Date of Award

Spring 2020

Document Type

Open Access Dissertation


Physical Education

First Advisor

Ali S. Brian


This dissertation is comprised of a systematic review of the literature and two descriptive analytic studies, for a total of three studies. The overall purpose of this dissertation was to examine the motor competence of youth with pediatric cancers, a visual impairment (VI), and VI sequela of cancer (VISC), and to explore if motor competence and other variables in the physical domain predict overall health-related quality of life (HRQoL).

The purpose of Study 1 systematic review of literature was to explore and describe the motor competence of pediatric cancer patients and survivors in comparison to peers without cancer and to examine the correlates of motor competence for this population.

Methods: A full electronic search was completed on the following databases: MEDLINE, platform EBSCOhost, Web of Science, and Physical Education Index. The last search was completed March 25, 2018. The search limits were set from 2005 to present, language as English, scholarly peer-reviewed journals, and full-text. Inclusion criteria used to screen records were as follows: human participants, pediatric cancer diagnosis, participants between the ages of 1 to 18 years old at the time of cancer diagnosis; measure of gross motor competence; and intervention studies that included baseline motor data. No letters to the editor, reviews, or published abstracts were included. There was a total of 27 studies identified out of 2,180 that were initially screened. Results: The motor competence of pediatric cancer survivors has a tendency to be lower than their peers without a cancer diagnosis. The following correlates of motor competence were identified: level of physical vi activity, body mass index and weight, grip strength, and age. Significant findings in this review were the gaps in the literature that were uncovered and included the following studies: perceived motor competence (n = 0), health-related quality of life (n = 4), and process-product measures (n = 1). To address these gaps in literature, future research should examine the differential effects and relationships on fundamental motor skills with process and product measures, perceived motor competence, and overall HRQoL in pediatric cancer survivors. Limitations: Further examination is necessary to generalize the results through larger sample sizes, valid, and reliable measures. Conclusions: The overall findings indicate low motor competence in pediatric cancer survivors compared to healthy peers and an association with level of physical activity, body mass index, grip strength, and age.

The purpose of Study 2 was to examine group differences between youth with a VI, VISC, and a healthy comparison group regarding HRQoL, motor competence, physical activity, and perceived motor competence. Methods: Participants (N = 45) had a mean age of 12.33 ± 2.65 years. Twenty-seven of the participants were male and 18 were female. There were three groups: VISC (n = 15), VI (n = 15), and a comparison group (n = 15). Each of the participants with a VISC was matched by age, degree of vision, and biological sex to participants in the other two groups. To examine group differences for HRQoL and perceived motor competence, a Kruskal Wallis Test with three groups (VI, VISC, and healthy peers) was used. Descriptive statistics, four (VI classifications) by three group (VISC, VI, and healthy peers) ANCOVAs, and Kruskal Wallis Tests with three groups were calculated to explore the mean differences. Results: The ANCOVAs revealed a significant difference between groups for TGMD-3 total scores (F = 10.62, p < .001, hp2 = vii .34), product total combined z-scores (F = 14.51, p > .001, hp2 = .41), and physical activity (F = 11.03, p < .001, hp2 = .35). However, the Kruskal Wallis test revealed that the groups were not statistically different in HRQoL (H = 2.10, p > .05) or perceived motor competence (H = 4.44, p > .05). Limitations: The limitations of this study include a small sample size, a purposive convenience sample, possible testing site impact and potential biased responses due to the nature of self-reporting. Conclusions: The motor competence of youth with a VI and VISC have a tendency to be lower than their peers without a VI or VISC. Although, the motor competence of youth with VIs and a VISC were not significantly different from one another, future research should examine these differences further with a larger sample and examine the potential differences based on age at onset of VI.

The purpose of Study 3 was to examine the underlying mechanisms predicting physical activity and HRQoL for youth with a VI or VISC. Methods: For this study there were a total number of participants (N = 30) with a mean age of 12.33 ± 2.64 years and biological sex (male = 18, female = 12). Of the 30 participants there were two groups, VISC (n = 15) and VI (n = 15). Each of the participants with a VISC was matched by age, degree of vision, and biological sex. To examine the underlying mechanisms of physical activity and HRQoL descriptive statistics, Pearson’s correlations, and two separate multilevel hierarchical regressions were used. Results: Physical activity was positively associated with product motor competence (r = .71, p < .001), TGMD-3 (r = .60, p < .001), HRQoL (r = .42, p = .020) and participants’ degree of vision (r = .58, p < .001). HRQoL (PedsQLTM) was positively associated with TGMD-3 (r = .37, p = .047), product motor competence (r = .53, p = .003), perceived motor competence (r = .42, p = .020), physical viii activity (r = .42, p = .020), biological sex (r = -.37, p = .043), and a co-morbidity (r = -.42, p = .022). Degree of vision, perceived motor competence, and motor competence accounted for 61 percent of the variance explained (R2 = .61, p = .005) in participants’ average step count scores, with motor competence accounting for 21 percent of the variance explained. A total of 51 percent of variance in participants’ total HRQoL scores was explained by the presence of a co-morbidity, biological sex, perceived motor competence and motor competence, with motor competence adding an additional 16 percent of the variance explained (R2 D = .16, p = .035). However, physical activity did not significantly contribute to the variance explained in HRQoL. Limitations: The limitations of this study consisted of a small sample size, a purposive convenience sample, and possible testing site impact. Conclusions: The findings of this study indicate that the physical domain has a strong relationship with overall HRQoL for youth with a VI or VISC. Specifically, motor competence was the strongest predictor for both physical activity and HRQoL beyond participant characteristics.

The potential implications of this dissertation include the importance of motor competence in predicting youth’s overall levels of physical activity and perceived HRQoL, which hold the possibility of having a large impact on health outcomes for youth with a VI and VISC. Based on the importance of motor competence, physical education has the potential to play an integral role in supporting the improvement and development of motor competence for youth with a VI or VISC.