Exploring needs and requirements for a prototype device measuring physical activity in pediatric physical therapy: A qualitative study.

AIMS: To analyze needs and requirements of Pediatric Physical Therapists (PPTs), parents, children and adolescents with and without developmental disabilities in the future use of an activity monitor prototype (AM-p) in everyday clinical practice. METHODS: Qualitative exploratory study with a thematic analysis approach, based on Braun and Clarke's six steps. Codes derived from the analysis and central themes were collated, based on Fleuren et al.'s groupings of determinants. RESULTS: We interviewed 25 PPTs, 12 parents, and 12 children and adolescents. Within four groupings of determinants, we found nine themes: 1) development of information materials; 2) application: output visualization and ease of use; 3) design; 4) relevance and acceptance; 5) shared decision-making; 6) compatibility in daily living; 7) finances, 8) time, and 9) legislation and regulations. CONCLUSIONS: End-users have similar basic needs, with individual fine-tuning to be addressed during further development of the AM-p. A child-friendly design, information material, and an easy-to-use application to read and interpret results, need to be developed. Efficient training for PPTs is important for the use of the AM-p and analysis of results. Communication between PPTs and children as well as parents enhances shared decision-making. We recommend involving diverse end-users to enable maximum customization of the AM-p.

Using a behavior change toolkit in pediatric physical therapy to support physical activity: A feasibility study.

INTRODUCTION: Physical activity levels of children with disabilities are low, as these children and their parents face a wide variety of both personal and environmental barriers. Behavior change techniques support pediatric physical therapists to address these barriers together with parents and children. We developed the What Moves You?! intervention Toolkit (WMY Toolkit) filled with behavioral change tools for use in pediatric physical therapy practice. OBJECTIVE: To evaluate the feasibility of using the WMY Toolkit in daily pediatric physical therapy practice. METHODS: We conducted a feasibility study with a qualitative approach using semi-structured interviews with pediatric physical therapists (n = 11). After one day of training, the pediatric physical therapists used the WMY Toolkit for a period of 9 weeks, when facilitating physical activity in children with disabilities. We analyzed the transcripts using an inductive thematic analysis followed by a deductive analysis using a feasibility framework. RESULTS: For acceptability, pediatric physical therapists found that the toolkit facilitated conversation about physical activity in a creative and playful manner. The working mechanisms identified were in line with the intended working mechanisms during development of the WMY Toolkit, such as focusing on problem solving, self-efficacy and independence. For demand, the pediatric physical therapists mentioned that they were able to use the WMY Toolkit in children with and without disabilities with a broad range of physical activity goals. For implementation, education is important as pediatric physical therapists expressed the need to have sufficient knowledge and to feel confident using the toolkit. For practicality, pediatric physical therapists were positive about the ease of which tools could be adapted for individual children. Some of the design and materials of the toolkit needed attention due to fragility and hygiene. CONCLUSION: The WMY Toolkit is a promising and innovative way to integrate behavior change techniques into pediatric physical therapy practice.

Using a Co-design Approach to Create Tools to Facilitate Physical Activity in Children With Physical Disabilities.

Introduction: There is a lack of effective interventions available for Pediatric Physical Therapists (PPTs) to promote a physically active lifestyle in children with physical disabilities. Participatory design methods (co-design) may be helpful in generating insights and developing intervention prototypes for facilitating a physically active lifestyle in children with physical disabilities (6-12 years). Materials and methods: A multidisciplinary development team of designers, developers, and researchers engaged in a co-design process-together with parents, PPTs, and other relevant stakeholders (such as the Dutch Association of PPTs and care sports connectors). In this design process, the team developed prototypes for interventions during three co-creation sessions, four one-week design sprint, living-lab testing and two triangulation sessions. All available co-design data was structured and analyzed by three researchers independently resulting in themes for facilitating physical activity. Results: The data rendered two specific outcomes, (1) knowledge cards containing the insights collected during the co-design process, and (2) eleven intervention prototypes. Based on the generated insights, the following factors seem important when facilitating a physically active lifestyle: a) stimulating self-efficacy; b) stimulating autonomy; c) focusing on possibilities; d) focusing on the needs of the individual child; e) collaborating with stakeholders; f) connecting with a child's environment; and g) meaningful goal setting. Conclusion: This study shows how a co-design process can be successfully applied to generate insights and develop interventions in pediatric rehabilitation. The designed prototypes facilitate the incorporation of behavioral change techniques into pediatric rehabilitation and offer new opportunities to facilitate a physically active lifestyle in children with physical disabilities by PPTs. While promising, further studies should examine the feasibility and effectivity of these prototypes.

Fitkids Treadmill Test: Clinical Utility and Factors Associated With Its Use Among Physical Therapists.

BACKGROUND: Although the Fitkids Treadmill Test (FTT) has been validated and normative values are available for healthy 6- to 18-year-old children and adolescents, these facts do not automatically imply uptake of the test in routine practice of physical therapists. OBJECTIVE: The objectives of this study were to evaluate the utility of the FTT in different diagnostic groups and to explore potential factors affecting the use of the FTT in clinical practice. DESIGN: Mixed methods with both quantitative and qualitative data were used in this study. METHODS: Outcome parameters from the FTT were retrieved from the Fitkids database. For evaluation of the utility of the FTT, 2 indicators, exercise duration and maximal effort, were used. An online survey was sent to physical therapists in Fitkids practices to identify factors affecting the use of the FTT in clinical practice. RESULTS: The proportion of children and adolescents in each of the diagnostic groups who reached the minimal duration of a maximal exercise test ranged from 94% to 100%. The proportion of participants who reached a peak heart rate ≥180 beats/min ranged from 46% for participants with cognitive, psychological, or sensory disorders to 92% for participants with metabolic diseases. The most important facilitator for use of the FTT was the fact that most physical therapists were convinced of the additional value of the FTT. The main barriers were therapists' attitudes (resistance to change/lack of experience) and, on the environmental level, the absence of a treadmill ergometer in physical therapist practice. LIMITATIONS: Structured interviews would have provided more information on potential factors affecting the use of the FTT in clinical practice. CONCLUSIONS: This study has shown the clinical utility of the FTT in different diagnostic groups in pediatric physical therapist practice. Responding to the factors identified in this study should enable improved uptake of the FTT in clinical practice.

Fitkids Treadmill Test: Age- and Sex-Related Normative Values in Dutch Children and Adolescents.

BACKGROUND: Recent research has shown that the Fitkids Treadmill Test (FTT) is a valid and reproducible exercise test for the assessment of aerobic exercise capacity in children and adolescents who are healthy. OBJECTIVE: The study objective was to provide sex- and age-related normative values for FTT performance in children and adolescents who were healthy, developing typically, and 6 to 18 years of age. DESIGN: This was a cross-sectional, observational study. METHODS: Three hundred fifty-six children and adolescents who were healthy (174 boys and 182 girls; mean age=12.9 years, SD=3.7) performed the FTT to their maximal effort to assess time to exhaustion (TTE). The least-mean-square method was used to generate sex- and age-related centile charts (P3, P10, P25, P50, P75, P90, and P97) for TTE on the FTT. RESULTS: In boys, the reference curve (P50) showed an almost linear increase in TTE with age, from 8.8 minutes at 6 years of age to 16.1 minutes at 18 years of age. In girls, the P50 values for TTE increased from 8.8 minutes at 6 years of age to 12.5 minutes at 18 years of age, with a plateau in TTE starting at approximately 10 years of age. LIMITATIONS: Youth who were not white were underrepresented in this study. CONCLUSIONS: This study describes sex- and age-related normative values for FTT performance in children and adolescents who were healthy, developing typically, and 6 to 18 years of age. These age- and sex-related normative values will increase the usefulness of the FTT in clinical practice.

Validity and Reproducibility of a New Treadmill Protocol: The Fitkids Treadmill Test.

PURPOSE: This study aimed to investigate the validity and reproducibility of a new treadmill protocol in healthy children and adolescents: the Fitkids Treadmill Test (FTT). METHODS: Sixty-eight healthy children and adolescents (6-18 yr) were randomly divided into a validity group (14 boys and 20 girls; mean ± SD age, 12.9 ± 3.6 yr) that performed the FTT and Bruce protocol, both with respiratory gas analysis within 2 wk, and a reproducibility group (19 boys and 15 girls; mean ± SD age, 13.5 ± 3.5 yr) that performed the FTT twice within 2 wk. A subgroup of 21 participants within the reproducibility group performed both FTT with respiratory gas analysis. Time to exhaustion (TTE) was the main outcome of the FTT. RESULTS: V˙O2peak measured during the FTT showed excellent correlation with V˙O2peak measured during the Bruce protocol (r = 0.90; P < 0.01). Backward multiple regression analysis provided the following prediction equations for V˙O2peak (L·min) for boys and girls, respectively: V˙O2peak FTT = -0.748 + (0.117 × TTEFTT) + (0.032 × body mass) + 0.263, and V˙O2peak FTT = -0.748 + (0.117 × TTEFTT) + (0.032 × body mass) [R = 0.935; SEE = 0.256 L·min]. Cross-validation of the regression model showed an R value of 0.76. Reliability statistics for the FTT showed an intraclass correlation coefficient of 0.985 (95% confidence interval, 0.971-0.993; P < 0.001) for TTE. Bland-Altman analysis showed a mean bias of -0.07 min, with limits of agreement between +1.30 and -1.43 min. CONCLUSIONS: Results suggest that the FTT is a useful treadmill protocol with good validity and reproducibility in healthy children and adolescents. Exercise performance on the FTT and body mass can be used to adequately predict V˙O2peak when respiratory gas analysis is not available.

Effects of the Fitkids exercise therapy program on health-related fitness, walking capacity, and health-related quality of life.

BACKGROUND: Children with disabilities have an increased risk for reduced fitness and reduced health-related quality of life (HRQoL). Fitkids, a nationwide exercise therapy program in the Netherlands, was developed to improve fitness and HRQoL in children with disabilities. OBJECTIVE: The study objective was to determine the effects of the Fitkids program on health-related fitness, walking capacity, and HRQoL in children with disabilities or chronic conditions. DESIGN: This was a quasi-experimental single-group longitudinal study. METHODS: Fifty-two children and adolescents who were referred to the Fitkids program participated in this study. Participants received a graded exercise training program for 6 months, with frequencies of 1 hour 2 times per week in the first 3 months and 1 hour per week during months 4 to 6. Health-related fitness (aerobic fitness, anaerobic fitness, and muscle strength), walking capacity, and HRQoL were evaluated at baseline and after 3 and 6 months of training. Multilevel modeling was used to quantify the contributions of repeated measures, participants, and Fitkids centers to variations in health-related fitness, walking capacity, and HRQoL during the intervention period. The models were adjusted for sex, height, and weight. RESULTS: After 6 months of training, significant intervention effects were found for aerobic fitness, anaerobic fitness, and muscle strength. A significant effect also was found for walking capacity. On the HRQoL measure, significant improvements were found for the self-reported and parent-reported physical and emotion domains and for the parent-reported total score for HRQoL. LIMITATIONS: No control group was included in this study. CONCLUSIONS: The Fitkids exercise therapy program has significantly improved health-related fitness, walking capacity, and HRQoL in children and adolescents with chronic conditions or disabilities.

Fitkids exercise therapy program in the Netherlands.

PURPOSE: To describe the demographics, medical diagnoses, and initial aerobic fitness levels of children participating in Fitkids: an exercise therapy program for children with chronic conditions or disabilities in the Netherlands. METHODS: We reviewed data of children who were in the program on September 2010. RESULTS: In total, 2482 children from 105 Fitkids centers were included. Results showed the large heterogeneity of the population regarding demographic characteristics and medical diagnoses. Significantly reduced scores on the 6-minute walk test and half Bruce treadmill test were observed. CONCLUSION: The Fitkids population has great heterogeneity. In addition, a plethora of fitness tests were used, and registration of data in the Fitkids database was suboptimal. Moreover, this study showed the impaired aerobic fitness of children participating in Fitkids. Future research should investigate the effectiveness of the Fitkids program.