P3A359: Physical Literacy Screening in Pediatric Practice: Identifying Potential Injury Risk and Barriers to Physical Activity

Purpose/Objectives:

Purpose: A recent clinical report by the American Academy of Pediatrics encouraged pediatric providers to identify potential barriers to physical activity, including physical literacy (PL). However, strategies for assessing PL are not widely employed in pediatric care. Our objective was to assess the feasibility of a brief, validated PL assessment in pediatric practice.

Design/Methods:

Design/Methods: Our proposed care algorithm is shown in Figure 1, utilizing the 2-step PL screen (Figure 2) developed and validated by the Healthy Active Living and Obesity Research Group. We performed two sequential plan-do-study-act (PDSA) cycles incorporating screening into office visits for children 8-12 years old. The first PDSA cycle was performed in two pediatric obesity clinics. Incorporating feedback from this cycle, we developed templates for point-of-care support, additional training materials and mitigation strategies. During our second PDSA cycle, six primary care pediatricians (PCPs) performed PL screening during well visits using these tools. Quantitative data collected included: number of eligible patients, number of patients successfully screened, and screening results. Qualitative data collected included: feedback from providers and clinic staff regarding barriers and facilitators to the screening process.

Results:

Results: In pediatric obesity clinics, 80% of eligible patients (n= 50) were successfully screened. Screening results were only available from one clinic with 22% of these patients (n=27) screening as higher risk.
In PCP settings, 50% of eligible patients (n= 135) completed the entire screen, and 24% partially completed the screen, with a high degree of variability of successful screening rates (17-96% of eligible patients) among PCPs. Several PCPs continued to perform the screen beyond the PDSA cycle. Including all PL screens done over this time (n= 217 over 3.5 months), 4% screened as higher risk.
Qualitative results included feedback that providers were unfamiliar with, but interested in learning about, PL and felt it was feasible to incorporate the screen into visits. PCPs desired templated scripting and incorporation into the electronic health record (EHR) and were interested in community-based resources for mitigation. Our PDSA cycles correlated with the onset of the SARS-CoV-2 pandemic and screening through telemedicine and in-person were both feasible.

Conclusion/Discussion:

Discussion: Pediatricians were not familiar with the concept of PL and its role as a determinant of physical activity, suggesting a need for increased awareness. Much of our effort centered on introducing this concept to providers, in addition to providing training and materials to perform the screen. PL screening via telemedicine or in-person visits is feasible, especially with templated scripting incorporated into the EHR and available community-based resources for mitigation. The rate of identifying children who lack PL skills via this screen may be more useful for certain patient populations compared to universal screening. Further study is needed to determine populations at risk for low PL.