Clinical Bottom Line
“How could I apply this information?”
Investigating physical activity outside of physical therapy is an important topic for pediatric physical therapists.1 , 2 As therapists, our goal is to encourage successful transition into normal, integrated community activities. By using swimming, an easily accessible activity, the authors “leveled the field” in participants' skills by eliminating the use of assistive devices emphasizing water versus land skills, and providing a safe environment. Decreased participant-to-leader ratio through the use of physical therapist students employed skilled leaders, while promoting student experience and learning. As modeled in this study, pediatric therapy expertise combined with community resources is important for the development of safe, inclusive programming for all children.
Quality-of-life, self-concept, and friendship measures serve as important reminders of the relationship between physical activity and psychosocial benefits. How a program is designed and the inclusion and mix of ages and disability levels may alter the outcomes and benefits for each individual child. Qualitative research may be useful in the future for assessing other factors affecting psychosocial outcomes, including time of year, parents' perspectives, current health, cognitive issues, and concurrent therapy.3 – 5 With psychosocial issues being important, pediatric therapists must be vigilant in incorporating such measures.
“What should I be mindful about in applying this information?”
When applying this information, some study limitations need to be acknowledged. Extending this program's frequency and duration beyond 8 hours may provide more conclusive data. Six participants were under the recommended age for the measures, thus compromising validity of the findings. The authors proposed a “fun” physical activity, without assessing this concept. Lastly, when examining effect sizes6 for reported significant differences, a large effect size (d = 0.96) was observed between groups on the pretest of PedsQL-School functioning, which may highlight the difficulty of a child with a disability keeping up in academics, not just mobility at school. Medium effect sizes were observed for both decreases within the group with disabilities on the Piers-Harris 2-Happiness measure (d = 0.52) and within the nondisabled group on the PedsQL-School functioning measure (d = 0.55). The difference between groups on the posttest Piers-Harris 2-Intellectual score had a small effect size (d = 0.27). All these results require further investigation to understand their applicability to inclusive community programs. Overall, this work provides a strong base from which to generate further questions and research.
Marybeth Grant-Beuttler, PT, PhD, PCS
Kimberly N. Drndarski, PT, DPT, PCS
County of Orange, California Children's Services,
The authors declare no conflicts of interest.
1. Fragala-Pinkham M, Haley S, Goodgold S. Evaluation of a community-based group fitness program for children with disabilities. Pediatr Phys Ther. 2006;18(2):159–167.
2. Demuth SK, Knutson LM, Fowler EG. The PEDALS stationary cycling intervention and health-related quality of life in children with cerebral palsy: a randomized controlled trial. Dev Med Child Neurol. 2012;54(7):654–661.
3. Trapp G, Giles-Corti B, Christian H, et al. Increasing children's physical activity: Individual, social, and environmental factors associated with walking to and from school. Health Educ Behav. 2012;339(2):172–182.
4. Holm K, Wyatt H, Murphy J, Hill J, Odgen L. Parental influence on child change in physical activity during a family-based intervention for child weight gain prevention. J Phys Activ Health. 2012;9:661–669.
5. Cong Z, Feng D, Liu Y, Esperat MC. Sedentary behaviors among Hispanic children: Influences of parental support in a school intervention program. Am J Health Promot. 2012;28(5):270–280.