Fall experiences of ambulatory children and adults with cerebral palsy: A qualitative study using thematic content analysis.

To qualitatively assess the causes, adaptations, and psychosocial impact of falls, and solutions for safer environments, as shared by individuals diagnosed with cerebral palsy (CP). Ambulatory adults with CP (n = 165; age median [interquartile range], range: 30 years [25-50], 18-76 years); 101 females, 59 males, five non-binary/not specified) and caregivers of ambulatory children with CP (n = 151; age median [interquartile range], range: 10 years [7-14 years], 5-17 years; 64 females, 83 males, four non-binary/not specified) responded to four open-ended prompts regarding falls. Deductive and inductive thematic content analysis was conducted. Eight themes were identified (psychological, physical, avoidance, adaptation, people, environment, policy, healthcare). Participants elaborated on the causes of falls (aging, physical, mental, environmental, situational), mechanics (most often trips), repercussions (psychological and physical), adaptations, difficulty getting up, and aspirations for themselves and society. Caregivers and adults detailed several adaptations to, or deliberate avoidance of, high-risk situations (e.g. uneven surfaces, crowds). Specific suggestions for environmental accessibility (e.g. more handrails), societal behavioral responses (e.g. give autonomy, be patient), healthcare practice, and policy were made. This study offers deep insights into how individuals with CP navigate the challenges of falls and how people and surroundings both positively and negatively affect their fall-related experiences. Many issues identified were multifactorial, requiring multidimensional, non-ableist solutions. Participants were offered simple, but impactful, actions that could be taken immediately to support the creation of safer physical and psychological environments. More research and clinical practice guidelines are warranted.

The aim of the study was to explore the perceptions of mothers about the effect of cerebral palsy on early attachment behaviours of their children in a rural area of the Eastern Cape province of South Africa. The study explored the mother-child attachment relationship. Semi-structured interviews were used to assess mothers' perception of cerebral palsy and its effect on attachment behaviour of children. The interviews were recorded and then analysed using thematic content analysis. The study identified three recurrent themes that emerged in thematic content analysis. These were factors that facilitated bonding, hindered bonding and maternal response to the needs of the child. The findings of this study showed that children with cerebral palsy were reported to experience early attachment difficulties. The mothers reported that the emotional bond between mothers and children was affected by the severity of cerebral palsy. The results indicated that mothers of children with cerebral palsy needed both psychological and material support in order to strengthen early attachment behaviours of children and mothering practices. Directions for future studies could focus on educational interventions that assist mothers accept cerebral palsy diagnosis and the development of positive attitudes towards cerebral palsy in mothers who live in rural areas in South Africa.

Activate-CP: Let's Ride a Bike! Efficacy of a functional-electrical-stimulation cycling, adapted cycling and goal-directed training program for children with cerebral palsy

To explore the participation experiences of adolescents and young adults with cerebral palsy (CP) in key life situations of young adulthood and investigate the impact of a government-funded, disability insurance scheme on participation and health service access. We conducted a qualitative descriptive study using semi-structured interviews. Sixteen young people with CP (aged 16-30 years; mean age = 24 years 4 months) participated. Interviews were audio-recorded and transcribed verbatim before thematic analysis. An overarching theme of 'branching out into adulthood' was identified. Participants described early adulthood as a time of change, choice, and challenge. The sub-themes were: (1) making sense of my CP as an adult; (2) people's attitudes towards disability and the impacts on me; (3) roadblocks and workarounds; and (4) participation at the time of the COVID-19 pandemic. Participants reported complex views on the new disability insurance scheme. While access to services and support increased, participants experienced significant difficulty negotiating appropriate funding, resulting in frustration and reduced confidence in the scheme. Young people with CP experience complexity as they participate during young adulthood. Alongside exploring how their identity is intertwined with having CP, they face significant barriers to participation when navigating relationships, accessing services, and being involved in the community.

The objective of this paper is to describe two methods of qualitative analysis - thematic analysis and content analysis - and to examine their use in a mental health context. A description of the processes of thematic analysis and content analysis is provided. These processes are then illustrated by conducting two analyses of the same qualitative data. Transcripts of qualitative interviews are analysed using each method to illustrate these processes. The illustration of the processes highlights the different outcomes from the same set of data. Thematic and content analyses are qualitative methods that serve different research purposes. Thematic analysis provides an interpretation of participants' meanings, while content analysis is a direct representation of participants' responses. These methods provide two ways of understanding meanings and experiences and provide important knowledge in a mental health context.

No pain, no gain? Children with cerebral palsy and their experience with physiotherapy.

Little is known about the reasons for suicidal behaviour in Africa, and communities' perception of suicide prevention. A contextualised understanding of these reasons is important in guiding the implementation of potential suicide prevention interventions in specific settings. To understand ideas, experiences and opinions on reasons contributing to suicidal behaviour in the Coast region of Kenya, and provide recommendations for suicide prevention. We conducted a qualitative study with various groups of key informants residing in the Coast region of Kenya, using in-depth interviews. Audio-recorded interviews were transcribed and translated from the local language before thematic inductive content analysis. From the 25 in-depth interviews, we identified four key themes as reasons given for suicidal behaviour: interpersonal and relationship problems, financial and economic difficulties, mental health conditions and religious and cultural influences. These reasons were observed to be interrelated with each other and well-aligned to the suggested recommendations for suicide prevention. We found six key recommendations from our thematic content analysis: (a) increasing access to counselling and social support, (b) improving mental health awareness and skills training, (c) restriction of suicide means, (d) decriminalisation of suicide, (e) economic and education empowerment and (f) encouraging religion and spirituality. The reasons for suicidal behaviour are comparable with high-income countries, but suggested prevention strategies are more contextualised to our setting. A multifaceted approach in preventing suicide in (coastal) Kenya is warranted based on the varied reasons suggested. Community-based interventions will likely improve and increase access to suicide prevention in this study area.

Adults with cerebral palsy (CP) are a growing population, with age-related mobility changes, balance dysfunction, and falls relatively unexplored. This contrasts with other populations with known vulnerabilities such as Parkinson's disease, stroke, or older adults, where falls characteristics have been documented and clinical practice guidelines to address falls and balance dysfunction are readily available. The studies reported in this thesis investigated what is known about falls and mobility dysfunction in ambulant adults with CP. Specifically, investigations of premature age-associated mobility decline, falls and near-falls, physical, psychosocial and health-related quality of life (HRQOL) consequences of mobility decline and falls were conducted. Interventions to address mobility dysfunction, and perceptions of current health services to address falls and mobility decline were also evaluated. The research series commenced with a systematic review exploring mobility decline, revealing it occurs in 25% or more of ambulant adults with CP. Those at higher risk of decline were individuals with worse initial gait ability, bilateral rather than unilateral motor impairment, older age, and higher levels of pain or fatigue. Given that balance and mobility dysfunction are typically associated with falls in other populations, two studies investigated the perceived causes, environmental influences, and consequences of falls or near-falls, and the association of falls with mobility decline. These studies revealed that many adults with CP experience falls during non-hazardous ambulation resulting in physical injuries and adverse psychosocial consequences. In addition, those who experienced mobility decline reported poorer satisfaction with HRQOl than those who had not. Worse physical health status and lower levels of well-being were strongly associated with frequent falls history. The next series of studies explored the performance of ambulant adults with CP using standardised mobility and balance outcomes to describe falls risk, and investigated associations between falls, gross motor performance (Gross Motor Function Classification System- Extended and Revised, GMFCS-E&R) and these measures. Significant differences were found in gait speed, gait endurance and standing balance between those with higher (GMFCS-E&R levels I and II) and lower (level Ill) levels of gross motor function. Significant differences were also found in falls risk indicators between those at higher and lower levels of GMFCS-E&R. However, fear of falling and falls risk did not differ between those who fell and those who did not, suggesting many ambulant adults with CP live with high fear of falling irrespective of actual falls experienced. Furthermore, standardised falls risk assessment tools appeared to have limited capacity to identify prospective falls frequency. A second systematic review synthesised and appraised evidence regarding the effect of conservative (physiotherapeutic and pharmacological) interventions on gait dysfunction in adults with CP. Of the ten studies included in the review, around half were found to provide low strength of evidence. Although a small between-group effect of exercise on gait speed was found, evidence to support the efficacy of one intervention over another to improve gait was limited. A pilot randomised controlled trial was conducted in ambulant adults with CP to evaluate the safety, feasibility and efficacy of an eight week program of individualised balance training on ambulatory self-confidence and balance. Results demonstrated that the customised balance program was feasible and safe. Evidence of small to medium effects from the balance training program in ambulatory self-confidence, postural responses, falls efficacy and fatigue were evident. Concurrent self-reported improvement also occurred. The final study reported outcomes of a qualitative investigation into experiences with health services to address falls and balance dysfunction. Adults with CP reported frustration and variability in the access to and matching of health service provided with self-perceptions of service type and need. In conclusion, many ambulant adults with CP experience falls and mobility decline. The clinical implications of this series of studies are considered, with recommendations for health promotion content, physiotherapy education and clinical research to add to the growing evidence base regarding falls and mobility dysfunction in ambulant adults ageing with CP.

Purpose This paper aims to evaluate the available research to identify the factors contributing to the delays in road construction projects. The primary goals of this study are to determine the critical elements that cause delays in road projects, and to investigate the appropriate corrective actions suggested to lessen the delays in road projects. The study also assesses the theoretical background, methodology, limitations and future research prospects suggested in relevant research works related to causes for delays in road construction. Design/methodology/approach This study adopted systematic literature review in three steps: collecting relevant literature, descriptive analysis and content analysis. This study used keyword analysis and thematic content analysis on some relevant selected studies. NVivo 12 was used for thematic content analysis utilising description-focused coding, the text was thematically analysed, three other software: MS Excel, VOSviewer and Mendeley were also used for analysis in this study. Findings The findings revealed that road projects around the world experienced delays and the reasons for delays are many. After the analysis of literature, number of factors causing delays in road projects were identified, which were then divided into seven broad groups using thematic content analysis. The investigation shows that variations in design and inefficient management of project by contractor including inadequate planning and scheduling are the top two factors of delay. The most frequent suggested corrective measure to reduce delay was employing technically competent employees and contractor should conduct thorough survey on his part, rather than just accepting the survey report at face value. Research limitations/implications This review paper is addressing the issues related to delays in road construction projects and suggests remedial measure to reduce them. The paper will be useful for researchers, industry professionals, academician and policy makers concerned with the road construction projects. The study conducted the review of selected relevant articles related to causes of delay in road construction projects for qualitative analysis. The research articles using quantitative methods and studies conducted on other types of infrastructure projects were not included; however, findings from this study may be applicable to other construction projects as well. Practical implications The findings of this paper are useful in the fields of economy, industry, academia and public policies. The paper thoroughly examined the factors causing delays in highway projects, offering insights for practitioners to identify best practices and mitigation strategies. These findings can guide investment and policy decisions for highway infrastructure projects, promoting a holistic approach to development. Additionally, this paper can help enhance research methods in studies about delays in road infrastructure projects. Originality/value The literature review in the paper used a qualitative method. The causes of road project delays, remedial action, context, methodology and theoretical foundation were all examined in this paper.

Advances in pediatric orthopaedic care have improved mobility and function for children with cerebral palsy (CP) as mobility declines from adolescence into adulthood. The long-term effectiveness of modern orthopaedic care is not widely reported. This study aimed to report the pediatric orthopaedic surgical burden, residual deformities, and outcomes using objective evidence of mobility in ambulatory adults with CP. An institutional review board-approved prospective cohort study was performed in ambulatory adults with CP between 25 and 45 years, who had an adolescent gait analysis. Orthopaedic interventions were reviewed, and adolescent and adult gait analyses were compared using paired 2-tailed t tests. Adults were categorized by the presence of no, mild, or severe residual deformities in rotation, crouch, stiff knee, equinus, and foot deformity. Of 106 adults with CP, Gross Motor Function Classification System (GMFCS) distribution was grade I (22%), II (50%), III (23%), and IV (5%). Sixty-one males and 45 females were tested. The average age was 30±4 years with follow-up of 13±4 years since previous analysis; 279 surgical events (1165 procedures) were performed with a mean per patient of 2.6 events and 11 procedures. Comm on procedures were gastrocsoleus complex (88%) and hamstring lengthening (79%). The mean gait deviation index at adolescent and adult visit were 72.7±13 and 72.3±13 (P=0.78). Mean gait velocity at the adolescent visit was 85±27 and 79±31 cm/s at adult visit (P=0.02). Both gait deviation index and gait velocity change were clinically insignificant. Fifty-seven adults (81 limbs, 54%) had mild residual deformities. Residual hip internal rotation, pes planovalgus, and crouch gait were common. Severe deformities impacting function or causing pain were present in 11 participants (14 limbs, 10%). Seven of the 11 adults with severe deformities were worse compared with their adolescent evaluation; 4 were unchanged. Correcting deformities before adulthood has lasting stability with little functional loss in most ambulatory young adults with CP. Increasing deformity after adolescence can occur in young adults but is uncommon. Level III.

Research has a long tradition of quantitative research which still dominates many university courses on research methods. Qualitative research is a younger phenomenon that was established in research after the second world war. An emerging research field that needed new analysis methods tailored for qualitative data. Two of the most frequently used approaches in qualitative data analysis are content analysis and thematic analysis. In several aspects content analysis and thematic analysis both share a common approach to analytically examine qualitative data, and the fact that they have been used interchangeably has made it difficult for the more unexperienced researchers to distinguish and choose between them. The aim of this study is to examine doctoral students’ perceptions of qualitative analysis with content analysis and thematic analysis. The study had a qualitative approach with data collected from two webinars on qualitative data analysis, where a total of 76 doctoral students participated. Data consists of participant reflections in a Padlet on content analysis and thematic analysis at the two webinars. Webinar participants have given their consent to use their reflections in the Padlet for research. Content analysis with an abductive coding approach was used to analyse the collected data and formulate categories that answer the study’s aim and research question. Results show both perceived similarities and differences between content analysis and thematic analysis. Both are perceived to have a similar process in the coding of data, although content analysis has a wider selection of coding approaches and thematic analysis support deeper immersion. Content analysis is also perceived as more practical and straightforward, while thematic analysis is perceived as more intuitive and faster to learn. Both content analysis and thematic analysis are perceived to have individual opportunities and challenges that make them appropriate for different types of research. Findings presented in this study can be used by researchers at any level to explore similarities and differences between content analysis and thematic analysis, and where to apply them in research.

Socioeconomic status (SES) tends to influence an individual's access to health care. It is commonly assumed that a poorer SES is associated with a weaker physical health status, especially in disadvantaged populations such as people with cerebral palsy (CP). However, to our knowledge, no study has looked at this assumption. Therefore, the aim of this study was to describe and compare the physical health status of ambulant adults with bilateral CP with different SES backgrounds. In addition, the physical health status of the ambulatory adults with CP was compared to well-matched, typically developing adults. Twenty-eight ambulatory adults with CP (gross motor functional classification system Level I/II/III: n = 11/12/5; SES low/middle/high: n = 10/9/9), and 28 matched typically developing adults were recruited for this study. No differences were observed between adults with CP from different SES backgrounds. Differences in physical health status between typically developing adults and ambulatory adults with CP in all SES backgrounds were found in passive range of motion (p < 0.05), muscle strength (p < 0.001), selectivity (p < 0.001), and muscle tone (p < 0.001) and balance (p < 0.05). The main finding of this study is that physical health status did not differ between ambulatory adults with CP from different SES backgrounds. This finding shows that SES does not always directly impact physical health status in ambulatory adults with CP and highlights the importance of an individual approach. Future research should determine the impact of SES on nonambulatory adults with CP.

The aim of this study was to identify, from the perspective of family members, the barriers and facilitators to participation in recreational and leisure activities for preschool-aged children with Cerebral Palsy (CP). This was an exploratory qualitative study involving six family members of children aged 3 to 6 years with spastic quadriplegic CP, ranging from Gross Motor Function Classification System (GMFCS) levels I to IV. Data collection was conducted through semi-structured interviews based on the concepts of the Family of Constructs related to Participation and on the environmental factors described in the International Classification of Functioning, Disability, and Health. Data analysis was performed using thematic content analysis. Four categories were formulated: favorite play activities; child's attendance in activities; child's engagement in activities; and environmental factors influencing participation. School attendance facilitated the diverse offering of activities, regardless of the level of motor function or type of CP. Interest among children with CP and their peer’s promoted engagement through social interaction, motivation, and affection. Assistive technology products, the presence of other children, and support from family members and teachers facilitated participation. Lack of school accessibility and social distancing due to COVID-19 were characterized as barriers to participation. It is concluded that physical, social, and attitudinal environmental factors were shown to influence the participation of children with CP, regardless of motor level or type of CP, acting as facilitators or barriers in recreational and leisure activities, especially in the school environment.

This paper is a review of content analysis or thematic analysis which is further explored though the lens of impressions of doctoral students who attended a presentation on the subject.The long tradition of quantitative research still dominates many university courses on research methodology and data analysis. During the 20th century the field of qualitative research has had a growing need for new analysis methods that accommodate qualitative data and two frequently used methods are content analysis and thematic analysis. They have several things in common and sometimes, they have been understood by researchers to be interchangeably. It has been argued by some researchers that conventional content analysis has really the same functional approach to analysing data as an inductive thematic analysis. This study reports on two webinars on qualitative analysis involving doctoral students and facilitated by the authors. The webinars presented, discussed content analysis and thematic analysis, and gathered participants’ reflections on these methods using a Padlet (padlet.com). The aim of the study was to analyse and describe doctoral students' perceptions of content analysis and thematic analysis. The data collected has been analysed using conventional content analysis applying an abductive coding approach. The study identifies several perceived similarities and differences between the two methods, but also opportunities and challenges for applying them. Findings highlight that the two methods are perceived to be applicable to different types of research. Furthermore, they offer similar challenges to the researcher including their potential for bias and could be considered a choice between an intuitive and a practical approach to analysis. Many of the identified perceptions can be related to previous literature on content analysis and thematic analysis. However, other perceptions seems to indicates a need for more thorough and nuanced discussions on methods for qualitative analysis. The study suggest that more efforts should be made to support doctoral students in attaining a nuanced understanding of qualitative methods for analysis.

There has been limited research published investigating the experiences of the children with a visual impairment in physical activity and sports. The aim of the study was to explore the experiences of children with a visual impairment on their physical self-concept (PSC). A hermeneutic phenomenological approach was employed to investigate the experiences of children with a visual impairment. Qualitative interviews were conducted with six children between 10 and 12 years, followed by a thematic content analysis. Within the framework of the PSC, four themes emerged: (1) adaptations, (2) friends, (3) bullying, and (4) eyes and glasses. Findings suggest that children with a visual impairment despite the occurrence of bullying or lack of adaptations in sports of physical activity are satisfied with their physical self and global self-esteem.