Open Access Study protocol

Participation in physical play and leisure: developing a theory- and evidence-based intervention for children with motor impairments

Niina Kolehmainen1*, Jillian J Francis2, Craig R Ramsay1, Christine Owen3, Lorna McKee1, Marjolijn Ketelaar4 and Peter Rosenbaum5

Author Affiliations

1 Health Services Research Unit, University of Aberdeen 3rd floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK

2 Health Services Research Unit and Aberdeen Health Psychology Group, University of Aberdeen 3rd floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK

3 Children's Occupational Therapy Service, St Johns Hospital, West Lothian, UK

4 Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Rembrandtkade 10, 3583 TM Utrecht, The Netherlands

5 Faculty of Health Sciences, Institute for Applied Health Sciences, Rm 408, 1400 Main Street West, Hamilton, Ontario, L8S 1C7, Canada

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BMC Pediatrics 2011, 11:100  doi:10.1186/1471-2431-11-100

Published: 7 November 2011



Children with motor impairments (e.g. difficulties with motor control, muscle tone or balance) experience significant difficulties in participating in physical play and leisure. Current interventions are often poorly defined, lack explicit hypotheses about why or how they might work, and have insufficient evidence about effectiveness. This project will identify (i) the 'key ingredients' of an effective intervention to increase participation in physical play and leisure in children with motor impairments; and (ii) how these ingredients can be combined in a feasible and acceptable intervention.


The project draws on the WHO International Classification of Functioning, Disability and Health and the UK Medical Research Council guidance for developing 'complex interventions'. There will be five steps: 1) identifying biomedical, personal and environmental factors proposed to predict children's participation in physical play and leisure; 2) developing an explicit model of the key predictors; 3) selecting intervention strategies to target the predictors, and specifying the pathways to change; 4) operationalising the strategies in a feasible and acceptable intervention; and 5) modelling the intervention processes and outcomes within single cases.


The primary output from this project will be a detailed protocol for an intervention. The intervention, if subsequently found to be effective, will support children with motor difficulties to attain life-long well-being and participation in society. The project will also be an exemplar of methodology for a systematic development of non-drug interventions for children.