Capacity to Participation in Cerebral Palsy: Evidence of an Indirect Path Via Performance

ObjectiveTo examine the hypothesis that the influence of physical activity capacity on participation is mediated through activity performance.DesignSecondary analysis of a prospective cross-sectional study sample.SettingRegional pediatric specialty care hospital.ParticipantsChildren (N=128; 59% boys; age range, 2–9y) with cerebral palsy with Gross Motor Function Classification System levels I to III; 49% had hemiplegia, and 72% had spasticity.InterventionsNot applicable.Main Outcome MeasuresActivity capacity was measured with the Gross Motor Function Measure-66, performance was measured with the Activities Scale for Kids, and participation was measured with the Assessment of Life Habits. Children's Assessment of Participation and Enjoyment and the Assessment of Preschool Children's Participation assessed diversity participation. Regression equations and Sobel z test were used to examine the mediated effect via performance.ResultsPhysical activity performance mediates 74.9% (β=.83, P<.001) of the effect of activity capacity on total participation levels and 52.8% (β=.47, P=.001) of the effect of capacity on diversity participation.ConclusionsThe relation between what an ambulatory child with cerebral palsy is able to perform in a clinical setting and their participation in life is significantly mediated by what they actually do motorically in day-to-day life. Results suggest that interventions focusing on improving what they actually do every day, regardless of their capacity to perform (what they can do when tested), may positively influence participation.