All statements were scored on a five-point ordinal scale (‘totally disagree’ to ‘totally agree’) and average domain scores were used for analyses.26 More information about the psychometric validity of the Modulators outcome measures, as well as detailed assessment procedures have been described elsewhere.13 and 18 The assessment procedure was as follows: at home, the parents and children completed the AQuAA, the Multidimensional Fatigue Scale, and the attitude questionnaires. At the hospital body height and weight were measured, and several family characteristics were determined (siblings, parental

marital status, parental educational level and sports frequency of the immediate family). Selective motor control was assessed with the see more modified Trost test, during which the ability of children to dorsiflex the ankle and extend the knee in an isolated movement was scored in four categories: N/A = not able to make the movement, 0 = completely synergistic, 1 = partly synergistic, 2 = no synergy.27 Scores for each joint and leg were added to obtain a total score for

selective motor control. Parents also indicated the sports frequency of immediate family members in five categories (from 1 = never to 5 = daily), from which a mean score was www.selleckchem.com/products/Lapatinib-Ditosylate.html calculated. Children then completed mobility capacity assessments and fitness tests, after which the ca-librated accelerometer was provided to register walking activity for one week. Additionally, children and parents received a diary to record their daily activities and accelerometer registration time. Information on data processing and controlling data quality of the accelerometer has been described elsewhere.18 A priori sample size calculation indicated that 22 children were needed in each group to detect a clinically relevant difference of 1000 strides per day between groups.28 Power was set at 80%, significance level at 5% and the standard deviation of the difference was set at 1175 strides (unpublished pilot data of TCL Dutch children with cerebral palsy). To allow for 10% loss

to follow-up, 25 children were included in each group. To determine the intervention effect, intention-to-treat analyses were performed using linear regression, or logistic regression for dichotomous outcomes (p < 0.05). Outcomes at 4 months, 6 months, and 12 months were the dependent variables, and group allocation and the measured outcome at baseline were the independent variables in the analyses. To correct for performing statistical tests over multiple time points, the critical p-value was divided by the number of tests performed, resulting in an alpha < 0.025 for outcomes measured three times, and an alpha < 0.017 for outcomes measured four times. Variables with non-normally distributed residuals were logarithmically transformed prior to performing linear regression analyses, after which the results were transformed back, providing a between-group change ratio.