Physical ACTivity in Survivorship (PACTS): study protocol for a randomized controlled trial evaluating a goal-directed therapeutic exercise program in pediatric posterior fossa brain tumor survivors

Abstract

Background Posterior fossa brain tumors (PFBT) are the most common solid tumor in children. Recent increases in survival rates are encouraging; however, survivors may experience a plethora of disease- and treatment-related complications that can persist into adulthood. Therapeutic exercise interventions have been shown to improve quality of survivorship in other pediatric cancer diagnoses. There is also evidence that goal-directed interventions are effective at improving motor activities, function, and self-care in children with complex health conditions. Yet, there is currently no evidence on the efficacy of goal-directed therapeutic exercise in pediatric PFBT survivors. The Physical ACTivity in Survivorship (PACTS) study aims to investigate the effects of a novel goal-directed therapeutic exercise program on cardiorespiratory fitness and physical activity-related goal attainment in pediatric survivors of PFBT. Method PFBT survivors, aged five to 17 years, who underwent surgery at least 12 months earlier and completed radiation therapy and/or chemotherapy at least 6 months prior will be recruited from the Queensland Children’s Hospital (Brisbane, Australia) (target n = 48). Following baseline assessment, participants are randomized into either the intervention or usual care group. The intervention group will receive weekly individualized, goal-directed exercise therapy delivered face-to-face for 12 weeks, along with an accompanying home-based program (three sessions per week). Outcomes will be assessed at baseline, immediately post-intervention, and at 6- and 12-months post-intervention. The primary outcomes are cardiorespiratory fitness (Peak VO2) and physical activity-related goal attainment. Secondary outcomes are cardiorespiratory endurance, high-level mobility skills, functional muscle strength, habitual physical activity, gait, balance, quality of life, fatigue, participation, perceived movement skill competence and parameters of body composition. Discussion PACTS is the first study to investigate the efficacy of goal-directed therapeutic exercise in children with PFBT and provide evidence needed to inform clinical practice recommendations for managing quality of survivorship in PFBT survivors. Trial registration ACTRN12619000841178.

Cerebellar mutism syndrome: From pathophysiology to rehabilitation

“…Face-to-face therapeutic sessions targeting: hierarchically graded massed practice; strategy acquisition; cognitive-behavioral therapy Significant improvements in academic achievement, attention, and improved implementation of metacognitive skills Frontiers in Cell and Developmental Biology frontiersin.org implemented rehabilitation strategies, allowing more oriented and more tailored treatments to be administered to the patient, also making rehabilitation possible at the patient's home, with indisputable logistic and psycho-emotional advantages and bringing indisputable advantages also in terms of motivation in the post-operative rehabilitation of the patient with tumor of the posterior cranial fossa (Clemenson and Stark, 2015;Corbetta et al, 2015;Jung et al, 2020;Lino et al, 2021;Sciancalepore et al, 2022). Furthermore, the most recent medical literature reports interesting data on the positive impact on clinical recovery of rehabilitation programs that include aerobic physical motor activity in pediatric neuro-oncological patients (Szulc-Lerch et al, 2018;Kohler et al, 2021).…”

Therapeutic exercise interventions in pediatric survivors of brain cancer and other solid tumors: A scoping review

“…There is evidence supporting the effectiveness of goal-directed interventions to improve motor performance, physical activity and QoL in other pediatric groups (e.g., children with cerebral palsy, muscular dystrophy, or intellectual disability), which may be more conducive to long-term improvements (71-73). There are a small number of published study protocols advocating for the use of goal-directed interventions (74)(75)(76).…”

Goal-directed therapeutic exercise for paediatric posterior fossa brain tumour survivors: a qualitative analysis of experiences

“…This qualitative study was undertaken as part of the PACTS study [14]. To be included in the study, participants were: aged between ve and 17 years; have had a diagnosis of a PFBT; undergone surgery for a PFBT a minimum of 12 months earlier, with no maximum time since surgery providing age eligibility was met; have completed radiation and/or chemotherapy in the previous six months; have no evidence of progressive disease; and, were deemed medically able to complete an exercise program, as determined by the treating oncologist.…”

“…The Physical ACTivity in Survivorship (PACTS) trial is an ongoing single-centre randomised controlled trial (RCT) designed to address the knowledge gap in relation to the effectiveness of goal-directed exercise programs for childhood cancer survivors [14]. The primary aim of PACTS is to evaluate the effects of a 12-week goal-directed therapeutic exercise intervention on physical activity related goal attainment and cardiorespiratory tness in children aged ve to 17 years previously diagnosed with a PFBT.…”