Um programa de esportes modificados associado a uma intervenção focada no contexto para crianças com paralisia cerebral: um ensaio clínico randomizado de viabilidade

Abstract

The effectiveness of different intervention models to improve the participation of children with Cerebral Palsy has been demonstrated in the literature. Among them, we can mention modified sports interventions, which promote participation by improving factors intrinsic to the individual, and context-focused therapy, which concentrates on extrinsic factors related to the context in which participation occurs. Considering that both promote participation through distinct mechanisms of action, the question arises whether the combination of the two models can lead to better results. Therefore, the aim of the present study was to investigate the feasibility of conducting a randomized controlled trial (RCT) to evaluate the effectiveness of a modified sports intervention (Sports Stars Brazil) combined with a context-focused therapy (Pathways and Resources for Engagement and Participation - PREP), as well as the preliminary effects of this combination. This is a feasibility clinical trial. Nine participants were randomly allocated to the Sports Stars Brazil + PREP group, and nine to the Sports Stars Brazil group. Feasibility measures included: willingness to participate in an RCT; acceptability of random allocation; acceptability of screening procedures; feasibility of assessor blinding; contamination between groups; adherence and satisfaction with the treatment; communication among therapists; occurrence of adverse events and resources for implementation. Secondary outcomes were obtained using the Canadian Occupational Performance Measure (COPM), the Participation and Environment Measure for Children and Youth (PEM-CY), the Family Empowerment Scale (FES), the Physical Literacy Questionnaire (PLP-Quest), and an accelerometer. These instruments were used in pre- and post-intervention assessments, and at a 12-week follow-up. Descriptive statistics and appropriate tests were used for data analysis. Feasibility analysis revealed adequate levels of satisfaction, credibility, and acceptability of the interventions in both groups; however, the recruitment rate and contamination between groups were not adequate. Regarding secondary outcomes, statistically significant differences were found in favor of the Sports Stars Brazil + PREP group on the COPM, in the FES, as well as in school involvement assessed by the PEM-CY. It can be concluded that it is feasible to implement a more robust clinical trial to investigate the effectiveness of combining these interventions, although some procedural adjustments are necessary. Moreover, the combination has the potential to improve relevant outcomes.