Abstract
Introduction: Limited data exist on the gross motor abilities of
children with cystic fibrosis (CF). The objective of this quality
improvement project was to implement a systematic gross motor assessment
in children with CF ages 4-12 years.
Methods: Physical therapists aimed to evaluate at least 50% of
eligible children at our CF Center over 1 year using the
Bruininks-Oseretsky Test of motor Proficiency, second edition (BOT-2), a
norm referenced assessment for gross motor skills, with delays defined
by scores less than 18th percentile. Demographic and
clinical data including body mass index, hospitalizations, genotype, and
comorbidities were collected. Basic descriptive statistics summarized
patient information. Parametric and non-parametric methods compared
groups of interest. Linear regression assessed associations between
BOT-2 measures and clinical characteristics.
Results: Of the 105 eligible children, 72 (69%) completed the
BOT-2 over 1 year. Forty-five (62.5%) scored below average in at least
one category. Impaired strength (22.2%) was most common, followed by
impaired balance (16.7%), running speed and agility (15.3%), and
bilateral coordination (8.3%). Eleven (15.5%) scored below average on
their total motor composite score (TMC). Increased age, comorbidities
and hospitalizations were associated with a lower TMC.
Conclusions: The BOT-2 was successfully implemented as part of
routine CF care to screen for gross motor delays. Results suggest that a
high percentage of children with CF, especially older children with
comorbid conditions or a history of hospitalization, have impaired gross
motor function. These findings support the need for routine gross motor
evaluations and physical therapy interventions within pediatric CF
clinics.
Introduction:
Little data exists on the gross motor abilities of school aged children
with cystic fibrosis (CF)(1). Persons with CF (pwCF) are less likely to
participate in vigorous physical activity (2-4). It is unclear if this
is due to CF related delays in gross motor skills, fear-avoidance, time
constraints, nutritional status, or peripheral skeletal muscle
weakness(5). The exercise recommendations for pwCF are to participate in
60 minutes of exercise daily. Since physical activity positively affects
lung function in pwCF(3, 6), evaluation for gross motor impairments and
delays influencing ability to participate is indicated. Historically,
physical therapy (PT) evaluations in CF clinics have not included
standardized gross motor assessments, and instead have focused on
exercise evaluations in older children(7). Gross motor skills are the
foundational skills for a child to participate successfully in
recreation, school, peer and family activities, and are a precursor for
exercise participation and tolerance.
The Bruininks-Oseretsky Test of Motor Proficiency, second edition
(BOT-2) is a pediatric assessment tool that assesses gross and fine
motor skills including coordination, balance, strength, running speed
and agility(8, 9). It is norm referenced and has excellent validity and
test-retest reliability (8-10). For this quality improvement project, we
aimed to implement a process to perform gross motor testing in
>50% of our eligible CF population over 1 year using the
BOT-2. Secondary objectives were to describe gross motor findings and
examine demographic and clinical factors that may be associated with
impaired gross motor function in children with CF.