Nível de mobilidade, atividade e participação de crianças e adolescentes com paralisia cerebral: efeitos mediadores e moderadores

Abstract

The relationship between functionality components and contextual factors is complex and multidirectional. Although several studies verify the simple relationship between the level of mobility and the performance of activities and the participation of individuals with cerebral palsy (CP), other factors can influence by mediating or moderating this relationship. Factors such as age, anatomical distribution, as well as environmental facilitators/barriers can act directly, mediate or moderate this relationship. To contemplate this complexity and broaden the understanding of the factors that influence the performance of activities and the participation of individuals with CP, is possible to use the analysis of paths by Structural Equation Modeling (SEM). The aim of this study was to evaluate the mediating and moderating effects of the relationship between different levels of mobility and the performance of functional activities, mobility, social/cognitive and the responsibility of children and adolescents with CP. A cross-sectional study was carried out, part of a multicenter project, and children/adolescents with CP aged 2 to 14 years were included. Four dependent variables were examined: trained activities; mobility; social/cognitive; and, responsibility, measured by the Pediatric Assessment of Disability Inventory – Computerized Adaptive Testing (PEDI-CAT). The independent variable was the level of mobility, measured by the Gross Motor Function Classification System (GMFCS). Age, anatomical distribution and environmental factors (barriers/facilitators) were also entered into the model. The MEE, via Path Analysis, was used to verify the relationship between the variables. 190 children/adolescents participated in the study. Facilitating environmental factors affected the moderating effect on the relationship between GMFCS level and mobility (=0.345, p=0.002), social/cognitive (=0.339, p=0.047) and responsibility (=0.372, p= 0.015) of children and adolescents with CP. Direct effect was also verified from the anatomical distribution at the GMFCS level. The percentages of variation for the daily activity, mobility, social/cognitive and responsibility domains were, respectively: 64.4% (R2= 0.644; p<0.001); 75.8% (R2= 0.758; p<0.001); 54.5% (R2=0.55; p<0.001); 51.2% (R2=0.512; p<0.001). It was observed that facilitating environmental factors can moderate the relationship between the level of GMFCS and the performance of the mobility, social/cognitive and responsibility domains of children and adolescents with CP. The level of GMFCS was the main factor that explained these domains and age contributed directly to explain this relationship. Furthermore, anatomical distribution had a direct effect on the GMFCS level of children and adolescents with CP.