Sharing of lessons learned from multisite research.

PURPOSE: To highlight key considerations for planning and implementing multisite research based on experiences and reflections in conducting a large, international, multisite study. DESCRIPTION: Successes and challenges encountered throughout a multisite study process, and collective recommendations for future researchers are presented. Considerations addressed include creation of the research team and a "community of practice," study preparation and management time, approval by institutional review boards, training of future researchers, recruitment and retention of participants, and dissemination and translation of study materials to consumers. IMPORTANCE TO MEMBERS: Multisite research has the potential to create knowledge for pediatric physical therapy through collaboration among knowledgeable researchers and expert practitioners and by increasing the potential for generalization of findings. Effective planning, including anticipation of challenges, is critical to a successful study. Our collective experiences may assist practitioners and researchers in planning, implementing, and completing future multisite studies.

Factors related to adaptive behavior in children with cerebral palsy.

OBJECTIVE: The purpose of this study was to describe the adaptive behavior of children with cerebral palsy and identify the child, family, and service factors that are related to their adaptive behavior. METHODS: A convenience sample of 319 children with cerebral palsy (3 to <13 years), and their caregivers (81% were children's mothers) participated in the study. Caregivers completed the Coping Inventory, Family Environment Scale, Service Questionnaire, and demographic questionnaire. Children's Gross Motor Function Classification System levels were determined by assessors who met the criterion for reliability. A sequential multiple regression on 297 children with a complete data set was used to determine the factors that explain children's adaptive behavior. RESULTS: Children's mean Adaptive Behavior Index was 3.9 (SD = 0.7), indicating that, on average, their behavior was "effective more often than not." The Adaptive Behavior Index was lowest for children with severe limitations in gross motor function. The final regression model explained 45% of the variance in children's adaptive behavior. Children's behavioral/emotional problems, communication problems, health, learning problems, and family cohesion were significant factors in the model. CONCLUSIONS: Caregivers of children with cerebral palsy rated the children's behavior as effective in meeting personal needs, adapting to environmental demands, and interacting with others. The findings support the view that adaptive behavior of children with cerebral palsy is complex and multidimensional. Service providers can capitalize on children's adaptive behavioral strengths and promote their self-determination and support adaptation to optimize participation in daily life.

A comparison of motor behaviors, interaction, and playfulness during mother-child and father-child play with children with motor delay.

The purpose of this investigation was to compare motor behavior, parent-child interactions, and child's playfulness during mother-child and father-child play with children with motor delay. Play sessions of 20 children (ages 7 to 36 months) and their parents were videotaped in the families' homes. Interval recording was used to measure the children's motor behaviors, the parents' handling/positioning, and the children's position of play. The Maternal Behavior Rating Scale and the Test of Playfulness were used to measure the parents' interactive behaviors and children's playfulness, respectively. Mean differences were analyzed using paired t-tests. Children demonstrated similar occurrence of motor behaviors and degree of playfulness when playing with their mothers and their fathers. Mothers and fathers had similar occurrence of carrying their children, using adaptive positioning equipment, and manually positioning their children. Fathers held their children on their lap for a greater proportion of the play intervals compared with mothers. Mothers were more responsive than fathers during the play sessions but both parents demonstrated similar achievement orientation, affect/animation, and directiveness. Children's playfulness was related to their developmental abilities and to parents' responsiveness. Therapists are encouraged to consider the interactive styles of both parents, capitalize on the unique strengths of each parent and child, and partner with parents to promote interactions with their children and children's playfulness.

Exploring physical therapy clinical decision making for children with spastic diplegia: survey of pediatric practice.

PURPOSE: The purpose of this special interest report is to describe the outcomes of a research round table discussion regarding the physical therapy management of mobility for children with spastic diplegia. DESCRIPTION: Sixty-two pediatric physical therapists and physical therapists assistants participated in focus groups during the Research Round Table at the American Physical Therapy Association (APTA) 1999 Combined Sections Meeting. A case description of a child with spastic diplegia and guiding questions were used to facilitate discussion. SUMMARY OF EXPERIENCE: Common practices in patient management across the child's life-span emerged from the discussion. Practices in examination, evaluation and prognosis, and intervention differed depending on the age and function of the child and the family's needs. In general, therapists reported that younger children receive examinations that include standardized tests of development and ongoing intervention with a frequency of one to five times per week. In contrast, older children receive therapy services on an episodic basis that address their specific needs. The elements of patient management served as a useful framework for exploring decision making. IMPORTANCE TO PEDIATRIC PHYSICAL THERAPY: The information compiled from this project needs to be validated through systematic inquiry. Therapists may, however, use the practices reported here to reflect on their clinical decision making and to identify questions for further exploration. This descriptive document is the first step in the development of a guideline for evidence-based practice. The development of such a clinical guideline could serve as an education tool for novice therapists, a program evaluation tool to ensure quality care, and a foundation for future research to promote evidence-based practice.