Childhood factors predict participation of young adults with cerebral palsy in domestic life and interpersonal relationships: a prospective cohort study

Figures & data

Table 1. Characteristics of participants at 13-year follow-up and of non-participants.

	Participantsn (%)	Non-participantsn (%)
Gender
Male/female	45/22 (67/33)	22/18 (55/45)
Age in years: mean (SD); min–max	24.6 (1.6); 21.6–27.4	na
GMFCS^a
I	30 (45)	19 (48)
II	7 (10)	7 (18)
III	8 (12)	5 (13)
IV	9 (13)	4 (10)
V	13 (19)	5 (13)
MACS^b
I	26 (39)	13 (45)
II	22 (33)	11 (38)
III	7 (10)	2 (7)
IV	7 (10)	3 (10)
V	5 (7)	0
		Missing: 11
Type of CP
Spastic	52 (78)	34 (85)
Unilateral	21	16
Bilateral	31	18
Dyskinetic	3 (5)	1 (3)
Ataxic	3 (5)	1 (3)
Mixed	9 (13)	4 (10)
ID
No/yes	46/21 (69/31)	29/11 (73/28)
Housing situation		na
with parents	36 (55)
alone	17 (26)
with partner	2 (3)
other	10 (15)
	Missing^c: 2
Housing type		na
Regular housing	34 (52)
Adjusted housing	17 (26)
Assisted housing	14 (22)
	Missing^c: 2
Ever in a romantic relationship		na
Yes/no	34/28 (55/45)
	Missing^c: 5

^a GMFCS data were assessed at baseline and considered constant for analysis.

^b MACS data were assessed at the 3-year follow-up or at the 13-year follow-up in case of missing values (n = 3) and considered constant for analysis.

^c Missing: Two participants did not complete the online questionnaire. Additionally, three participants chose not to answer the question on romantic relationships.

na: not available, since this data was collected at the 13-year follow-up.

SD: standard deviation; GMFCS: gross motor function classification system; MACS: manual ability classification system; CP: cerebral palsy; ID: intellectual disability.

Table 2. Possible predictive factors by ICF component at baseline.

		Domestic life		Interpersonal relationships
	Total n = 67,	Attendance	Difficulty	Attendance	Difficulty
	age at baseline: 9-13 years	(Vine-II)	(Life-H)	(Vine-II)	(Life-H)
CP-related characteristics (health condition)	n (%)	Selected predictors of cluster, β (SE); R^2		Selected predictors of cluster, β (SE); R^2
GMFCS in 3 categories
I + II	37 (55)	ref category	ref category	ref category	ref category
III + IV	17 (25)	−16.66 (2.69)***	−1.80 (0.39)***	−4.99 (3.31)	−0.56 (0.42)
V	13 (19)	−27.62 (4.12)***	−5.26 (0.43)***	−19.45 (5.07)***	−3.9 (0.49)***
MACS in 2 categories
I + II	48 (72)	ref category		ref category
III + IV + V	19 (28)	−11.66 (3.46)***		−8.45 (4.26)*
Type of CP (spastic/other)	52/15 (78/22)				0.92 (0.45)**
		R^2: 76%	R^2: 70%	R^2: 50%	R^2: 51%
Body functions and structures	n (%)	Selected predictors of cluster, β (SE); R^2		Selected predictors of cluster, β (SE); R^2
ID (no/yes)	46/21 (69/31)	−17.88 (3.81)***	−2.92 (0.52)***	−18.50 (2.74)***	−1.97 (0.37)***
Epilepsy (no/yes)	61/6 (91/9)	−11.44 (5.27)**	−1.42 (0.74)*	−17.30 (4.45)***	−3.19 (0.59)***
Visual impairment (no/yes)	53/14 (79/21)	−15.00 (4.07)***	−1.35 (0.57); 0.021**
Hearing impairment (no/yes)	64/3 (96/4)
Speech problems (item 79 of CBCL) (no/yes)	35/31 (52/46)
	missing: 1 (1)	R^2: 62%	R^2: 61%	R^2: 59%	R^2: 58%
Motor capacity	mean (SD); min-max	Selected predictors of cluster, β (SE); R^2		Selected predictors of cluster, β (SE); R^2
Gross motor capacity (GMFM-66) (66 items, range 0-100)	64.73 (28.28); 3.66 to 99.45	0.55 (0.04)***	0.07 (0.01)***	0.35 (0.05)***	0.05 (0.01)***
		R^2: 79.7%	R^2: 71%	R^2: 44.3%	R^2: 40.6%
Activities and participation	mean (SD); min-max	Selected predictors of cluster, β (SE); R^2		Selected predictors of cluster, β (SE); R^2
VABS Motor skills
– Gross (20 items, range 0-40)	24.23 (12.45); 2.07 to 39.23	0.82 (0.14)***	0.06 (0.02)***
– Fine (16 items, range 0-32)	23.73 (10.23); 0.10 to 31.70	0.62 (0.17)***	0.14 (0.03)***	1.13 (0.11)***	0.14 (0.02)***
		R^2: 81%	R^2: 77%	R^2: 60%	R^2: 50.4%
VABS Communication
– Receptive (13 items, range 0-26)	24.42 (3.94); 2.13 to 25.94		0.19 (0.05)***		0.31 (0.04)***
– Expressive (31 items, range 0-62)	53.24 (14.03); 2.45 to 60.50			0.83 (0.07)***
– Written (23 items, range: 0-46)	22.66 (12.84); 0.06 to 40.39	1.14 (0.09)***	0.12 (0.02)***	0.23 (0.07)***	0.05 (0.01)***
		R^2: 70%	R^2: 70%	R^2: 87%	R^2: 71%
VABS Daily living skills
– Personal (39 items, range 0-78)	55.36 (21.31); -0.30 to 75.88	0.75 (0.04)***	0.10 (0.03)***		0.07 (0.01)***
– Domestic (21 items, range 0-42)	14.34 (6.98); 0.61 to 25.02
– Community (32 items, range 0-64)	30.55 (13.99); -0.55 to 47.19		0.04 (0.02)**	0.91 (0.07)***
		82%	R^2: 82%	R^2: 73%	R^2: 57%
VABS Socialization
– Interpersonal relationships (28 items, range: 0-56)	42.08 (7.79); 11.21 to 49.01			0.63 (0.35)*	0.10 (0.05)**
– Play and leisure (20 items, range: 0-40)	29.44 (7.14); 1.98 to 36.14		0.14 (0.06)**	0.74 (0.34)**	0.13 (0.05)**
– Coping (18 items, range: 0-36)	26.93 (8.70); 0.72 to 34.75	1.28 (0.19)***	0.10 (0.05)**	0.40 (0.23)*
		R^2: 40%	R^2: 59%	R^2: 78%	R^2:72%
Environmental characteristics	n (%)	Selected predictors of cluster, β (SE); R^2		Selected predictors of cluster, β (SE); R^2
Housing type (non-adjusted/adjusted home)	38/29 (57/43)	−15.25 (3.1)***	−2.22 (0.44)***	−10.82 (3.34)***	−0.90 (0.48)**
Educational type child (regular/special education)	31/36 (46/54)	−16.57 (3.12)***	−2.08 (0.44)***	−9.52 (3.28)***	−1.27 (0.48)**
Parental education (low/high)	34/23 (51/34)
	missing: 10 (15)
Marital status parents (single/living with partner)	6/61 (9/91)
Siblings (0 and 1/2 or more)	12/55 (18/82)
Life Stressors and Resources: mean (SD); min-max
– Relational stress/support (7 items, range 1-4)	1.7 (0.4); 1 to 2.6			−7.78 (3.99)*
– Situational stress/support (13 items, range 1-4)	1.7 (0.4); 1 to 2.8			6.47 (3.53)*
		R^2: 60%	R^2: 58%	R^2: 41%	R^2: 24%
Personal characteristics	n (%)	Selected predictors of cluster, β (SE); R^2		Selected predictors of cluster, β (SE); R^2
Gender (Male/female)	45/22 (67/33)				no significant factors
Ethnicity (Dutch/ other)	62/5 (93/7)
Behavior problems (CBCL): mean (SD); min-max
– Internalizing behavior problem (32 items, range 0-64)	9.4 (7.5); 0 to 34.0
– Externalizing behavior problem (33 items, range 0-66)	8.3 (6.8); 0 to 40.0	−0.70 (0.28)**
	missing: 1
Self-competence (SPPC): mean (SD); min-max
– scholastic competence (6 items, range 1-4)	2.9 (0.7); 1.1 to 4.0
– social acceptance (6 items, range 1-4)	3.0 (0.7); 1.3 to 4.0
– athletic competence (6 items, range 1-4)	2.6 (0.6); 1.1 to 3.6		−0.86 (0.39)**
– physical appearance (6 items, range 1-4)	3.2 (0.7); 1.3 to 4.0	6.79 (4.03)*
– global self-worth (6 items, range 1-4)	3.3 (0.6); 1.4 to 4.0	−10.42 (4.15)**		−1.39 (0.78)*
– motor competence (6 items, range 1-4)	2.8 (0.6); 1.8 to 4.0	6.21 (2.40)**	1.17 (0.39)**	1.64 (0.79)**
	missing: 19	R^2: 27%	R^2:18%	R^2: 12%

* p-value <0.1.

** p-value <0.05.

*** p-value <0.01.

Vine-II: Vineland Adaptive Behavior Scale second edition survey version; Life-H: Assessment of Life Habits 3.1; β: Regression coefficient; SE: standard error; R²: explained variance; CP: cerebral palsy; GMFCS: Gross Motor Function Classification System; MACS: Manual Ability Classification System; SD: standard deviation; ID: intellectual disability; CBCL: Child Behavior Checklist; GMFM: Gross Motor Function Measure; SPPC: Harter’s Social Perception Profile for children; VABS: Vineland Adaptive Behavior Scale.

Table 3. Final prediction models.

	Domestic life						Interpersonal relationships
	Attendance (Vine-II)			Difficulty (Life-H)			Attendance (Vine-II)			Difficulty (Life-H)
Prediction models	β (SE)	St β	p-value	β (SE)	St β	p-value	β (SE)	St β	p-value	β (SE)	St β	p-value
MACS III-V compared to I-II	−8.49 (2.59)	−0.22	0.002	–	–	–	−12.94 (2.45)	−0.40	<0.001	–	–	–
ID	−10.54 (2.23)	−0.28	<0.001	−1.86 (0.38)	−0.36	<0.001	−13.07 (2.52)	−0.41	<0.001	−1.02 (0.41)	−0.24	0.016
Epilepsy	–	–	–	–	–	–	−17.29 (3.73)	−0.33	<0.001	−3.07 (0.54)	−0.45	<0.001
GMFM	0.35 (0.05)	0.56	<0.001	0.05 (0.01)	0.62	<0.001	–	–	–	0.03 (0.01)	0.37	<0.001
R^2	86.5%			78.9%			73.5%			66.6%
Extended models	β (SE)	St β	p-value	β (SE)	St β	p-value	β (SE)	St β	p-value	β (SE)	St β	p-value
MACS III-V compared to I-II	−8.49 (2.59)	−0.22	0.002	–	–	–	−5.86 (1.60)	−0.18	0.001	–	–	–
ID	−10.54 (2.23)	−0.28	<0.001	−1.44 (0.33)	−0.27	<0.001	−5.45 (1.66)	−0.17	0.002	−0.47 (0.34)	−0.11	0.180
Epilepsy	–	–	–	–	–	–	−4.34 (2.53)	−0.08	0.091	−1.58 (0.50)	−0.23	0.002
GMFM -66	0.35 (0.05)	0.56	<0.001	0.03 (0.01)	0.35	<0.001	–	–	–	0.02 (0.01)	0.23	0.005
VABS fine motor skills	–	–	–	0.07 (0.02)	0.32	0.002	–	–	–	–	–	–
VABS receptive communication	–	–	–	0.10 (0.04)	0.17	0.010	–	–	–	–	–	–
VABS expressive communication	–	–	–	–	–	–	0.72 (0.07)	0.68	<0.001	–	–	–
VABS interpersonal relationships	–	–	–	–	–	–	–	–	–	0.13 (0.02)	0.61	<0.001
R^2	86.5%			86.3%			90.0%			78.5%

Vine-II: Vineland Adaptive Behavior Scale second edition survey version; Life-H: Assessment of Life Habits 3.1; β: regression coefficient; St β: standardized regression coefficient; SE: standard error; R²: explained variance; MACS: Manual Ability Classification System; ID: intellectual disability; GMFM-66: Gross Motor Function Measure; VABS: Vineland Adaptive Behavior Scale.