interventions to enhance physical/walking activity and participation in daily life on QOL in this population INTRODUCTION Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain that can be associated with impairments in other systems (1). The World Health Organization (WHO) defines quality of life (QOL) as an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations and concerns (2). The International Classification of Functioning, Disability and Health (ICF) provides a framework for discussing health and disability in the context of one’s environment but does not include QOL (3). To date, there is no literature examining the relationship of walking performance within the context of daily life to QOL for ambulatory children with CP. Quality of Life Activity Performance ASKp StepWatch Capacity GMFM Dimension E Body/Function Impairment Topography Health Condition Ambulatory Children with CP Participation CAPE LIFE-H Personal Factors Age OVERALL QOL Predictors B (Confidence Interval) P Value Physical Activity Performance..54 ( ).00 Walking Performance.15 ( ).06 Participation Frequency -.20 (-.16 to -.02).01 Participation Level.18 (-.23 to 2.99).09 Topography of CP.07 (-2.80 to 7.40).37 Age -.46 (-4.82 to -2.16).00 Satisfaction with participation in daily life -.03 (-.03 to -.48).63 Partial Correlation (R2).52 PHYSICAL QOL Predictors Β (Confidence Interval) P values Physical Activity Performance.64 ( ).00 Walking Performance.16 ( ).05 Participation Frequency -.09 ( ).06 Participation Level -.02 (-2.24 – 1.82).84 Topography of CP.13 (-1.08 – 11.92).10 Age -.46 ( ).00 Satisfaction with participation in daily life -.02 (-4.35 – 2.93).70 Partial Correlation (R2).56 PSYCHOSOCIAL QOL PredictorsB (Confidence Interval)P Values Physical Activity Performance.25 (-.03 to.33).11 Walking Performance.07 (.00 to.00).44 Participation Frequency -.24 (-.17 to -.03).01 Participation Level.44 (1.28 to 4.70).00 Topography of CP -.05 (-6.95 to 3.77).56 Age -.43 (-4.19 to -1.46).00 Satisfaction with participation in daily life -.03 (-3.56 – 2.41).70 Partial Correlation (R2).38