Determinants of Intensity of Participation in Leisure and Recreational Activities by Youth With Cerebral Palsy

Palisano RJ, Orlin M, Chiarello LA, Oeffinger D, Polansky M, Maggs J, Gorton G, Bagley A, Tylkowski C, Vogel L, Abel M, Stevenson R. Determinants of intensity of participation in leisure and recreational activities by youth with cerebral palsy. Arch Phys Med Rehabil 2011;92:1468-76. Objective: To test a model of determinants of intensity of participation in leisure and recreational activities by youth with cerebral palsy (CP). Design: Prospective cohort study. Setting: Children's hospitals (N=7). Participants: Youth with CP (N=205; age, 13-21y) and their parents. The sample included 107 (57.2%) males and 26 (12.7%) to 57 (27.8%) youth in each of the 5 levels of the Gross Motor Function Classification System (GMFCS). Interventions: Not applicable. Main Outcome Measures: Youth completed the Children's Assessment of Participation and Enjoyment by means of an interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, a demographic questionnaire, and a services questionnaire. Results: Structural equation modeling was used to test the model. Fit statistics indicate good model fit. The model explains 35% of the variance in intensity of participation. Path coefficients (P <=.05) indicate that higher physical ability, higher enjoyment, younger age, female sex, and higher family activity orientation are associated with higher intensity of participation. GMFCS level and caregiver education have indirect effects on intensity of participation. The path between services and intensity of participation was not significant. Conclusions: Participation by youth with CP is influenced by multiple factors. The influence of physical activity supports the importance of activity accommodations and assistive technology for youth who are not capable of improving physical ability. Knowledge of family activity orientation is important for identifying opportunities for participation. The unexplained variance suggests that the model should include other determinants, such as physical accessibility and availability of transportation and community leisure and recreational activities.