Quality Improvement Project to Implement a Systematic Assessment of
Gross Motor Skills in School-Aged Children with Cystic Fibrosis
Abstract
Introduction: Limited data exist on the gross motor abilities of
children with cystic fibrosis (CF). The objective of this quality
improvement project was to implement a systematic gross motor assessment
in children with CF ages 4-12 years. Methods: Physical therapists aimed
to evaluate at least 50% of eligible children at our CF Center over 1
year using the Bruininks-Oseretsky Test of motor Proficiency, second
edition (BOT-2), a norm referenced assessment for gross motor skills,
with delays defined by scores less than 18 th
percentile. Demographic and clinical data including body mass index,
hospitalizations, genotype, and comorbidities were collected. Basic
descriptive statistics summarized patient information. Parametric and
non-parametric methods compared groups of interest. Linear regression
assessed associations between BOT-2 measures and clinical
characteristics. Results: Of the 105 eligible children, 72 (69%)
completed the BOT-2 over 1 year. Forty-five (62.5%) scored below
average in at least one category. Impaired strength (22.2%) was most
common, followed by impaired balance (16.7%), running speed and agility
(15.3%), and bilateral coordination (8.3%). Eleven (15.5%) scored
below average on their total motor composite score (TMC). Increased age,
comorbidities and hospitalizations were associated with a lower TMC.
Conclusions: The BOT-2 was successfully implemented as part of routine
CF care to screen for gross motor delays. Results suggest that a high
percentage of children with CF, especially older children with comorbid
conditions or a history of hospitalization, have impaired gross motor
function. These findings support the need for routine gross motor
evaluations and physical therapy interventions within pediatric CF
clinics.