Telehealth Movement-to-Music to Increase Physical Activity Participation Among Adolescents with Cerebral Palsy: Pilot Randomized Controlled Trial
Prepared by: Gaela Kilgour
Adaptive Sports/Recreation Topic Categories
- Physical Activity
- Participation
- Leisure
- Movement-to-Music
- Adolescents with cerebral palsy
Study Type: Randomised control trial with mixed methods
Summary: There is little high quality evidence that supports the implementation of leisure time physical activity (LTPA) programs in adolescents with cerebral palsy (CP). Most interventions are clinic based and often exclude youth who use wheelchairs. The use of telehealth with inclusion of behavioural coaching has been successfully implemented in youth with disabilities and is able to target larger numbers and those whom barriers inhibit participation e.g., costs, accessibility.
This study had three aims:
- To determine the preliminary efficacy of an adult Movement-to-Music (M2M) program for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP using a behavioural telecoaching approach.
- To explore the effects of the program on perceived levels of pain and fatigue.
- To evaluate the factors that influenced adherence using a qualitative grounded theory approach (aims to generate theories based on data).
A virtual 4-week Movement-to-Music (M2M) was offered to adolescents with CP of all motor ability levels (Gross Motor Classification System I-V). The randomised control trial recruited 58 participants with the M2M group asked to complete physical activity sessions 3 times each week at home using progressive video recordings of the exercises whilst the control group continued with daily activities. Measures included adherence, changes in activity and LTPA participation before and after the intervention, perceived pain and fatigue, one-on-one interviews, coaching notes, and feedback surveys.
Of the 58 adolescents enrolled, 84% completed all follow-up assessments. Adherence progressively declined over the 4 weeks with an overall 68% adherence to the exercises and 91% for coaching calls. Participation levels showed significant improvement in the intervention group for enjoyment, active physical recreation and intensity. Five critical factors were identified that influenced participants’ adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioural coaching. Overall, M2M telecoaching program had adherence levels that enhanced LTPA levels and did not increase pain or fatigue in adolescents with CP.
Article Strengths
- Inclusion of children with CP across all GMFCS levels with over half GMFCS IV-V
- Sample size large compared to past LTPA interventions.
- Mixed methods therefore able to inform future trials.
- All participants who completed the intervention were also interviewed (n=28) and caregiver perspective was also included.
- Videos of exercises used adults with disability to model exercise routines and any required adaptations.
- Low cost and resource intervention - Equipment was easily accessible, all exercise routines were free and easily downloadable, barriers to attend an intervention such as transportation were avoided.
- Telecoaches were available to guide exercise adaptations.
- Inclusion of behaviour change was valued by caregivers.
Article Weaknesses
- Intervention during was limited to 4 weeks due to COVID and difficulties with implementation. No follow up data was able to be collected.
- Program adherence reduced with increasing duration (43% by week 4)
- Levels of physical activity and health were not collected.
- Children’s Assessment of Participation and Enjoyment (CAPE)is a retrospective assessment and relies on recall.
- The number of caregivers who contributed to the interviews is not discussed. Furthermore, it is unclear which participants’ caregivers were interviewed i.e. whose voice is being represented?
- Unable to ascertain the effect of behaviour coaching within 2 group methods and would require a third group.
- Study was based in Southeast USA and may not be generalisable across different communities and settings.
Take Home Messages
- A virtual Movement-to-Music program can be implemented in children with CP, however changes are required from the original adult version.
- Keys to the success of the 4-week virtual Movement-to-Music program: age-appropriate and motivating music, program elements matched to the participant age and functional ability, and support provided by caregivers and the behavioural coach.
- A low-cost virtual Movement-to-Music program has acceptable adherence for children with CP across all GMFCS levels.
- Caregivers reported ongoing support was required during sessions.
- A program longer than 4 weeks with a follow up period would need to be conducted to determine adherence, acceptability and feasibility over time and in other population groups.
- Modifications to the current programme will be needed to ensure implementation across different settings (see below for author suggestions).
Impacts on Clinical Practice
The authors provide an important checklist for implementation of a Movement-to-Music virtual program based on their learning from this trial:
- Exercises and their instructions should be repetitive with slow transitions between different movements.
- Exercises should always be visually guided, in addition to verbal instruction.
- Music should be integrated into all components of the program (even the instructions).
- Music preferences vary, and thus, the choice of music should emphasize the upbeat tempos that are specific to the target group.
- Videos should include actors with disabilities that match the mobility and functional abilities of the participants.
- Telecoaches should have behaviour change techniques readily available for both the caregiver and adolescent.
- Videos should be presented with adolescent-appropriate themes.