Mastery motivation: a way of understanding therapy outcomes for children with unilateral cerebral palsy

Abstract

Purpose: To investigate the impact of mastery motivation on occupational performance outcomes immediately following upper limb (UL) training and 6 months post-intervention for school-aged children with unilateral cerebral palsy. Method: This prediction study was a post-hoc analysis of a matched pairs randomized comparison trial (COMBiT Trial Registration: ACTRN12613000181707). The Canadian Occupational Performance Measure (COPM) was administered at baseline, 13 and 26 weeks post-intervention. Parents completed the Dimensions of Mastery Questionnaire (DMQ), Parenting Scale and a demographic questionnaire. Children’s UL capacity and performance was assessed using the Melbourne Assessment of Unilateral UL Function and assisting hand assessment (AHA). Regression models were fitted using generalized estimating equations to baseline, 13 and 26 week measurements. Results: Forty-six children (7.78 years SD 2.27 years, 31 males, Manual Ability Classification System I = 23, II = 23) participated. Higher levels of bimanual performance (AHA: β = 0.03, p < 0.001), greater object-oriented persistence (DMQ: β = 0.31, p = 0.05), and treatment group allocation (Standard Care: β = 0.24, p = 0.01) were positively associated with COPM performance scores post-intervention. Conclusions: Children’s bimanual performance and persistence with object-oriented tasks significantly impact occupational performance outcomes following UL training. Predetermining children’s mastery motivation along with bimanual ability may assist in tailoring of intervention strategies and models of service delivery to improve effectiveness.

Implications for Rehabilitation

• Children’s object persistence and bimanual performance both impact upper limb training outcomes

• Working with children’s motivational predispositions may optimize engagement and therapy outcomes.

• Supporting positive parenting styles may enhance a child’s mastery motivation and persistence with difficult tasks.

• Cerebral palsy
• motivation
• occupational performance
• rehabilitation
• upper limb

Acknowledgements

We would like to thank the children and youth and families that participated in this study. We would also like to acknowledge the contributions of the project coordinators Joanne Bowden and Katherine Nevin; and the clinicians who assisted with masked scoring of the MUUL and AHA: Melinda Lewis, Tracey Carson, and Megan Thorley. We also wish to thank the volunteers who assisted with the camps and the standard care therapists who delivered individualized OT as part of the COMBiT randomized trial.

Declaration of interest

Laura Miller was supported by a National Health Medical Research Council (NHMRC) Scholarship (1039832) and a University of Queensland Research Scholarship. Roslyn Boyd was supported by a Career Development Fellowship from the NHMRC of Australia (1037220). This project was supported by funding from the National Health Medical Research Council Grant (COMBiT project grant: 1003887).