title: Capacity to participation in cerebral palsy: evidence of an indirect path via performance.
abstract: OBJECTIVE
  To examine the hypothesis that the influence of physical activity capacity on participation is mediated through activity performance.
  
  
  METHODS
  Secondary analysis of a prospective cross-sectional study sample.
  
  
  METHODS
  Regional pediatric specialty care hospital.
  
  
  METHODS
  Children (N=128; 59% boys; age range, 2-9y) with cerebral palsy with Gross Motor Function Classification System levels I to III; 49% had hemiplegia, and 72% had spasticity.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Activity capacity was measured with the Gross Motor Function Measure-66, performance was measured with the Activities Scale for Kids, and participation was measured with the Assessment of Life Habits. Children's Assessment of Participation and Enjoyment and the Assessment of Preschool Children's Participation assessed diversity participation. Regression equations and Sobel z test were used to examine the mediated effect via performance.
  
  
  RESULTS
  Physical activity performance mediates 74.9% (β=.83, P<.001) of the effect of activity capacity on total participation levels and 52.8% (β=.47, P=.001) of the effect of capacity on diversity participation.
  
  
  CONCLUSIONS
  The relation between what an ambulatory child with cerebral palsy is able to perform in a clinical setting and their participation in life is significantly mediated by what they actually do motorically in day-to-day life. Results suggest that interventions focusing on improving what they actually do every day, regardless of their capacity to perform (what they can do when tested), may positively influence participation.
authors.affiliation: Seattle Children's Research Institute, University of Washington, Seattle, WA. Electronic address: Kristie.bjornson@seattlechildrens.org.
authors.forename: Kristie F
authors.initials: KF
authors.lastname: Bjornson
authors.affiliation: Seattle Children's Research Institute, University of Washington, Seattle, WA.
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.affiliation: University of Virginia, Charlottesville, VA.
authors.forename: Richard
authors.initials: R
authors.lastname: Stevenson
authors.affiliation: Seattle Children's Research Institute, University of Washington, Seattle, WA.
authors.forename: Dimitri A
authors.initials: DA
authors.lastname: Christakis
mesh_terms: D061725:Accelerometry / Q000295:instrumentation; D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology
keywords: 1-minute walk test; 1MWT; APCP; ASKp-30; Activity Scale for Kids, performance version–30 items; Assessment of Life Habits; Assessment of Preschool Children's Participation; CAPE; CP; Cerebral palsy; Children's Assessment of Participation and Enjoyment; GMFCS; GMFM; GMFM-66-IS; Gross Motor Function Classification System; Gross Motor Function Measure; Gross Motor Function Measure-66 Item Set; ICF; International Classification of Functioning, Disability and Health; LIFE-H; Motor activity; Rehabilitation; cerebral palsy