Evaluation of a community-based group fitness program for children with disabilities

Effectiveness of an adapted physical activity intervention on health-related physical fitness in adolescents with intellectual disability: a randomized controlled trial

This study aimed to examine the effects of an adapted physical activity (APA) intervention on health-related physical fitness (HRPF) in adolescents with intellectual disability (ID). With a randomized controlled trial design, adolescents aged 12-18 years, with mild and moderate ID, and being overweight and obese were recruited and randomly assigned to either an intervention or a control group. The APA intervention consisted of overall moderate intensity aerobic and resistance exercise, with a duration of 45 min/session, a frequency of 2 sessions/week, and lasting for 9 months. A negative control was involved, in which participants received no treatment. Changes in four fitness tests, including the 9-min run/walk, handgrip strength, 30-s sit-ups, and sit-and-reach tests, were assessed between the groups using general linear models. A total of 57 participants (39 in the intervention group and 18 in the control group) completed the study. Significant mean differences in changes in the 9-min run/walk test (413.6 m [95% CI 146.72 m, 680.41 m], p = 0.003) and the right-side sit-and-reach test (2.2 cm [95% CI 0.37 cm, 4.09 cm], p = 0.020) respectively were observed in the intervention group, compared to the control group. No significant between-group improvement was observed for the handgrip strength and the 30-s sit-ups tests. The APA intervention induced beneficial effects on cardiorespiratory fitness and potential beneficial effects on flexibility for adolescents with ID. However, no significant effects of this intervention on muscular strength and endurance were observed in this study. Future studies should consider involving effective exercises in interventions to improve muscular strength and endurance.

Quality of Life, Participation, and Individualized Support in a Community-Based Yoga Class: A Case Series

PURPOSE

To assess quality of life and participation in children with disabilities following a community-based yoga class, to examine the feasibility of implementing a community-based program with individualized support, and to make recommendations for the development of future programs.

SUMMARY OF KEY POINTS

Four children participated in a 10-week yoga class, with doctor of physical therapy students providing individualized physical and behavioral support. Children improved in components of the Children's Assessment of Participation and Enjoyment (CAPE) following the program; however, changes in quality of life on the Pediatric Quality of Life Inventory (PedsQL) were inconsistent. Parents provided feedback regarding the family's experience and reported that the children improved behavior, communication, and relationships following the yoga class.

WHAT THIS CASE ADDS TO EVIDENCEBASED PRACTICE

A community-based yoga class for children with disabilities using individualized support is feasible and can improve participation and enjoyment in recreational activities.

Pediatric care for children with developmental coordination disorder, can we do better?

This paper adopts a method of narrative critical review based on a non-systematic search of the literature to provide insights into the trends of developmental coordination disorder (DCD) treatment and to point out some future alternative approaches to prevent secondary health implications in children with DCD. The cause of DCD is unknown, but evidence suggests that these children have atypical brain structure and function. Interventions to help children cope with their activity limitations are effective in improving motor competence and motor skill related fitness in the short term. Although activity-orientated interventions can improve motor outcomes in children with DCD, high quality intervention trials and evaluation of long-term effects are urgently needed. Importantly, motor coordination problems associated with DCD extend to exercise-related activities leading to reduced participation in play and sports, which causes secondary problems in muscular fitness and body composition. Hence, treatment goals should not be limited to the improvement of motor skills (in ADL), but should also focus on health-related quality of life. We therefore propose when noticing motor problems in a child, already before enrolling but also during intervention, to explore ways to adapt everyday physical activities to optimally match the child's skill level. Hence, such activities will not only train the skills and improve physical fitness but will lead to positive engagement, thereby preventing the child from opting out of active play and sports. This provides the child with chances for exercise-dependent learning and will also positively impact social-emotional well-being.

Analysis of a Group-Based Treadmill Program for Children with Neuromotor Delay Who Are Pre-Ambulatory

PURPOSE

To analyze data from a prospective cohort study, a group-based treadmill program, administered twice weekly for 14 weeks, in regard to gross motor skills related to walking and walking attainment in young children with neuromotor delay who are pre-ambulatory.

METHODS

Seventy children (F = 29), mean age 25.6 (SD 10.1) months participated in the program 2×/week for 14 weeks. The Gross Motor Function Measure-88 Dimensions D and E (GMFM D/E), Functional Mobility Scale for 5, 50, and 500 meters (FMS 5, 50, 500), the timed 10-m walk test (10MWT), and the Pediatric Evaluation of Disability Inventory Caregiver Mobility Scale (PEDI) were administered before and after the program.

RESULTS

Statistically significant improvements were found in the GMFM D, GMFM E, FMS 5, 50, 500 and PEDI, but not in 10MWT.

CONCLUSIONS

A group-based treadmill program was associated with improvements in motor skills related to walking in young children when administered in adjunct to ongoing physical therapy.

Repeated-sprint training under cyclic hypoxia improves body composition in healthy women

BACKGROUND

To investigate if the cyclic hypoxia exposure combined with repeat-sprints training would be more effective in reducing body fat of health women than the same protocols performed in normoxia.

METHODS

Twelve female volunteers were randomly divided into two groups: 1) repeated-sprint in hypoxia (RSH; N.=6; FiO2: 17.2%); and 2) repeated-sprint in normoxia (RSN; N.=6; FiO2: 20.9%). During 6 weeks, both groups undertook 30 seconds of all-out (130%Wmax) followed by 3 minutes of active recovery at 55-65%Wmax on a cycle ergometer. Anthropometric, body composition and biochemical parameters were assessed at baseline and after intervention.

RESULTS

RSH experimented a greater significant decrease of body mass index (P=0.017) and percentage of fat mass (P=0.05) respect to normoxia group. Total cholesterol of RSN experimented a significant (P=0.001) reduction (-12.66±14.35) compared with RSH (24.00±14.61).

CONCLUSIONS

Repeated-sprint training under normobaric cyclic hypoxia during 6-weeks could be a more effective prevention program because it causes a higher decrease in body mass index and fat mass compared with the same training in normoxic conditions in healthy women.

More Than Just a Game: The Public Health Impact of Sport and Physical Activity for People With Disabilities (The 2017 DeLisa Lecture)

Although people with disabilities make up a large proportion of our global population and are known to be disproportionately impacted by sedentary lifestyles leading to chronic disease, programs promoting physical activity often fail to address their unique needs. Both environmental and attitudinal factors also act as barriers to full participation. In this context, increasing evidence shows the positive impact of physical activity and sport on outcomes related to physical health, mental health, community participation, and, in some cases, neurorecovery for people with disabilities. Thus, participation should be seen not only as a medical intervention but also as a rights-based issue. We, as physiatrists, can be agents of change by promoting concepts of universal design and inclusion in physical activity and sport programs.

The role of physical activity in improving physical fitness in children with intellectual and developmental disabilities

BACKGROUND

One in three children in North America are considered overweight or obese. Children with intellectual and developmental disabilities (IDD) are at an increased risk for obesity than their typically developing peers. Decreased physical activity (PA) and low physical fitness may be contributing factors to this rise in obesity.

AIM

Because children with IDD are at an increased risk of diseases related to inactivity, it is important to improve health-related physical fitness to complete activities of daily living and improve health.

METHODS AND PROCEDURES

The focus of this research is on improving the performance of physical fitness components through physical activity programming among a group of children with IDD, ages 7-12 years. The Brockport Physical Fitness Test was used assess levels of physical fitness of 35 children with IDD (25 boys, 10 girls) before and after participation in a 10-week program.

OUTCOMES AND RESULTS

The results of paired sampled t-tests showed participation in 15-h PA program can significantly increase aerobic capacity and muscular strength and endurance in children with IDD.

CONCLUSIONS AND IMPLICATIONS

This study is aimed at understanding the role of PA in helping children with IDD to develop the fitness capacities essential to participation in a wide variety of activities.

Obesity in children with developmental and/or physical disabilities

Children with developmental or physical disabilities, many of whom face serious health-related conditions, also are affected by the current obesity crisis. Although evidence indicates that children with disabilities have a higher prevalence of obesity than do children without disabilities, little is known of the actual magnitude of the problem in this population. To address this concern, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) held a conference on obesity in children with intellectual, developmental, or physical disabilities, bringing together scientists and practitioners in the fields of obesity and disability to foster collaboration, identify barriers to healthy weight status in populations with disabilities, propose avenues to solutions through research and practice, and develop a research agenda to address the problem. This article describes current knowledge about prevalence of obesity in this population, discusses factors influencing obesity risk, and summarizes recommendations for research presented at the conference.

The scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities

PURPOSE

The purpose of this report is to discuss the scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities.

SUMMARY OF KEY POINTS

Evidence is provided that supports integration of health promotion and fitness strategies in physical therapy clinical management. Physical therapists' roles in community-based adapted sports and fitness interventions and reimbursement considerations are discussed.

CONCLUSIONS

Physical therapists are in a unique position to provide expertise in the design and implementation of health promotion and fitness programs for youth with disabilities. These programs are important to promote active, healthy lifestyles and reduce comorbidities associated with sedentary behaviors and unhealthy weight, which are often seen in youth with disabilities.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Pediatric physical therapists should incorporate health promotion and fitness strategies into practice.

Treadmill training for a child with spina bifida without functional ambulation

PURPOSE

To describe and report the effect of an 8-week individualized, progressive, treadmill training program on the ambulatory ability of a 4-year-old child with myelomeningocele without functional ambulation.

SUMMARY OF KEY POINTS

Heart rate and speed on the 2-minute walk test (2MWT) were used to individualize training. Ambulatory outcome measures taken at baseline, postintervention, and 6 weeks postintervention included the 2MWT and the Timed "Up and Go" (TUG). The Pediatric Evaluation of Disability Index was used to measure functional mobility. Improvements were noted in ambulatory ability after training (2MWT, 64.10%; TUG, 34.66%) and at the 6-week follow-up (2MWT, 58.97%; TUG, 34.24%). The Pediatric Evaluation of Disability Index showed no significant difference.

CONCLUSION AND RECOMMENDATIONS

Use of an individualized treadmill training program may have improved the ambulatory skills of a preschooler with myelomeningocele. More rigorous studies are needed to determine the effects of treadmill training with the spina bifida population and identify optimal training parameters.

Factors influencing physical activity in children and youth with special health care needs: a pilot study

Background. Evidence suggests that children and youth with special health care needs (CYSHCN) have decreased physical activity compared to peers. This study describes weight status and physical activity in CYSHCN and identifies factors associated with physical activity and community resources to promote physical activity. Methods. Parents (n = 21) and CYSHCN (n = 23) were recruited from a pediatric clinic. The most prevalent diagnoses were autism (n = 7, 30%) and cerebral palsy (n = 3, 13%). Interviews were conducted with parents for information on physical activity and community resources. Children's height and weight were measured to calculate body mass index (BMI). Results. The majority of CYSHCN (n = 13, 59%) were obese. CYSHCN did not meet recommended levels of 60 minutes of daily physical activity and engaged in more screen time than recommended. More children with cognitive/behavioral/emotional diagnoses were obese compared to children with physical/medical diagnoses. A majority of parents (n = 16, 73%) indicated their CYSHCN need more supervision to participate in physical activity in community programs. Conclusion. The majority of CYSHCN in this study were obese and sedentary. Resources to promote physical activity are needed for this population.

Efficacy of a peer-guided exercise programme for adolescents with intellectual disability

BACKGROUND

Peer support is strongly associated with physical activity of adolescents. This study examined the efficacy of a YMCA-based, peer-guided exercise training programme for increasing health-related physical fitness among adolescents with intellectual disabilities.

MATERIALS AND METHODS

Adolescents with intellectual disabilities and typically developing peer partners provided reciprocal support during 1-h exercise sessions that included aerobic exercise, weight training and stretching activities. The programme was conducted 2 days/week for 15 weeks and pre- and post-test fitness testing was conducted.

RESULTS

Participants demonstrated significant improvements in curl-ups, 6-min walk and BMI. Exercise session attendance was high and participants typically completed all of the prescribed aerobic and stretching exercises, whereas weight training exercises were completed less consistently.

CONCLUSIONS

This peer-guided model integrates social and instructional support for adolescents with intellectual disabilities and may encourage exercise participation in community settings.

Group swimming and aquatic exercise programme for children with autism spectrum disorders: a pilot study

OBJECTIVE

To evaluate the effectiveness of a 14-week aquatic exercise programme for children with autism spectrum disorders (ASD).

DESIGN

Non-randomized control trial.

METHODS

Twelve children participated in this pilot study with seven participants in the aquatic exercise group and five in the control group. The programme was held twice per week for 40 minutes per session. Swimming skills, cardiorespiratory endurance, muscular endurance, mobility skills and participant and parent satisfaction were measured before and after the intervention.

RESULTS

No significant between-group changes were found. Within-group improvements for swimming skills were found for the intervention group. Programme attendance was high. Parents and children were very satisfied with the programme activities and instructors.

CONCLUSIONS

This pilot programme was feasible and showed potential for improving swimming ability in children with ASD. Exercise intensity was low for some participants, most likely contributing to a lack of significant findings on fitness outcomes.

Continued ambulation gains through high school in a student with cerebral palsy: a case report

PURPOSE

The purpose of this case report is to describe school-based physical therapy services received throughout high school by a student with diplegic cerebral palsy and to share her functional gains.

KEY POINTS

This previously discharged 15-year-old freshman was re-referred due to a perceived walking regression using long-leg braces/reverse rolling walker and her desire to again try crutches. She subsequently resumed walking, typically 4 days per week at school and progressed to axillary crutches on level surfaces and stairs. Gross Motor Function Measure scores increased from 66.4% freshman year to 78.8% senior year, with the greatest dimension changes in standing (35.9%-69.2%) and walking, running, and jumping (8.3%-25.0%).

CONCLUSION

School-based physical therapists are uniquely positioned to work with students in natural environments to optimize activity and participation. This report shows that continued ambulation gains in individuals with cerebral palsy are possible throughout adolescence.

Sport-specific fitness testing and intervention for an adolescent with cerebral palsy: a case report

BACKGROUND AND PURPOSE

This case report describes the development, implementation, and outcomes of a fitness-related intervention program that addressed the sport-specific goals of an adolescent with cerebral palsy.

CASE DESCRIPTION

The participant in this case was a 16-year-old African American male with spastic diplegia. The participant joined his high school wrestling team and asked to focus his physical therapy on interventions that would improve his wrestling performance. An examination was performed using the muscle power sprint test, the 10 x 5-m sprint test, strength tests, the 10-m shuttle run test, and the Gross Motor Function Measure. The intervention consisted of interval training, which focused on the demands of wrestling.

OUTCOMES

Scores on all tests and measures were higher after the intervention.

DISCUSSION

The outcomes of this case report seem to support the use of a fitness-related intervention program for addressing the sport-specific goals of an adolescent with cerebral palsy.

Health, mortality, and wellness issues in adults with cerebral palsy

For many years, children with cerebral palsy (CP) and their parents have been told that health and functional status stabilize by early adulthood. However, adults with CP report ongoing health conditions and aging and secondary conditions that are not always recognized or managed by their healthcare providers. There is a growing body of literature to better define the health, mortality, and wellness of those aging with CP. In general, adults with CP report good health, although health outcomes appear to be linked to the severity of CP and to increasing age. Studies reporting on lifespan warrant caution in interpretation because of biases in the survey and surveillance systems. It appears that lifespan of persons with CP is at or close to that of the typical population. The most commonly reported age-related changes and secondary conditions involve pain/fatigue, physical performance, and the musculoskeletal system. Not all adults have serious health problems, and many now recognize the aging process as a natural course of events. Few adults with CP engage in typical screening and health promotion activities due to a variety of barriers. There continues to be much to be learned and disseminated, in order to improve the care of adults with CP.

Evaluation of an adaptive ice skating programme for children with disabilities

OBJECTIVE

To describe an adaptive ice skating programme designed by paediatric therapists.

METHODS

Twenty-two children, ages 5-12 years, with developmental disabilities participated in this once per week skating programme lasting 6 weeks. Ice skating instructors led the group lessons, while university student coaches provided individualized assistance to the children. The programme was evaluated using a summative evaluation design. Outcomes included participant attendance, incidence of injuries, skating skills and parent and student coach survey data.

RESULTS

On average, participants attended 83% of the sessions and one minor injury was reported. Participants' parents were very satisfied with the programme and reported improvements in their child's skating skills, leg strength, endurance, balance, self-esteem/confidence and ability to participate in a group. Student coaches also reported high levels of satisfaction with this programme and reported similar improvements in the children they coached.

CONCLUSION

The programme appeared promising, but may require minor modifications.

A qualitative study of fitness instructors' experiences leading an exercise program for children with juvenile idiopathic arthritis

Children with arthritis face challenges when they try to increase their physical activity. The study's objective was to identify elements of a successful community-based exercise program for children with arthritis by investigating the perspectives of fitness instructors who led the program. This qualitative study used a phenomenological approach. Four fitness instructors participated in individual interviews. Themes were developed through inductive analytic methods. Three main themes were identified: (a) children with arthritis require encouragement and guidance throughout the program from fitness instructors who understand their arthritis, and support from parents and peers; (b) children need help to overcome their negative perceptions about exercise; and (c) exercise program participation can launch the adoption of a more active lifestyle. Pediatric physiotherapists can encourage the establishment of successful exercise programs for children with arthritis in nonmedical or community environments through the formation of supportive, education-based partnerships with community-based fitness instructors.

The Benefits of Physical Activity for Youth with Developmental Disabilities: A Systematic Review

Objective.

Analyze evidence of the benefits of physical activity for youth with developmental disabilities.

Data Sources.

Key word searches for “disability,” “physical activity,” “exercise,” “fitness,” and “sport” in major databases. A total of 3263 citations was found.

Study Inclusion/Exclusion Criteria.

Systematic reviews and articles about studies quantitatively examining the effects of physical activity in youth with developmental disabilities ages 0 to 20 years were included. Only articles published in English in peer-reviewed journals were included.

Data Extraction.

A Measurement Tool to Assess Reviews criteria were used for systematic reviews; Grading of Recommendations, Assessment, Development, Evaluation criteria were used for observational studies; and Population, Intervention, Comparison, Outcome criteria were used for all studies.

Data Synthesis.

Data, shown in table format, were synthesized in relation to five research questions.

Results.

Three systematic reviews and 14 studies were reviewed. Strong evidence indicated that children and adolescents with developmental disabilities derive health benefits from participation in group exercise programs, treadmill training, or therapeutic riding/hippotherapy. Lesser levels of evidence indicated that health benefits might be present for adapted skiing or aquatic programs. Documented benefits of physical activity include improvements in aerobic capacity, improved gross motor function, and high levels of participant/parent satisfaction.

Conclusions.

Evidence exists that physical activity is beneficial for youth with developmental disabilities. Further research studies are needed that are of greater scientific rigor including larger sample sizes, control groups, and stringent, replicable methodology.

Effects of aquatic aerobic exercise for a child with cerebral palsy: single-subject design

PURPOSE

The purpose of this study was to evaluate the effects of an aquatic aerobic exercise program for a child with cerebral palsy.

METHODS

A 5-year-old girl with spastic diplegia classified at level III on the Gross Motor Function Classification System participated in this single-subject A-B-A design study. The aquatic aerobic exercise intervention was carried out 3 times per week for 12 weeks at an intensity of 50% to 80% of heart rate reserve. The Canadian Occupational Performance Measure, Gross Motor Function Measure, and 6-minute walk test were used as outcomes.

RESULTS

Statistically significant improvements were found in the participation, activity, and body function components of the International Classification of Functioning, Disability, and Health model. Improvements in functional abilities and walking endurance and speed were recorded.

CONCLUSION

These findings suggest that an aquatic aerobic exercise program was effective for this child with cerebral palsy and support the need for additional research in this area.

Group aquatic aerobic exercise for children with disabilities

The effectiveness and safety of a group aquatic aerobic exercise program on cardiorespiratory endurance for children with disabilities was examined using an A-B study design. Sixteen children (11 males, five females) age range 6 to 11 years (mean age 9y 7mo [SD 1y 4mo]) participated in this twice-per-week program lasting 14 weeks. The children's diagnoses included autism spectrum disorder, myelomeningocele, cerebral palsy, or other developmental disability. More than half of the children ambulated independently without aids. Children swam laps and participated in relay races and games with a focus of maintaining a defined target heart rate zone. The strengthening component consisted of exercises using bar bells, aquatic noodles, and water resistance. The following outcomes were measured: half-mile walk/run, isometric muscle strength, timed floor to stand 3-meter test, and motor skills. Complaints of pain or injury were systematically collected. Significant improvements in the half-mile walk/run were observed, but not for secondary outcomes of strength or motor skills. The mean program attendance was 80%, and no injury was reported. Children with disabilities may improve their cardiorespiratory endurance after a group aquatic aerobic exercise program with a high adult:child ratio and specific goals to maintain training heart rates.

Reproducibility and minimal detectable change of three-dimensional kinematic analysis of reaching tasks in people with hemiparesis after stroke

BACKGROUND AND PURPOSE

Three-dimensional kinematic analysis of reaching has emerged as an evaluative measure of upper-extremity motor performance in people after stroke. However, the psychometric properties supporting the use of kinematic data for evaluating longitudinal change in motor performance have not been established. The objective of this study was to determine, in a test-retest reliability manner, the reproducibility and minimal detectable change for reaching kinematics in people after stroke.

SUBJECTS AND METHODS

Fourteen participants with hemiparesis after stroke performed forward reaching tasks on 2 occasions 37.3 (SD=9.8) days apart. At each session, participants performed 4 forward reaching tasks produced by the combination of 2 target heights (low and high [109 and 153 cm from the floor, respectively]) and 2 instructed movement speeds (self-selected and as fast as possible). Two analytical methods were used to calculate kinematic parameters.

RESULTS

Relative reliability (intraclass correlation coefficient) ranged from .04 to .99, and absolute reliability (standard error of measurement) ranged from 2.7% to 76.8%, depending on the kinematic variable, the demands of the motor task (target height and movement speed), and the analytical method. Bland-Altman analysis, a statistical method used to assess the repeatability of a method, revealed few systematic errors between sessions. The minimal detectable change ranged from 7.4% to 98.9%.

DISCUSSION AND CONCLUSION

Depending on the demands of the motor task and the analytical method, most kinematic outcome measures (such as peak hand velocity, endpoint error, reach extent, maximum shoulder flexion range of motion, and minimum elbow extension range of motion) are reliable measures of motor performance in people after stroke. However, because of the magnitude of within-subject measurement error, some variables (such as peak hand velocity, time to peak hand velocity, and movement time) must change considerably (>50%) to indicate a real change in individual participants. The results of our reliability analysis, which are based on our cohort of participants with hemiparesis after stroke and our specific paradigm, may not be generalizable to different subpopulations of people with hemiparesis after stroke or to the myriad movement tasks and kinematic variables used for the assessment of reaching performance in people after stroke.

Physical activity for youth with disabilities: a critical need in an underserved population

The recommended amount of daily physical activity for youth is 60 minutes a day, most days of the week. Youth with disabilities are not achieving this target and are significantly less active and more obese than their non-disabled peers. The combination of the health risks associated with physical inactivity and obesity presents a serious health concern in this population. While there is a small amount of research on interventions aimed at improving fitness among youth with disabilities, the majority of these studies were conducted in clinical settings where most or all of the common barriers to participation were eliminated (e.g. transportation, lack of knowledgeable staff, adaptation of programmes and/or facilities to child's needs). One of the most important challenges for paediatric rehabilitation and healthcare professionals is finding ways to increase physical activity and fitness among youth with disabilities in community-based settings. The use of information technology (IT) to customize physical activity programmes for youth with disabilities offers a promising approach to addressing this important health issue in the future.

Training programs for children: literature review

INTRODUCTION

Training programs are increasingly being prescribed for occupational therapy for adults affected by chronic illness and/or handicap, but their use is more recent for children and teenagers.

OBJECTIVE

A review of the literature to synthesize information concerning training programs for children, whether healthy or with disease or handicap, considering the target population, methodology, the results and limitations.

METHODS

We searched the Medline database with use of the key words retraining, training, training programs, physical activity, physical training, fitness program, sport, children, disability, and handicap. We also searched references of the selected articles for appropriate studies.

DISCUSSION/CONCLUSION

Physical activity seems to be a good means of primary preventing adverse health in the healthy child and secondary prevention in children with chronic disease or handicap. Thus, training programs could be adapted and integrated into the global treatment of sick or handicapped children in the health care situation or in the home. These programs are feasible and do not undermine children's health, but few studies have shown clear data on the methods of the programs. The suggested training programs, not always validated, included two to five sessions from 30 to 60 min/week, for 6-16 weeks, of variable activity and intensity, adapted to the condition and the objectives of therapy. Training programs adapted to children should be validated to allow their accessibility by health care professionals dealing with children with chronic disease and/or handicap.

Sensitivity of a computer adaptive assessment for measuring functional mobility changes in children enrolled in a community fitness programme

OBJECTIVE

To examine the relative sensitivity to detect functional mobility changes with a full-length parent questionnaire compared with a computerized adaptive testing version of the questionnaire after a 16-week group fitness programme.

DESIGN

Prospective, pre- and posttest study with a 16-week group fitness intervention.

SETTING

Three community-based fitness centres.

SUBJECTS

Convenience sample of children (n = 28) with physical or developmental disabilities.

INTERVENTIONS

A 16-week group exercise programme held twice a week in a community setting.

MAIN MEASURES

A full-length (161 items) paper version of a mobility parent questionnaire based on the Pediatric Evaluation of Disability Inventory, but expanded to include expected skills of children up to 15 years old was compared with a 15-item computer adaptive testing version. Both measures were administered at pre- and posttest intervals.

RESULTS

Both the full-length Pediatric Evaluation of Disability Inventory and the 15-item computer adaptive testing version detected significant changes between pre- and posttest scores, had large effect sizes, and standardized response means, with a modest decrease in the computer adaptive test as compared with the 161-item paper version. Correlations between the computer adaptive and paper formats across pre- and posttest scores ranged from r = 0.76 to 0.86.

CONCLUSIONS

Both functional mobility test versions were able to detect positive functional changes at the end of the intervention period. Greater variability in score estimates was generated by the computerized adaptive testing version, which led to a relative reduction in sensitivity as defined by the standardized response mean. Extreme scores were generally more difficult for the computer adaptive format to estimate with as much accuracy as scores in the mid-range of the scale. However, the reduction in accuracy and sensitivity, which did not influence the group effect results in this study, is counterbalanced by the large reduction in testing burden.