Participation in Physical Play and Leisure in Children With Motor Impairments: Mixed-Methods Study to Generate Evidence for Developing an Intervention

Background. 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. Objective. 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.. Design. This was a mixed-methods, intervention development study. The World Health Organization framework International Classification of Functioning, Disability and Health was used. Methods. 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. Results. Children's (n=195) PPP ((X) over bar =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. Limitations. 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. Conclusions. 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.