Involvement In Life Situations Research Articles

Does exercise affect quality of life and participation of adolescents and adults with cerebral palsy: a systematic review

PurposeInvestigate the effect of exercise for adults with cerebral palsy (CP) on quality of life, participation (attendance and involvement in life situations), functional mobility, pain, fatigue, mood, and self-efficacy.MethodsA systematic review was completed. Twelve databases were searched from inception to August 2022 for studies including participants (≥16 years) with cerebral palsy, and that evaluated an exercise intervention. Two reviewers independently assessed eligibility, risk of bias, and extracted data.ResultsSeventeen studies (total n = 532) were included: 12 randomised control trials, four non-randomised trials, and one single case experimental design. Interventions studied were predominantly strength, aerobic or treadmill training, dance, and swimming. No study assessed participation, pain or mood. Of two studies that assessed quality of life, one reported a positive effect on an aspect of mental health immediately after the programme finished. All studies assessed functional mobility, but only one reported a positive effect. One study assessed self-efficacy and found no effect, and another assessed fatigue and reported conflicting results.ConclusionsThe effect of exercise for adults with CP, on outcomes that adults report as important to them – quality of life, participation, pain, mood, and fatigue – are unknown.IMPLICATIONS FOR REHABILITATIONTo address outcomes important to adults with cerebral palsy (CP), it is important to understand how exercise affects participation and quality of life.All modes of exercise reviewed appear safe for adults with CP and choice should be based on the client’s preferences, access to services, and convenience.Addressing any needed accommodations in the environment and context is likely more important than exercise prescription parameters when tailoring exercise to meet the needs of adults with CP and sustain participation.

Sensory Processing and Occupational Participation

ABSTRACT Children with atypical sensory integration have difficulty responding to the processing and/or organization of sensory information, this disability affects functional participation in routines and activities of daily living. Participation is defined as involvement in life situations, it is essential to promote life experiences and the development of sensorimotor, cognitive, and social skills. Improving these skills, in turn, allows children to fully participate in age-appropriate activities and occupations. This study aimed to investigate the putative association between sensory processing and occupational participation in children with neurotypical development. Parents or caregivers of 186 children, aged between 6 and 10 years old, completed the Sensory Profile Caregiver Questionnaires (SPCQ) and the Participation in Childhood Occupations Questionnaire (PICO-Q). Surprisingly, 80 children (43%) presented atypical sensory integration. This sub-group presented several associations between the SPCQ and the areas evaluated by PICO-Q, suggesting an association between sensory processing and occupational participation. We suggest that it is important to carry out screenings for sensory integration in preschool children, to promote better occupational participation in school-aged children.

Participation importance and satisfaction across the lifespan: A traumatic brain injury model systems study.

In rehabilitation research and practice, participation is defined as involvement in life situations and most often measured as frequency of engaging in these life situations. This narrow measurement approach overlooks that individuals perceive importance of and satisfaction with participation in activities in various life areas differently. The purpose of this study was to determine differences in meaningful participation (perceived importance and satisfaction) after moderate to severe traumatic brain injury (TBI) across age groups and to identify predictors of participation satisfaction. Secondary data analysis of a TBI Model Systems substudy, including the Participation Assessment with Recombined Tools-Subjective (PART-S) that rates participation importance and satisfaction in 11 life areas that we grouped into three domains (i.e., productivity, social relations, out-and-about). We identified differences across age groups (i.e., 16 to 24 years, 25 to 44 years, 45 to 64 years, and 65 + years) and predictors of participation satisfaction. Participation satisfaction in and importance of the 11 life areas varied across age groups. In all age groups, participants rated relationships as being of medium or high importance more often than other life areas. Older adults reported the highest participation satisfaction across life areas, despite having the lowest participation frequency. Consistent predictors of participation satisfaction were cognitive functioning and frequency of participation in the domain examined. Participation importance, satisfaction, and frequency are related, yet distinct, dimensions of participation that should all be measured to adequately evaluate meaningful participation. Future research should explore interventions across the lifespan that target modifiable predictors, like functional cognition and access to frequent participation in important life activities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Participation Assessment Scales for 4 to 18-Year-Old Individuals With Cerebral Palsy: A Systematic Review

Objectives: Participation is defined as involvement in life situations and the ultimate outcome for individuals with disabilities. One of the most common causes of chronic disabilities that restrict individuals’ participation is cerebral palsy (CP). The main goal of rehabilitation is to empower clients’ participation in various life areas. To affect participation, assessing the outcomes in individuals with different health conditions is necessary. Accordingly, this study aims to overview the psychometric properties of participation assessment scales for 4 to 18-year-old individuals with CP. Methods: A systematic review using PRISMA guidelines was completed. The searched keywords included the following items: participation, cerebral palsy, ADL, IADL, education, play, leisure, social participation, rest/sleep, work, leisure, scale, assessment tools, activity, meaningful activity, purposeful activity, function, performance, creational activity, physical activity participation, recreational activity, self-care, mobility, and functional mobility. The inclusion criterion for articles was being published in a peer review journal from 2000 to 2020. Results: After examining the title, abstract, and full text, 22 articles were eligible to be included. Among 1482 studies, a total of 22 studies assessing the participation of children with CP in meaningful activities were included in this review. Discussion: The psychometric properties of 8 outcome measures for 4 to 18-year-old individuals with CP were available and 5 assessment scales have the potential to be used for this population; however, the psychometric properties of these scales were unavailable.

The Contribution of Frailty to Participation of Older Adults.

Background: Participation, which is involvement in life situations, is an important indicator of human health and well-being of older adults. Frailty is known to be related to difficulties in activities of daily living (ADL) but the association with participation restriction has not been sufficiently researched. Therefore, we aimed to (1) to assess the correlations between frailty, ADL, and participation; and (2) to identify the contribution of frailty to explaining the participation restriction of older adults. Methods: A cross-sectional study included home visits to community-dwelling older adults aged 75 and older. The Reintegration to Normal Living Index (RNL-I) assessed participation, PRISMA-7 assessed frailty, and the Functional Independence Measure and IADL questionnaire assessed the basic and instrumental ADL. Cognition, which may explain participation, was also assessed (The Montreal Cognitive Assessment) and demographic information was collected. Results: Older adults (N = 121, 60 women), aged 75 to 91 years (mean (SD)—79.6 (3.1)), were included. Older adults demonstrated full to restricted participation (RNL-I-mean (SD)—78.2 (18.0)/100). Frailty was identified in 39 (32%) older adults (mean (SD) PRISMA-7—2.9 (1.4)/7points). A negative moderate significant correlation was found between participation and frailty (r = −0.634, p < 0.001). The variance of participation was significantly explained by frailty, 31.5%, and basic ADL, 5.6% (after controlling for age and cognition); the total model explained 44.6% (F = 23.29, p < 0.001). Conclusions: Frailty is significantly associated with participation restriction. Since participation has many health benefits, understanding which factors are associated to participation is central to developing interventions for older adults. These findings may help health professionals in the future develop interventions for maintaining and promoting the participation of older adults.

The Importance of Collaboration in Pediatric Rehabilitation for the Construction of Participation: The Views of Parents and Professionals

Purpose: Collaboration between parents and professionals is essential to enable participation of children with disabilities. Participation is a widely researched topic in pediatric rehabilitation, and evidence for it providing opportunities for involvement and a sense of belonging in community and in larger society exists. There are, however, less research results on how collaboration builds participation pertaining to involvement in life situations. In collaboration with parents, therapists and teachers, the aim of the study was to describe factors that (a) promote and (b) prevent participation in life situations for school-aged children with disabilities, working towards participation in adulthood. Methods: The study applied a qualitative research design. The data was collected during the 2015–2016 academic year with five focus-group interviews by sampling procedure. The study involved five parents of children with disabilities, three therapists and two teachers. The research data was analyzed by inductive content analysis. Results: The results identified thirteen factors that promote child participation, with an emphasis on taking the child’s individuality into account. There were three barriers, which focused on attitudes or technical issues. Conclusions: The results suggest that collaboration on child-related factors has been well identified and implemented, but collaboration on enabling environmental factors needs to be developed. The results can be utilized to design what adults’ collaboration should focus on in promoting child participation.

Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT

Background It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified. Objectives The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations). Design Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales. Setting The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales. Participants Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services. Data sources Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified. Intervention Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks. Results A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains. Conclusions We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation. Future work Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation. Trial registration Current Controlled Trials ISRCTN38920246. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.

A Qualitative Photo Elicitation Research Study to elicit the perception of young children with Developmental Disabilities such as ADHD and/or DCD and/or ASD on their participation.

Participation, defined as 'involvement in life situations' according to the World Health Organisation, is a well-recognized concept and critical indicator of quality of life. In addition it has become an important outcome measure in child rehabilitation. However, little is known about the level of participation of young children with Developmental Disabilities. The aim of this study was to capture their subjective experiences of participation. An adapted informed consent based on a comic strip was used to get the children's assent. A Photo Elicitation study was used, in which photographs were taken by the children when they were involved in meaningful activities. The photographs were then used to facilitate communication with the children and to initiate in depth-interviews. Forty-seven interviews with 16 children between five and nine years were conducted based on their photographs. This method generated rich data, confirming that young children with Developmental Disabilities were able to inform us accurately on their experiences of participation. Data was analysed by means of an inductive thematic analysis. Results showed that children perceived their participation as satisfying when they can play, learn and join in family gatherings resulting in feelings of inclusion, recognition and belonging. When there are-on occasions-moments that their participation was obstructed, the children used two strategies to resolve it. Or they walked away from it and choose not to participate, or when autonomously motivated for the activity, they relied primarily on their context (i.e. mothers) as enabling their participation. Related to the data, children discussed themes related to their person, activities, connections and mediators between those themes. These themes fit well within earlier and current research on the subject of participation.

Neuropsychological Disability: A Hidden Epidemic of Neurological Conditions.

Many neurological conditions may result in long-term disability. The measures of prevalence and mortality vastly understate the disability they cause. In the Persons with Disabilities Act 1995 (equal opportunities, protection of rights, and full participation), neurological conditions are ignored. Although Indian Disability Evaluation and Asessment Scale (IDEAS), which assesses psychiatric conditions, does include dementia as one of the neurodegenerative conditions. Additionally, according to the global burden of disease report, 33% of years lived with neurological disability and 13% of disability-adjusted life years (DALYs) are due to neurological and psychiatric disorders. In 2001, the World Health Organization (WHO) established a new definition of disability, declaring it an umbrella term with the following three major components; 1) impairments: problems in body function or structure, 2) activity limitations: difficulties encountered by a person in executing a task or action, and 3) participation restrictions: problems of involvement in life situations experienced by a person. Hence, an attempt was made to rectify the above concerns. To address the above mentioned concerns, we think that there is a need of a comprehensive format for neurological disabilities assessment which would also include objective neuropsychological assessments. As future directions, national level meetings are required to formulate 'Indian Standard Track for Assessing Neurological Disability' (I-STAND) and uniform guidelines for disability assessment in 'chronic neurological conditions' with a special focus on "neuropsychological disability".

The Entanglements of Affect and Participation.

The purpose of the article is to elaborate on the scholarly debate on affect. We consider the site of affect to be the activities of embodied, socioculturally and spatially situated participants: “Affective activity is a form of social practice” (Wetherell, 2015, p. 147). By studying affect as a social phenomenon, we treat affect as a social ontology. Social practices are constituted through participation in social interaction, which makes it possible to study affect empirically. Moreover, we suggest that to consider affect a social ontology connects affect to agency. We regard affect as a participants’ phenomenon where emotions and knowledge are not separated, i.e., as a social epistemology. To capture the complexity of affective activity, the study of situated participation requires video data. We collected data at a center for persons with acquired brain injury (ABI), which highlights research ethics. The International Classification of Functioning, Disability and Health (ICF) framework defines participation as involvement in life situations. ICF focuses on two broader perspectives: the body and the individual in society. We turn ICF’s abstract societal perspective on participation to meaningful local accomplishments in lived social practices. Our focus is, in line with a critical social ontology in disability studies, on how-ability, the communicative abilities of the residents (Hughes, 2007). To get closer to life situations as they unfold, we analyze participation in its details as embodied actions during activities in the material environment of the center. To conclude, we demonstrate a resident’s competent participation in an occupational therapy session through a fine-grained analysis of affective activity. Interaction, practices, and phenomena are complex theoretical and practical issues. In the analysis of the encounters as complex multimodal and -sensorial situations, we use an extended version of ethnomethodological conversation analysis (EMCA) that incorporates the body and material environment with the interconnectedness of interactional episodes. To do this, we enlarge the scope of analysis from the complexity of local occasions of affective activity to connections between consecutive affective entanglements. In the indicated work we draw on theoretical (lamination) and methodological (nexus analysis) suggestions in order to best pursue the sociocultural nature of situated interactions.

Psychometric properties of Children Participation Assessment Scale -Parent Version (CPAS-P) in Iranian children with autistic spectrum disorder

Background and Objective: Children with Autism spectrum Disorder (ASD) are limited in participation in everyday activities due to nature of their disorder. Participation means involvement in life situations. The aim of this study was to evaluate psychometric properties of the Children Participation Assessment Scale-Parent Version (CPAS-P) in activities outside of school in Iranian children with ASD. Material and Methods: The sample consisted of 55 parents of 6-12 years old children with ASD who selected with convenience sampling. For assessing convergent validity of CPAS-P and Vinland Adaptive Behavior Scale (VABS), spearman's correlation coefficient test was used. The internal consistency and test-retest reliability were determined by using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Results: The mean age of children was 7.62 years. Cronbach's alpha was obtained 0.91 to 0.94, which indicates proper internal consistency and ICC was 0.90 to 0.95, which indicates acceptable test-retest reliability. Finally, significant correlations were reported between CPAS-P and VABS tests in related subscales. Conclusion: Increasing independence in doing daily activities of children with ASD is a concern for rehabilitation professions such as occupational therapists. Valid and reliable instruments are necessary for documenting treatment that should culturally adapted among Iranian children. According to result of this study, CPAS-P has good psychometric properties for clinical practice and research.

A study of measuring participation according to the International Classification of Functioning, Disability and Health with the Revised Role Checklist

Objective: To empirically test the hypothesis that the 10 roles on the Revised Role Checklist are represented in the International Classification of Functioning, Disability and Health participation areas. Design: Cross-sectional survey. Subjects: Investigators from Japan, Norway, Sweden, Switzerland, the United Kingdom and the United States recruited a total of 295 adults from the general population. There were 103 (34.9%) male and 191 (64.7%) female participants with one participant not indicating gender. The age distribution of participants was from <25 (n = 68) to 75+ with a mode of 25–34 years. Main measure: The Revised Role Checklist Part 1 was used to assess perceived incumbency in 10 roles. In addition, subjects were asked to provide role examples. Results: Of the 7087 examples provided by participants, 6578 (92.8%) fit the original hypothesis that the roles in the Revised Role Checklist were covered in participation areas. Fit was determined when the role example was either named in the associated International Classification of Functioning, Disability and Health participation area or when the criteria of: “does this example conceivably fit in the respective area as ‘a person’s involvement in life situations’ fit relative to each role.” Slight modification of the scope of three roles of the original hypothesis resulted in a 97.6% match. Conclusion: The roles in the Revised Role Checklist are well represented in the International Classification of Functioning, Disability and Health categories of participation.

Tracking Changes in Participation With Participation Measurement Scale in Community-Dwelling Stroke Survivors in Africa

ObjectiveTo investigate responsiveness of the Participation Measurement Scale (PM-Scale) for the measurement of participation of stroke survivors. DesignA 6-month observational study with 3 evaluation time points. Responsiveness of the PM-Scale was investigated over a period of 6 months. SettingRehabilitation centers. ParticipantsStroke survivors (N =64); mean age ± SD, 56.9±12.6 years; sex, 45 men (70%). InterventionsNot applicable. Main Outcome MeasuresParticipants were evaluated using the PM-Scale. The modified Rankin Scale was used to categorize the overall disability level for each participant. ResultsThe mixed-effect model analysis showed a significant difference in the participation over time (χ2=35.04; df=2; P<.001). In addition, the model exhibited significant effects of the sex, age, and disability at enrollment on the subjects’ participation levels. Furthermore, the PM-Scale detected different levels of changes in the entire cohort over time (small change, effect size [ES]=0.33; moderate change, ES=0.67; and large change, ES=1). The PM-Scale also facilitated the classification of the participants into discriminative categories such as important improvement (t score≥1.96; 1.8≤ES≤2.13), moderate improvement (0<t score<1.96; 0.56≤ES≤0.78), no change (t score=0), moderate decrease (−1.96<t score<0; ES=0.67), and important decrease (t score≤−1.96; ES=1.47). ConclusionsThe PM-Scale exhibited good responsiveness and accurately detected changes in stroke subjects’ involvement in life situations. These results validate the usefulness of the PM-Scale for clinical trials and in settings to evaluate the effects of interventions on subjects with stroke in Africa.

Differences between Pre-School Children with and without Special Educational Needs Functioning, Participation, and Environmental Barriers at Home and in Community Settings: An International Classification of Functioning, Disability, and Health for Children and Youth Approach

The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY; WHO, 2007) provides a framework for child functioning with an emphasis on child participation. Participation is defined as “involvement in life situations” and can be influenced by both child characteristics (health conditions, body functions and structures) and by contextual factors (facilitators or barriers of the physical or social environment) (WHO, 2007). This study aimed at characterizing functioning of pre-school aged children, based on their frequency of participation in home and community activities and on the perception of environmental barriers to their participation by parents, using an ICF-CY approach. Differences between children with Special Educational Needs (SEN) (n = 42) and children without SEN (n = 74) were analyzed. Parents of 116 children from Porto District (Portugal) completed an adapted version of the Young Children's Participation and Environment Measure (YC-PEM; Khetani et al., 2013a). To assess child functioning, pre-school teachers completed 6 items of the Matrix for Assessment of Activities and Participation (MAAP; Castro & Pinto, 2015), corresponding to 6 code sets of the ICF-CY Developmental Code Sets (Ellingsen & Simmeonsson, 2011). Children with SEN showed lower levels of functioning when compared to children without SEN, according to their pre-school teachers. Parents of children with SEN reported that their children participated less frequently in home activities. Specifically, significant differences were found in household chores, at home. Parents of children with SEN perceived more environmental factors as barriers in both settings when compared to parents of children without SEN. Differences between groups in specific environmental factors are presented with reference to the YC-PEM environmental content linked to the ICF-CY environmental domains (Khetani, 2015). Findings highlight the importance of identifying and adjusting environmental barriers, through family centered practices, to promote child participation and overall functioning. The adoption of the ICF-CY (WHO, 2007) is recommended when implementing and monitoring inclusive services and practices. Results are further analyzed and discussed with reference to the biopsychosocial model of the ICF-CY (WHO, 2007)

The Rediscovery of the Social Side of Medicine: Philosophy and Value of the International Classification of Functioning, Disability and Health (ICF)

Medicine is at a risk to slide into a sole repair service for the malfunction of organs. But the patients’ hopes and confidence toward doctors practicing this repair work go far beyond that: after acute medical treatment, many patients suffer from chronic impairments due to the natural course of disease or as a result of medical interventions. Despite the resulting handicaps, patients aim toward participating in family and social life, retaining a workplace, and receiving support to remain a valued member of family and community. Doctors should therefore not only concentrate on the natural science and technological part of medicine but also consider the background of their patients and their involvement in life situations, including environmental and personal factors, as these may influence functioning and disability as facilitators or barriers. Health insurances must organize, finance, and control the achievements of the post-acute treatment process with the goal of participation. Public health must combine and assess individual views to prepare reasonable population-based social, economic, and political decisions. The philosophy and structure of the International Classification of Functioning, Disability and Health (ICF) is supporting this attitude of medicine to complement the International Classification of Diseases (ICD) as a basis for health reports.

Abstract TP171: Differences Between Men and Women in Long-term Participation Restriction After Stroke: The International Stroke Outcomes Study (INSTRUCT)

Introduction: As women suffer worse functional outcomes of stroke than men, they may also face more challenges with community reintegration but data are scarce. We examined sex differences in participation after stroke and which factors might account for these disparities. Methods: INSTRUCT is an individual participant data pooling study of incident strokes obtained from 13 population-based cohorts worldwide. Two of the cohorts (Melbourne ’96-‘99 and Auckland ’02-‘03) included assessment of participation at 5 years after stroke using the London Handicap Scale (LHS). The LHS is used to assess the individual’s perspective of their involvement in life situations including orientation (person’s awareness of surroundings), physical independence, mobility, occupation, social interaction and economic self-efficiency. The total score ranges from 0 (worst disadvantage) to 100 (no disadvantage). Linear regression was used to compare LHS total scores and sub-domains for women compared to men. Study-specific multivariable models incorporated adjustment for socio-demographics, stroke-related factors, pre-stroke health and post-stroke factors were combined using random-effects meta-analysis. Results: At 5 years after stroke, there were data on participation for 351/592 (59%) of survivors in Melbourne and 266/881 (30%) of survivors in Auckland. Women suffered greater participation restriction than men (total LHS, pooled mean difference, MD -5.55 [95% CI -8.47, -2.63]). The magnitude of the difference attenuated after adjusting for covariates (pooled MD -2.48 [-4.99, 0.03]). Significant confounders in study-specific models included age, stroke severity, pre-stroke dependency and pre-stroke dementia for Melbourne; and age, stroke severity and pre-stroke dependency for Auckland. In sub-dimensions, women had greater restriction than men in mobility, physical independence and occupation. Additionally, women in Melbourne experienced poorer social integration and orientation than men. Conclusion: Greater restriction in participation after stroke among women than men was mostly attributable to their advanced age and greater pre-stroke dependency. Interventions targeting participation could reduce the impact of stroke in women.

Client Perspectives on Reclaiming Participation After a Traumatic Spinal Cord Injury in South Africa.

The development of rehabilitation services promoting participation in people living with a traumatic spinal cord injury (TSCI) is of major concern for physical therapists. What the client sees as effective participation, barriers, and facilitators might be different due to their particular context. This study was conducted to gain insight into the experiences of attaining an important outcome in a developing context. The aim of this study was to explore the experiences of reclaiming participation in community-dwelling people with TSCI in South Africa. This was an explorative, qualitative study with inductive content analysis. Individual semistructured interviews were conducted with 17 adults living with a TSCI in order to explore their experience of participation. The verbatim transcripts were analyzed, and the end result was an overall theme that included 4 emerging categories. The theme "participation possibility" denotes the eventual involvement in life situations. Within this theme, there were 4 categories that emerged as a representation of essential aspects along the continuum of reclaiming participation: (1) dealing with the new self, (2) a journey dominated by obstacles, (3) the catalyst of participation, and (4) becoming an agent. Dealing with and recognizing these intervening conditions seem critical for clients to reconstruct the meaning that is necessary for a broader conception of participation. The transferability of these findings to dissimilar contexts may be limited. Client perspectives on reclaiming participation after injury affirm the notion of eventual participation, with each person finding strategies to succeed. In order to help clients reclaim participation, health professionals should develop contextually sensitive programs that include peer mentoring and reduce the influence of hindering factors.

Impact of social support on participation after stroke in Nigeria

Background: Participation which entails involvement in life situations and represents a higher level of functioning can be severely restricted after a stroke. This study investigated the impact of social support on participation of stroke survivors in Nigeria.Methods: Ninety-six community-residing stroke survivors were recruited from physiotherapy outpatient departments of two tertiary care hospitals in Northern Nigeria. Socio-demographic, clinical, participation (London Handicap Scale), and social support (Multidimensional Scale of Perceived Social Support) data were obtained. The impact of social support on global and domain-specific participation was examined using bivariate analyses and multiple regression analyses.Results: Mean (SD) age of the stroke survivors was 56.6 (12.0) years. Social support was a significant (β = 0.41, p < 0.0001) and independent determinant of the economic self-sufficiency domain of participation (p < 0.0001) in a regression model that accounted for 27% of the variance in the domain (R2 = 0.27). Social support, however, had no independent effect on overall participation and the other participation domains namely mobility, physical independence, occupation, social integration, and orientation.Conclusion: The impact of social support was significant only in the economic self-sufficiency domain of participation with higher availability of social support related to better economic self-sufficiency. This finding provides additional information on the importance of social support post-stroke.

Improving health in children with disabilities: an intervention-development study to support participation in leisure in 8-12 year olds with communication and mobility limitations

Participation (i.e. involvement in life situations, such as leisure, education and self-care) is a fundamental health outcome for all children. Children with communication and mobility limitations experience restrictions to their participation in leisure, and the gap widens at age 8-12 years. These restrictions have negative consequences for their development and longer-term health and wellbeing. Evidence indicates that personal factors (e.g. child's motivation) and social-environmental factors (e.g. family behaviours) determine participation in leisure; however these pathways have rarely been systematically investigated and targeted in intervention-development research. The proposed study will address three questions: What modifiable personal and social-environmental factors influence participation in leisure in 8-12 years with communication and mobility limitations? What intervention techniques should National Health Service (NHS) clinicians use to target these factors? And, how should clinicians go about delivering these techniques? The methods will consist of two systematic reviews of current evidence; a Delphi study involving parents, clinicians and researchers; focus groups with parents, clinicians and children; and three mixed methods (QUANT+qual) single case studies. The primary output will be an intervention manual containing: (i) clearly specified, replicable intervention techniques for targeting modifiable personal and social environmental factors related to children's participation in leisure; and (ii) clear descriptions of feasible and acceptable approaches to delivering the techniques in NHS settings. The manual will enable NHS clinicians to provide evidence-based participation support, and will be a basis for further evaluation of participation interventions techniques. The secondary output will be a design for a feasibility trial of selected intervention techniques.

The Associations Between Executive Functions’ Capacities, Performance Process Skills, and Dimensions of Participation in Activities of Daily Life Among Children of Elementary School Age

Effective executive functions (EFs) are crucial for efficient daily functioning. Daily functioning or involvement in life situations is defined as “participation” (International Classification of Functioning, Disability, and Health [ICF]; World Health Organization, 2001). Yet associations between them have been inadequately studied for children. The present study aimed to explore the associations between EFs and child participation. Participants were 60 typically developing children aged 6 to 9 years old and their parents. The children were individually evaluated using five EF cognitive tests. The parents completed three questionnaires: the Children Participation Questionnaire, the Process Skills (the observed executive performance) Questionnaire, and the Environmental Restrictions Questionnaire. Most of the EF scores were associated with the child's age. A unique contribution of executive capacities was found for the “independence” aspect of child participation, though the quantum of contribution was limited compared with the other predictors’ process skills and environmental restrictions. In the context of child participation, EFs should be studied through multivariate analysis, as otherwise, the unique contribution of executive capacities measured by neuropsychological cognitive tests are likely to be ignored. Process skills are crucial for a child's independence and autonomy in daily functioning. These findings are supported by the capacity–performance distinction suggested by the ICF model.