A Multifactorial Model of Physical Literacy for Clinical Practice

Thesis Abstract

This study addresses the fragmented approach to physical literacy in clinical contexts, where assessments often emphasize motor competence or physical activity alone, neglecting the integrated interplay of cognitive, motivational, psychosocial, and functional factors critical for patient-centered rehabilitation and health promotion. The aim is to develop and validate a multifactorial model of physical literacy (MFPL) tailored for clinical practice that integrates motor, cognitive, affective, and social dimensions to guide assessment, goal setting, and intervention planning. Specific objectives are (1) to conceptualize the MFPL framework grounded in contemporary physical literacy theory and the Self-Determination Theory (SDT) to capture autonomy, competence, relatedness, and motivation; (2) to operationalize a clinically feasible measurement battery combining the Canadian Assessment of Physical Literacy (CAPL) subdomains with validated psychosocial scales and functional performance tests; (3) to examine the predictive validity of MFPL scores for rehabilitation outcomes (e.g., return-to-activity timelines, patient-reported outcome measures) using a longitudinal design; (4) to explore clinicians’ and patients’ perceptions of MFPL utility through qualitative interviews to assess barriers and enablers to implementation; and (5) to propose a standardized clinical protocol for incorporating MFPL into routine practice. The study employs a mixed-methods design conducted in three phases over 24 months. Phase I involves instrument development and expert validation with a panel of 12 clinicians (physiotherapists, occupational therapists, sport medicine physicians) and 8 physical education researchers to establish content validity (Content Validity Index > 0.78) and refine the MFPL battery. Phase II comprises a prospective cohort study of 320 patients undergoing rehabilitation for musculoskeletal and cardiopulmonary conditions across five urban clinics. Data collection includes motor competence via the Movement Assessment Battery for Children–2 adapted for adults, cognitive processing via the Trail Making Test, functional mobility via the Timed Up and Go, cardiorespiratory fitness via submaximal ergometry, psychosocial factors via the Intrinsic Motivation Inventory and the Exercise Self-Efficacy Scale, and patient-reported outcomes via the SF-12 and condition-specific measures. Data analysis utilizes structural equation modeling (SEM) to test the MFPL structure, multilevel growth models to assess trajectory of rehabilitation outcomes, and hierarchical multiple regression to determine incremental validity beyond existing clinical measures. Phase III uses semi-structured interviews with 20 clinicians and 20 patients to perform thematic analysis, triangulating with quantitative findings to identify practical implications and implementation barriers. Expected findings indicate that MFPL comprises four interrelated domains—Motor-Competence, Cognitive-Strategic Skills, Affective-Motivational Resources, and Social-Functional Context—each contributing uniquely to rehabilitation progress and sustained activity engagement. SEM is expected to demonstrate a robust higher-order MFPL factor accounting for a substantial portion of variance in rehabilitation outcomes (anticipated CFI > 0.95, RMSEA < 0.06). It is anticipated that MFPL will exhibit incremental predictive validity over traditional motor-focused measures, with higher MFPL scores associated with shorter return-to-activity times, greater adherence to home programs, and improved health-related quality of life at 6- and 12-month follow-ups. Qualitative analyses are projected to reveal practical facilitators (integrated assessment workflows, time-efficient tools, clinician training) and barriers (resource constraints, resistance to practice change), informing a feasible clinical protocol. The study contributes to knowledge by operationalizing physical literacy within a clinical paradigm, integrating theory (Self-Determination Theory) with empirical measurement to produce an evidence-based, multidimensional assessment framework that informs individualized rehabilitation planning. It advances psychometric validation of an MFPL battery suitable for routine clinical use and offers a standardized protocol for implementation, including scoring procedures, interpretation guidelines, and decision rules linking MFPL profiles to intervention pathways. The findings will support policy and practice by providing a comprehensive framework to optimize patient engagement, functional recovery, and long-term health behaviors, as well as guiding future research on intervention efficacy targeting multiple domains of physical literacy. Recommendations include adoption of MFPL in clinical guidelines, training curricula for clinicians, and longitudinal studies assessing MFPL’s impact across diverse patient populations and settings.