Pediatric Endurance and Limb Strengthening PEDALS

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Pediatric Endurance and Limb Strengthening
(PEDALS)

• Research to determine the effectiveness of a
  cycling intervention on strength and function in
  children with spastic diplegic CP
• Multi-site, randomized clinical trial (USC, UCLA,
  MSU)
• PIs Drs. Fowler/Knutson/DeMuth
• Fellows Kara Siebert MsEd, DPT, Mia Sugi DPT,
  Victoria Simms MPT
• Data Management/Statistical analysis team Stan
  Azen PhD, Carolyn Ervin PhD, Wenli Wang MS

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ICF Framework and Outcomes
Body function structures
Participation
Activity

• GMFCS
• GMFM

• ISOKINETIC
• STRENGTH
• TESTING

• DAILY CALENDAR

• 600 YARD WALK RUN
• 30 SECOND WALK TEST

HRQOL PedsQL, PODCI
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Activity Measures GMFCS and GMFM

• GMFCS Gross Motor Function Classification System
• Inclusion criteria Level I, II or III
• I Walks no restrictions
• limitations advanced gross motor skills
• II Walks no assistive devices
• limitations walking outdoors community
• III Walks with assistive mobility devices
• limitations walking outdoors community
• GMFM Gross Motor Function Measure
• Dimension D Standing
• Dimension E Walking, running, jumping
• Total score D E

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HRQOL- Health Related Quality of Life
Questionnaires

• PedsQL Pediatric Quality of Life Inventory
• Self report
• Young children 5-7years
• Children 8-12 years
• Teens 13-18 years
• PODCI Pediatric Orthopedic Disability Collection
  Instrument
• Specific for musculoskeletal conditions
• Self report, Adolescent 11-18 years
• Parent report
• Child 2-10 years
• Adolescent 11-18 years

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HRQOL - Health Related Quality of Life
Questionnaires

• Methods
• Interview
• Standardized
• Translation Spanish, Asian
• PedsQL
• N60 subjects, 7-18 years
• PODCI
• N32 subjects, 11-18 years

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HRQOL Questionnaires

• PedsQL
• 4 subscales
• Physical
• Emotional
• Social
• School
• Psychosocial Summary Score
• PedsQL Total Scale Score
• 23 items

• PODCI
• 7 subscales
• UE and Physical Function
• Transfers Basic Mobility
• Sports/Physical Functioning
• Pain/Comfort
• Treatment Expectations
• Happiness
• Satisfaction with Symptoms
• Global Function Symptoms
• Up to 117 items

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PedsQL PHYSICAL FUNCTIONING SUBSCALE
ITEMS 1. Hard to walk more than 1 block 2. Hard
to run 3. Hard to do sports activity or
exercise 4. Hard to lift something heavy 5. Hard
to take bath/shower by self 6. Hard to do chores
around house 7. I hurt or ache 8. I have low
energy
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PODCI TRANSFERS BASIC MOBILITY SUBSCALE
ITEMS 1. Put on socks 2. Climb 1 flight of
stairs 3. Walk 1 block 4. Get on/off a bus 5.
Stand washing hands/face at sink 6. Sit, regular
chair, no holding on 7. Get on/off toilet or
chair 8. Bend over from standing - pick up object
from floor 9. Help from another for
sitting/standing 10. How often are assistive
devices used for sitting/standing
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Research Question

• Were there Relationships among Activity and HRQOL
  measures for Baseline Data ?
• - GMFM,GMFCS for Activity
• - PedsQL, PODCI for HRQOL

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• Was there a significant difference in PedsQL /
  PODCI scores between GMFCS levels?

Yes
ANOVA and Tukey post hoc significant Subjects
with greater mobility (GMFCS I) reported higher
health related quality of life as compared to
those with less mobility (GMFCS III) (p lt 0.05).
ANACOVA PedsQL Age was not a covariate for
total score. PODCI Age was not a covariate
for the global function scale.
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Total score


plt0.05
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plt0.05
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2. Was there a relationship (correlation)
between scores on the GMFM and PedsQL, PODCI?
Yes
Correlation existed between GMFM - the
physical therapist examination of physical
function PedsQL PODCI - the subjects
self-report on HRQOL measures. Higher GMFM
scores were associated with higher HRQOL scores
(p lt 0.05).
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Univariate correlations PedsQL GMFM N60
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Univariate correlations PODCI GMFM N32
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3. Did younger versus older children differ in
the way they self reported HRQOL (PedsQL)?
Yes

• The relationship (correlation) between the
  PedsQL scores for the physical functioning
  subscale and the psychosocial summary suggested
• Younger subjects (7-10 years) DID NOT show a
  relationship
• (r .22 p 0.27)
• Older subjects (11-18 years) DID show a
  significant relationship higher physical health
  scores were associated with higher psychosocial
  health scores (r .72 p lt 0.0001)

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PedsQL Physical score vs. Psychosocial summary
score Scatterplot of 7-10 year olds (r .22 p
0.27)
Physical score
Psychosocial score
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PedsQL Physical score vs. Psychosocial summary
score Scatterplot of 11 18 year olds (r.72, p
lt .0001)
Physical score
Psychosocial score
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Summary

• Children with fewer physical limitations per the
  GMFCS reported higher quality of life on HRQOL
  measures
• Significant correlations existed between the GMFM
  and HRQOL. Correlations are similar for summary
  scores highest for the GMFM and PODCI Transfer
  and Mobility subscale.
• Older children who reported higher (better)
  physical functioning also reported higher
  (better) psychosocial scores on the PedsQL

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Acknowledgements

• Southern California
• Orthopaedic Hospital, Downtown LA
• Pediatric Therapy Network, Torrance
• Therapy West, Culver City
• The Childrens Therapy Center, Garden Grove
• Missouri
• Cox South Hospital, Springfield
• Capable Kids, Rolla
• St. Johns Mercy Hospital, Lebanon

THANKS