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.