Deciphering participation: an interpretive synthesis of its meaning and application in rehabilitation

Nurturing the Seeds of Participation: Unveiling the Foundational Path for Understanding Aging in Place Barriers and Facilitators From the Perspective of Older Adults Using Mixed Methods and Translational Science

Participation in society is a cornerstone for quality of life, active aging, and aging in place. While the majority of older adults prefer aging in place, health and financial challenges can hinder this vision. Conducted in suburban South Jersey, this study utilized mixed methods, including surveys and interviews with older adult participants. Surveys indicated that satisfaction with participation in the community is influenced by functional ability, healthcare service availability, and information access. Interviewees identified suggestions to overcome barriers (e.g., improve access to community and address ageism). Combined results provide a theory of change which suggests older adults' empowerment in community participation hinges on home living support, participation options aligning with ability and interest, and accessible information on community events. This person-centered planning approach emphasizes the importance of older adult and stakeholder participation in foundational community planning, offering translational foundational tools for evidence-based strategies to engage them in future community action plans (CAPs).

Unmet Need for Outpatient Occupational Therapy Services Among Veterans With Mild Traumatic Brain Injury in the Veterans Health Administration: The Role of Facility Characteristics

OBJECTIVE

To investigate whether participation restrictions, an indicator of need for occupational therapy (OT), was associated with outpatient OT utilization in the Veterans Health Administration (VHA) among Veterans with mild traumatic brain injury (mTBI), and whether this relation differs by facility characteristics.

DESIGN

In a secondary analysis of national VHA data, we used modified Poisson regression to model OT utilization (yes/no) as a function of participation restrictions (Mayo-Portland Adaptability Inventory Participation Index [M2PI]), facility characteristics, and covariates. Facility characteristics included complexity, geographic region, and self-reported access to specialty care. Covariates included prior OT utilization, sociodemographic factors, injury characteristics, and spatial access (eg, drive time). Interactions estimated whether the relation between participation restrictions and OT utilization differed across facility characteristics.

SETTING

Outpatient setting in the VHA.

PARTICIPANTS

8684 Veterans with a clinician-confirmed mTBI who received outpatient VHA care between 2012 and 2020 (N=8684).

INTERVENTIONS

None.

MAIN OUTCOME MEASURE(S)

OT utilization was measured within a year of M2PI administration using VHA administrative data.

RESULTS

Many Veterans who did not receive OT reported participation limitations, indicating unmet need for OT (eg, 67% with leisure restrictions). Participation restrictions were associated with increased likelihood of receiving OT (risk ratio [RR]=1.01; 95% confidence interval [CI]=1.006-1.019), suggesting a tendency for Veterans' OT-related needs to be satisfied. However, interactions indicated that this was not the case among Veterans receiving care in lower complexity facilities, and those in the South. Veterans with longer drive times were less likely to receive OT (RR=0.82; 95% CI=0.744-0.904).

CONCLUSIONS

Participation restrictions were associated with OT utilization, yet many Veterans with mTBI who may have benefited did not receive such care. Specific barriers to accessing OT (eg, OT practitioner supply) should be investigated. Novel care models can ensure access to OT services among Veterans seeking care at less-resourced and/or geographically distant VHA facilities.

What does social participation mean? A qualitative study exploring the concept of participation from the perspectives of experts and parents

OBJECTIVES

This study aimed to assess the theoretical framework regarding social participation from the perspectives of experts and parents of youth aged between 10 and 17 years, and therefore, provides new insights into the concept of social participation.

DESIGN

A qualitative study was conducted to understand the construct of social participation in more detail. Eight focus groups were held with experts (n=21) and parents (n=24) and analysed based on content analysis.

PARTICIPANTS

We used purposive and snowball sampling to obtain a comprehensive sample of (A) parents of adolescents with and without chronic and/or physical-motor impairments and (B) experts involved in participatory research and/or treatment of adolescents with chronic and/or physical-motor impairments. The final sample consisted of 3 focus groups with a total of 21 experts and 5 focus groups with 24 parents. This included 10 parents who had disabled children.

RESULTS

The concept of social participation consists of subjective and objective components. The focus from the experts' perspective is clearly on the subjective level; that is, revolving around the question 'Does the adolescent feel involved?' In contrast, the parents' focus is more on normative expectations. The possibility of participation in all areas of life through the adjustment of environmental factors was identified as a central factor.

CONCLUSIONS

The results underline the importance of the subjective feelings of adolescents, as well as the significance of normative requirements. To capture the subjective component of participation, suitable measurements are needed.

TRIAL REGISTRATION NUMBER

DRKS00014739.

Agreement between children with long-term health conditions and their primary caregivers on reports of perceived participation

Background

There is limited knowledge regarding the perceived participation of children with long-term health conditions in everyday activities. Children may have perceptions that differ from those of their primary caregivers. It is unclear whether children and caregivers rate their participation in everyday situations in the same way.

Objectives

We aimed to explore the level of agreement pertaining to perceived participation (attendance and involvement) and examine whether differences exist in the rank order of activities selected as the three most important between reports from children with long-term health conditions and their primary caregivers.

Methods

The simplified Chinese version of the Picture My Participation (PMP-C; Simplified) was used in an interview with children with long-term health conditions; meanwhile, their primary caregivers finished the questionnaire independently. Data were analyzed using Wilcoxon tests, weighted kappa values, and Spearman's rank order correlation.

Results

Children with long-term health conditions reported significantly lower attendance scores for six activity items (p < 0.05) and higher involvement scores for two activity items (p < 0.05) than their primary caregivers did. An overall slight to fair agreement in perceived participation was found at the child-caregiver dyad level, though differences in dyads were observed. A strong correlation was identified between the rank order of the most important activities for both groups (r = 0.81).

Conclusions

Differences may exist between the perceived participation of children with long-term health conditions, as reported by primary caregivers and the children themselves. The findings highlight that children with long-term health conditions exhibit unique views with respect to their perceived participation and have to be asked regarding their perceptions themselves.

Post-concussive symptoms mediate the relationship between sleep problems and participation restrictions among veterans with mild traumatic brain injury

Background

Sleep problems are common among Veterans with mild traumatic brain injury (mTBI) and may contribute to participation restrictions. However, explanatory mechanisms underlying this relationship are poorly understood. Sleep problems are associated with post-concussive symptoms (e.g., headaches). In turn, post-concussive symptoms contribute to participation restrictions. We hypothesized that post-concussive symptom severity mediates the purported relationship between sleep problems and participation restrictions among Veterans with mTBI.

Materials and Methods

This study was a retrospective analysis of clinical data among 8,733 Veterans with mTBI receiving Veterans Health Administration outpatient care. Sleep problems (yes/no) were identified using the sleep-related item from the Neurobehavioral Symptom Inventory (NSI). Post-concussive symptoms were measured using remaining NSI items. Participation restrictions were measured using the Mayo-Portland Adaptability Inventory Participation Index. We specified a latent variable path model to estimate relationships between: (1) sleep problems and three latent indicators of post-concussive symptoms [vestibular-sensory (e.g., headache)]; mood-behavioral [e.g., anxiety]; cognitive [e.g., forgetfulness]); and, (2) the three latent indicators of post-concussive symptoms and two latent indicators of participation restrictions (social and community participation [e.g., leisure activities]; productivity [e.g., financial management]). We examined the indirect effects of sleep problems upon participation restrictions, as mediated by post-concussive symptoms. Estimates were adjusted for sociodemographic factors (e.g., age), injury characteristics (e.g., blast), and co-morbid conditions (e.g., depression).

Results

87% of Veterans reported sleep problems. Sleep problems were associated with greater social and community participation restrictions, as mediated by mood-behavioral (β = 0.41, p < 0.001) and cognitive symptoms (β = 0.13, p < 0.001). There was no evidence that vestibular-sensory symptoms mediated this relationship (β = -0.01, p = 0.48). Sleep problems were associated with greater productivity restrictions, as mediated by vestibular-sensory (β = 0.16, p < 0.001) and cognitive symptoms (β = 0.14, p < 0.001). There was no evidence that mood-behavioral symptoms mediated this relationship (β = 0.02, p = 0.37).

Discussion

Findings suggest that evidence-based sleep treatment should occupy a prominent role in the rehabilitation of Veterans with mTBI. Indirect effects of sleep problems differed when considering impact on social and community participation vs. productivity, informing individualized rehabilitative care for Veterans with mTBI.

Exploring the Multidimensional Participation of Adults Living in the Community in the Chronic Phase following Acquired Brain Injury

This exploratory study aimed to examine multiple aspects of the participation of adults in the chronic phase following acquired brain injury (ABI), considering different disability levels. Our study included 25 adults ≥6 months after ABI (predominantly stroke), living at home, without severe cognitive decline. Primary measures included the Canadian Occupational Performance Measure (subjective participation) and the Mayo-Portland Adaptability Inventory-4 Participation Index (objective participation). The results indicated subjective participation problems in all of the International Classification of Functioning, Disability and Health participation domains. In addition, objective participation was reported as most limited in the areas of leisure and recreational activities, residence, and employment. Both subjective and objective participation profiles varied according to the disability level except for the social and leisure areas, which were found to be similar across all subgroups. However, only partial compatibility was found between the subjective and objective participation aspects. To conclude, our findings indicated that chronic ABI survivors report a variety of subjective and objective participation concerns that varied according to their disability levels. Moreover, the incongruity between the participation aspects suggests that the level of limitation may not necessarily correspond to the importance of a particular participation area. This highlights the need for comprehensive assessments to determine unique individual participation profiles in order to facilitate client-centered interventions supporting the rehabilitation of community-dwelling ABI survivors.

Measuring subjective aspects of participation in adults with disabilities: A systematic review of the coverage, content validity and internal structure of standardised instruments

OBJECTIVE

To systematically review evidence on the coverage, content validity and internal structure of self-report measures capturing subjective aspects of participation for adults with disabilities.

DATA SOURCES

EMBASE, MEDLINE and reference lists were searched until July 10^th, 2022 for articles on measurement properties of instruments measuring participation as defined in the International Classification of Functioning, Disability and Health, from a subjective perspective.

METHOD

Each instrument was assessed for its coverage of subjective aspects of participation. The Consensus-based Standards for the Selection of Health Measurement Instruments were used to assess the quality of each study. Content validity and internal structure (structural validity, internal consistency and cross-cultural validity) were rated against published standards and qualified by the adapted Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

Thirty-eight studies regarding 10 instruments were analysed. Most instruments mix activity and participation items. Only the Measure of Experiential Aspects of Participation (with high-quality evidence of sufficient structural validity and generally sufficient internal consistency), the Participation Enfranchisement and the Community Integration Measure showed adequate coverage. For all instruments, evidence of content validity is of low- to very low quality. There is high-quality evidence that the Participation Scale is not unidimensional.

CONCLUSION

In general, the coverage and the evidence for content validity and internal structure of measures capturing experiential aspects of participation are limited. The Measure of Experiential Aspects of Participation has the best level of evidence in support of its use. The score of the Participation Scale cannot be considered an adequate reflection of participation.

Participant Engagement in Supported Employment: A Systematic Scoping Review

Purpose This study aimed to synthesise the available knowledge on how participant engagement in supported employment (SE) interventions is presented, defined, and conceptualised. We also aimed to develop a working definition of participant engagement in SE based on the results of our study. Methods This systematic scoping review was conducted following the PRISMA extension for scoping reviews. The following databases were systematically searched: EBSCO, SCOPUS, Social Care Online, and JSTOR. We included peer-reviewed publications in English based on empirical studies. Results Sixteen articles met the inclusion criteria and were included in the final analysis. Thematic framework analysis resulted in three themes conveying the concept of participant engagement: self-determined choice, empowerment, and collaboration/working alliance. We suggest that participant engagement in SE is an active multifaceted process that involves the empowerment of participants, participants' exercise of self-determined informed choice, and their collaboration with SE practitioners in a working alliance. Conclusions Participant empowerment, self-determined choice, and collaboration are important aspects of participant engagement in SE. The study results will appeal to SE practitioners and make significant contributions to the broader field of other vocational services supporting people in (re-)entering the competitive labour market.

Instructors' Perspectives of Social and Motor Influences on Participation in Children With Autism Spectrum Disorder

Participation is key to childhood development and is essential for health and well-being; yet children with Autism Spectrum Disorder (ASD) participate less in social and physical activities compared to their typically developing peers and little is known about how social and motor challenges impact participation patterns. Purpose: The current research garnered experiential insights of the quality and quantity of participation, through the lens of instructors (N = 9) working with a child or children with ASD. Method: Semi-structured qualitative interviews were conducted to capture a comprehensive and informative profile of how social and motor functioning of children with ASD influence involvement in social and physical activities. Results: Thematic analysis revealed consistent viewpoints in four main areas: (1) Viewpoints extend beyond the World Health Organization definition of participation; (2) Participation depends on who is involved; (3) Although motivation, confidence, and competence in social/motor domains underlie participation, social challenges were perceived as the greatest barrier; (4) While acknowledging the benefits of participation, it is necessary to be cognizant of the required supports. Throughout these themes, the notion of heterogeneity was made very clear. Conclusion: Collectively, perspectives offer descriptive insight which may be useful when designing opportunities for participation in social and physical activities among children with ASD.

Participation Mediates the Relationship Between Postconcussive Symptoms and Suicidal Ideation Among Veterans

IMPORTANCE

Veterans with mild traumatic brain injury (mTBI) and associated symptoms are at risk for suicide. Postconcussive symptoms (PCS) may heighten risk for suicidal thoughts by limiting veterans' participation.

OBJECTIVE

To investigate whether participation mediates the relationship between PCS and suicidal ideation.

DESIGN

Cross-sectional, exploratory design. Structural equation models were used to investigate whether participation mediated the relationship between PCS and suicidal ideation.

SETTING

Community.

PARTICIPANTS

Veterans with mTBI (N = 145).

OUTCOMES AND MEASURES

The Ohio State University TBI Identification Method was used to establish mTBI diagnosis. We identified latent variables for PCS and participation using the Neurobehavioral Symptom Inventory and select domains of the Medical Outcomes Study Short Form-36, respectively. We used the Beck Scale for Suicide Ideation to measure the presence of suicidal ideation.

RESULTS

Participation mediated the relationship between PCS and the presence of suicidal ideation (odds ratio [OR] = 1.09, p = .011). More severe PCS were associated with lesser participation (β = -.86, p < .001); greater participation was associated with lower odds of suicidal ideation (OR = 0.92, p = .007).

CONCLUSIONS AND RELEVANCE

PCS may heighten risk for suicidal thoughts among veterans by limiting successful participation, a primary target of occupational therapy intervention. Thus, the results suggest that occupational therapy practitioners can play a substantial role in suicide prevention services for veterans with mTBI. Preventive services could mitigate suicide risk among veterans with mTBI by enabling sustained engagement in meaningful and health-promoting activity (e.g., reasons for living) and targeting PCS. What This Article Adds: Researchers have proposed that occupational therapy practitioners can help prevent veteran suicide by supporting their engagement in meaningful, health-promoting activity and by targeting suicide risk factors within their scope of practice. To the best of our knowledge, this is the first study to offer empirical support for such proposed suicide prevention efforts. Although additional research is needed, these results are promising and highlight a distinct role for occupational therapy in suicide prevention.

Pilot of Patient Engagement in Continence Care on Geriatric Rehabilitation Units

PURPOSE

The aim of this study was to pilot a process of engaging geriatric rehabilitation patients in the assessment and management of their continence concerns.

DESIGN

A descriptive study was conducted.

METHODS

The study has four phases: (1) staff education on continence with a pre-post knowledge quiz, (2) design of patient engagement process by a working group, (3) a 6-week pilot of a patient symptom questionnaire and process of engaging patients with audits of disciplinary admission histories and documentation, and (4) patient and staff feedback surveys.

RESULTS

Patients in geriatric rehabilitation identify a range of bladder and bowel symptoms. However, there was little documented evidence from the interprofessional team that corresponded to patients' reported symptoms.

CONCLUSION

Further research into symptoms bothersome to patients and engagement of both patients and the interprofessional team in addressing these in the rehabilitation setting is needed.

CLINICAL RELEVANCE TO REHABILITATION NURSING

Patients admitted to geriatric rehabilitation have a range of bladder and bowel symptoms, which need to be addressed.

A Scoping Review of the Maternal Role at Older Age; Perceptions and Occupations

Motherhood is a meaningful life role among adult women. Occupations within the maternal role of younger mothers have been well documented, but less is known regarding the maternal-role at older age. This review aimed to describe the occupations, activities, and perceptions that older women ascribe to their maternal role. In the future, this information may promote health and wellbeing of older women. A systematic search of peer reviewed articles, that included healthy, community-dwelling mothers, 60 years of age or older, was conducted. Maternal-role occupations and perceptions of older mothers were identified and classified according to the Occupational Therapy Practice Framework (OTPF). Fourteen articles, representing 3102 older mothers, were included. The identified occupations and activities within the maternal role were from two categories: Instrumental Activities of Daily Living (IADL) (such as assistance with daily chores) and social participation (such as sharing holiday rituals). Three themes reflecting maternal-role perceptions were identified: providing support; relationship with children; and motherhood as a never-ending role. Maternal occupations were identified in only a few articles and from only two categories, IADL and social participation. These findings together with the perception that motherhood is a ‘never-ending’ role suggests that further research is needed to better characterize the maternal role of older women from an occupational perspective.

Exploring two subdimensions of participation, involvement and engagement: A scoping review

BACKGROUND

The conceptualisation of participation is an ongoing discussion with importance for measurement purposes. The aim of this study was to explore the two subjective subdimensions of participation, involvement and engagement. The purpose was related to measure development within the field of paediatric rehabilitation.

METHODS

In a scoping review, following the PRISMA-ScR, the databases MEDLINE, PubMed, Academic Research Complete, PsychINFO, and Business Source Complete were searched for publications that described engagement and/or involvement constructs.

RESULTS

Thirty-nine publications met the inclusion criteria. Involvement could be conceptualised as an unobservable state of motivation, arousal, or interest towards a specific activity or product. Building a consensus over different fields of research, engagement can be seen as the individual's behavioural, cognitive and affective investment during role performance.

CONCLUSIONS

This scoping review points in a direction that the two subdimensions of participation need to be separated, with involvement being a more stable internal state of interest towards an activity, and engagement referring to the specific behaviour, emotions, and thoughts meanwhile participating in a specific setting. Clear definition of concepts will enhance the development of measures to evaluate rehabilitation interventions in the field of occupational therapy and related fields.

Psychometric properties and sex differences on the Mayo-Portland Adaptability Inventory Participation subscale (M2PI) in Veterans with TBI

OBJECTIVE

To evaluate the structural validity of the Mayo-Portland Adaptability Inventory - Participation subscale (M2PI) in a sample of Veterans and to assess whether the tool functioned similarly for male and female Veterans DESIGN: Rasch analysis of M2PI records from the National Veterans TBI Health Registry database from 2012-2018.

SETTING

National VA Polytrauma System of Care outpatient settings.

PARTICIPANTS

Veterans with a clinically confirmed history of TBI (N = 6,065; 94% male).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

M2PI, a five-point Likert-type scale with eight items. For this analysis, the two employment items were treated individually for a total of nine items.

RESULTS

The employment items misfit the Rasch Measurement model (paid employment MnSq=1.40; other employment MnSq=1.34) and were removed from subsequent iterations. The final model had eigenvalue 1.87 on the 1^st contrast, suggesting unidimensionality of the remaining 7 items. Item order from least to most participation restriction was transportation, self-care, residence management, financial management, initiation, leisure, and social contact. Wright's person separation reliability for non-normal distributions was 0.93 indicating appropriateness of M2PI for making individual-level treatment decisions. Mean person measure was -0.92 logits (SD 1.34) suggesting that participants did not report restrictions on most items (item mean = 0 logits). 3.8% of the sample had the minimum score (no impairment on all items) and 0.2% had the maximum score. Four items had different item calibrations (≥0.25 logits) for females compared to males but the hierarchy of items was unchanged when the female sample was examined separately.

CONCLUSION(S)

These findings suggest that, although employment is a poor indicator of participation restrictions among Veterans with TBI, the M2PI is unidimensional. Because of subtle differences in scale function between male and female Veterans, M2PI should be part of a more thorough clinical interview about participation strengths and restrictions.

Pediatric measure of participation short forms version 2.0: development and evaluation

DESIGN

Mixed methods cohort study.

OBJECTIVES

To develop and assess psychometric properties of the pediatric measure of participation (PMoP) short forms (SF) version 2.0.

SETTING

Secondary analyses of data collected from 381 children with spinal cord injury (SCI) of at least 3-month duration living in the community, and 322 parents of children with SCI at three pediatric orthopedic hospitals in the United States.

METHODS

Mixed methods iterative process to customize SF based on, highly relevant items, age and school analysis of item distributions; ceiling and floor effects; internal consistency and group-level reliability; correlation of SF scores with scores derived from the total item bank; and assessment of the degree to which item difficulty matched the abilities of children in the sample.

RESULTS

PMoP SF V2.0 mean T scores ranged from 47.59 to 51.23. Overall, mean scores were somewhat higher for older children and parent respondents. Group-level reliability values ranged from 0.66 to 0.79; Cronbach's alpha values ranged from 0.79 to 0.90; ICC values ranged from 0.89 to 0.95. Pearson Correlations ranged from 0.80 to 0.95, showing good to strong correlation between scores from the SFs and total item bank for each domain. Test information function demonstrated that score estimates will be less precise at higher ends of the scale.

CONCLUSIONS

PMoP SFs V2.0 contain items relevant to participation among children with SCI, and are tailored for four age groups and school status. They are recommended for use when computer adaptive testing (CAT) is not possible.

Older Persons and Nursing Staff's Perspectives on Continence Care in Rehabilitation: A Qualitative Study

PURPOSE

The aim of the study was to understand continence care in geriatric rehabilitation from the perspectives of older persons and nursing staff.

DESIGN

This is a qualitative descriptive study.

METHODS

Ten patients and 10 nursing staff participated in semistructured interviews. Observations of care were recorded in field notes. Content analysis was used to develop themes of patient and nursing staff perspectives.

FINDINGS

Three themes were developed: Perceptions of Assessment, Continence Management, and Rehab: The Repair Shop. Patients had limited insight into continence assessment and management by nursing staff. For older persons, incontinence was embarrassing and created dependence; independence in toileting meant gaining control. Staff viewed continence as an important part of rehabilitation nursing but focused on containment and regular toileting, with patients seeing absorbent pads as commonly suggested.

CONCLUSIONS

Continence care approaches that engage older persons during rehabilitation are needed.

CLINICAL RELEVANCE

Restoration of continence through patient-centered care is core to older person rehabilitation.

Understanding activity participation 3-months after stroke: a mixed methodology study

PURPOSE

To investigate stroke survivors' activity participation 3-months after stroke, reasons for activity participation and the change in reason for activity participation.

METHOD

Thirty stroke survivors were administered the Activity Card Sort-Australia concurrent with a semi-structured interview about their activity participation. Data were analyzed using descriptive statistics and spiral content analysis.

RESULTS

Participants had returned, in part, to 96% of their previous leisure, social/educational and household activities 3-months after-stroke; retaining more sedentary and home-based activities but fewer physically demanding and community-based activities. Thirteen participants described a change in their reasons for their activity participation. Personal, environmental and temporal dimensions explained these reasons for activity participation, as well as the changes in reason for activity participation. Full activity participation involved participants' orchestrating a dynamic mix of fulfilling their personal desires according to their current physical, mental and emotional capacity; their social, organizational and physical environmental demands and obligations; and their routines, available time and future plans.

CONCLUSION

Qualitative interviews extend our understanding of the process of returning to participation in life activities and occupations following stroke to reveal that it involves the stroke survivor in a dynamic adaptation process of synchronizing personal, environmental and temporal dimensions in their daily lives.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals need to recognize the unique knowledge and ability stroke survivors have to manage their capacities, activities, occupations and environments.Client-centered practice involving true collaborative partnerships are needed to ensure stroke survivors return more satisfactorily to their activities and occupations.Rehabilitation professionals need to continually consider the ongoing changing relationships that occur between the person, their capacities, social, organizational and physical environments, and the person's activity/occupational participation during recovery from stroke.Returning to full activity/occupational participation after stroke is a dynamic and continuous process.Rehabilitation needs to be provided in different forms at different stages beyond the immediate post-stroke time so that stroke survivors benefit from the "right rehabilitation" at the "right time" throughout their recovery journey.

The feasibility and effectiveness of internet-based rehabilitation for patients with knee osteoarthritis: A study protocol of randomized controlled trial in the community setting

BACKGROUND

Internet-based rehabilitation can ease the progression of chronic diseases. There had been studies on internet-based rehabilitation of knee osteoarthritis (OA), but them were conducted at home and ignored the potential benefits in the community setting. This study will explore the feasibility and effectiveness of internet-based rehabilitation accompanies wearable devices in the community setting for the patients with knee OA.

METHODS

An assessor-blinded randomized controlled feasibility trial will be performed to study the feasibility and effectiveness of internet-based rehabilitation program for the patients with knee OA in the community setting. Forty participants with knee OA will be recruited and randomly allocated into internet-based rehabilitation group (IRG) or control group (CG). The interventions of IRG will be performed in the community setting via web-based platform and wearable devices. The outcome measures will be conducted at baseline, and post-intervention 6 weeks, 12 weeks during the study. The feasibility will be tested by the proportion of participants who will complete the internet-based rehabilitation program within 12 weeks in IRG as well as the compliance and satisfaction. Additionally, the effectiveness of internet-based rehabilitation will be assessed by the Western Ontario and McMaster Universities Osteoarthritis Index, 11-point Numerical Rating Scale and Short Form-36 quality-of-life questionnaire.

CONCLUSION

The internet-based rehabilitation program and community-based interventions is feasible and efficacy to ameliorate the osteoarthritic pain and promote the physical function and quality of life for the patients with knee OA in the community setting.

TRIAL REGISTRATION NUMBER

The study was registered in the clinical trial registry ChiCTR2000033397.

Perceived facilitators and barriers for participation in leisure activities in children with disabilities: Perspectives of children, parents and professionals

BACKGROUND

There is limited knowledge about facilitators and barriers to leisure activity participation for children with disabilities in Norway, which is needed to improve rehabilitation interventions.

AIM

This study aims to explore the main facilitators and barriers for participation in leisure activities for children and youth with disabilities in Norway.

METHODS

Semi-structured group interviews with 31 parents, 20 healthcare professionals, and nine children with disabilities were conducted. Qualitative content analysis with thematic coding was used, and the model of factors affecting the participation of children with disabilities developed by King et al. was applied for further deductive analysis.

RESULTS

Child factors, as viewed by parents and professionals, worked primarily as barriers and tended to increase with the child's age. The children themselves focussed on their own preferences, friendship and enjoyment as their main facilitators for participation. Most environmental and family factors worked both as facilitators and as barriers, with parental support as the most important facilitator. Differences between urban and rural areas in the availability and accessibility of activities were reported.

CONCLUSION AND SIGNIFICANCE

Knowledge from this study is important for the improvement of rehabilitation interventions that aim to increase participation in leisure activities for children and youth with disabilities.

The Priming Effects of Mirror Visual Feedback on Bilateral Task Practice: A Randomized Controlled Study

The priming effect of mirror visual feedback can be simply provided by inexpensive mirror therapy (MT), which exhibits beneficial effects on sensorimotor recovery in stroke. The present study was a single-blind pretest-posttest study that examined whether the priming effect of mirror visual feedback on bilateral task practice would render better outcomes. Twenty-three patients with chronic stroke were randomized to receive hospital-based task-oriented MT or bilateral arm training (BAT) for 4 weeks at 90 minutes/day, 3 days/week and a home practice for 30-40 minutes/day, 5 days/week. There was the potential trend for MT to improve temperature sense as measured by the revised Nottingham Sensory Assessment (Cohen's d = 1.00; 95% confidence interval, -0.09 to 2.09), and MT increased the Stroke Impact Scale 3.0 total score (d = 0.89; 0.003 to 1.71). MT also showed a trend for greater improvements in the Motor Activity Log (amount of use: d = 0.62; -0.24 to 1.44; quality of movement: d = 0.50; -0.35 to 1.31). MT involving bilateral movement practice with the priming effect of mirror visual feedback may render beneficial effects. The unilateral approach or MT augmented by extra feedback might be appropriate modifications.

The social construction of disability and the capabilities approach: Implications for nursing

PROBLEM

Improving the health and well-being of people with disabilities (PWD) should be included https://plato.stanford.edu/cgi-bin/encyclopedia/archinfo.cgi?entry=justice-distributivein any strategies aimed at eliminating health disparities and achieving health equity in the United States. However, practitioners and policymakers often overlook disability when considering health equity. This is problematic because structural injustices including social and environmental barriers frequently worsen health for PWD. A commitment to social justice, however, dictates that everyone should have equitable opportunities to participate in chosen aspects of life to the best of their abilities and desires.

METHODS

We use a critical commentary to provide suggestions for the nursing discipline. Specifically, we 1) position the disparities in health and well-being experienced by PWD as matters of equity and social justice, 2) describe Amartya Sen's capabilities approach, and 3) provide suggestions for incorporating tenets of the capabilities approach into nursing practice, research, and policy.

CONCLUSION

The capabilities approach can provide a useful framework to guide nursing practice, research, and policy in order to advance social justice for PWD.