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Perret C, Alvarelhão JJM, Pennington L, Ehlinger V, Duffaut C, Arnaud C, Vidart d'Egurbide Bagazgoïtia N. Assessing the Adequacy of the Physical, Social, and Attitudinal Environment to the Specific Needs of Young Adults With Cerebral Palsy: The European Adult Environment Questionnaire. Arch Phys Med Rehabil 2024; 105:906-920. [PMID: 38206241 DOI: 10.1016/j.apmr.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To present the development of the European Adult Environment Questionnaire (EAEQ), to assess to what extent it covers the International Classification of Functioning, Disability and Health (ICF), and to describe the adequacy of the physical, social, and attitudinal environment to the specific needs of young adults with cerebral palsy (CP). DESIGN Cross-sectional. SETTING Administrative regions in France, Germany, Italy, Portugal, and Sweden. PARTICIPANTS Young adults with CP (N=357), with varying severity profiles, aged 19-28 years at time of interview (2018-20). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Physical, social, and attitudinal environment unmet needs. RESULTS Relevant environmental factors (EFs) for young adults with CP were identified during focus groups in England and Portugal. EFs were mapped to the ICF environmental classification and the EAEQ analytical structure resulted from this linking procedure. It comprised 61 items, linked to 31 ICF environmental classification categories, and covered 4 of its 5 chapters. Content validity assessed with the bandwidth index (percentage coverage of ICF Core Sets for adults with CP) was satisfactory (79.3%). A descriptive analysis was carried out. Participants had a mean age of 24 years, 56% were men, 38% had severely limited mobility. Less than 16% reported unmet needs for EFs relating to home, college/work/day placement, and communication in the Products and technology chapter. Unmet needs were higher (>20%) for the other items in the Public use and Land development categories. Social support, attitudes, and understanding of relatives were often adequate to the participants' needs. The proportion of unmet needs varied by sex (women were more often concerned) and raised with increasing gross motor impairment. CONCLUSION The EAEQ describes in detail the adequacy of the environment to the specific needs of young adults with CP. Its ICF-based structure opens up possibilities for use in a universal conceptual framework.
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Affiliation(s)
- Célia Perret
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | | | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Virginie Ehlinger
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | - Carine Duffaut
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | - Catherine Arnaud
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France; Clinical Epidemiology Unit, University Hospital, Toulouse, France
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Validity and Reliability of the Caregiving Difficulty Scale in Mothers of Children with Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115689. [PMID: 34073272 PMCID: PMC8198070 DOI: 10.3390/ijerph18115689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
This study was conducted to determine the construct validity and reliability of the Caregiving Difficulty Scale, a tool developed to measure difficulties experienced by parents of children with cerebral palsy. To this end, a survey was conducted with 215 mothers of children with cerebral palsy, and the resultant data were analyzed. A confirmatory factor analysis was performed to verify the construct validity of this scale, and the intra-item fit value was calculated for reliability analysis. Validity analysis confirmed that a bi-factor model comprising four sub-factors, Concern for the Child, Impact on Self, Support for Caregiving, and Social and Economic Strain, was suitable for the Caregiving Difficulty Scale. In addition, the reliability analysis results showed that the reliability coefficients of three of these areas, excluding Social and Economic Strain, and the reliability of the entire scale were acceptable. Therefore, the Caregiving Difficulty Scale is an appropriate tool to measure the burden of caregiving for children with cerebral palsy, and the findings emphasize the need to improve its reliability by comparing sub-factors’ reliability.
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I Want to Play: Children With Cerebral Palsy Talk About Their Experiences on Barriers and Facilitators to Participation in Leisure Activities. Pediatr Phys Ther 2020; 32:190-200. [PMID: 32604358 DOI: 10.1097/pep.0000000000000719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore how children with cerebral palsy (CP) experience participation in leisure activities and to describe the environmental barriers and facilitators. METHODS Sixteen children with cerebral palsy aged 7 to 17 years participated in 3 focus groups. Data were analyzed thematically by 3 researchers on the basis of the International Classification of Functioning, Disability and Health. RESULTS A total of 38 International Classification of Functioning, Disability and Health categories were identified (4 linked to Body functions; 2 linked to Body structures; 8 linked to Activities & Participation, and 24 to Environmental factors: 10 facilitators and 14 barriers). The most mentioned categories were Voluntary movement control functions, Functions related to gait pattern, Structure of upper arm, Recreation and leisure, Nuclear family and finally, and Individual attitudes of acquaintances. CONCLUSIONS The main barriers identified by children with cerebral palsy highlight aspects of the physical, social, and attitudinal environment that could be modified to enhance participation in leisure activities.
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Natkunam T, Tristani L, Peers D, Fraser-Thomas J, Latimer-Cheung AE, Bassett-Gunter R. Using a think-aloud methodology to understand online physical activity information search experiences and preferences of parents of children and youth with disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1478-1488. [PMID: 32602211 DOI: 10.1111/jar.12775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Internet is a preferred source of physical activity (PA) information. However, limited research exists regarding the experiences of parents of children and youth with disabilities (CYWD) in searching for PA programme information online. This research examined the experiences and preferences of parents of CYWD in searching for PA programme information online. METHOD Parents of CYWD (n = 10) participated in a think-aloud exercise while searching for PA programme information online. Following the think-aloud exercise, semi-structured interviews were used to further understand parents' experiences and preferences in searching for PA programme information online. RESULTS Parents identified key features that contributed to a positive online search experience. Additionally, parents noted challenges and resulting negative affect that was experienced. CONCLUSIONS This research can inform the development and dissemination of online PA programme information that is accessible and relevant to the preferences of parents of CYWD and can facilitate positive search experiences.
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Affiliation(s)
- Tharsheka Natkunam
- School of Kinesiology and Health Science, Faculty of Health York University, Toronto, ON, Canada
| | - Lauren Tristani
- School of Kinesiology and Health Science, Faculty of Health York University, Toronto, ON, Canada
| | - Danielle Peers
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Fraser-Thomas
- School of Kinesiology and Health Science, Faculty of Health York University, Toronto, ON, Canada
| | - Amy E Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Rebecca Bassett-Gunter
- School of Kinesiology and Health Science, Faculty of Health York University, Toronto, ON, Canada
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Yilmaz G. Spiritual Orientation, Meaning in Life, Life Satisfaction, and Well-Being in Mothers with Disabled Children. JOURNAL OF RELIGION AND HEALTH 2019; 58:2251-2262. [PMID: 31595446 DOI: 10.1007/s10943-019-00925-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study was planned in order to investigate the relationship between spiritual orientation with meaning in life, life satisfaction and well-being in mothers with disabled children. The research was carried out with 128 mothers in a private rehabilitation center at eastern Turkey. The Spiritual Orientation Scale (SOS), Meaning in Life Questionnaire (MLQ), Life Satisfaction Scale (LSS), and Well-Being Index (WBI) were used in the data collection. The mean score of the mothers on the SOS was found to be high (89.34 ± 7.14). It was determined that as the mean scores of mothers on the SOS increased, their mean scores on MLQ, LSS, and WBI increased and that the relationship between them was significant (p < 0.05). It was found that as the spiritual orientation of the mothers increased, meaning in life, life satisfaction, and well-being increased as well.
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Affiliation(s)
- Gamze Yilmaz
- Nursing Department, İbrahim Çeçen University School of Health, Ağrı, Turkey.
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Milićević M. Home participation of children with and without cerebral palsy in Serbia: an exploratory study. Disabil Rehabil 2019; 42:3696-3706. [DOI: 10.1080/09638288.2019.1610506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Milena Milićević
- Institute of Criminological and Sociological Research, Belgrade, Serbia
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Downie A, Chamberlain A, Kuzminski R, Vaz S, Cuomo B, Falkmer T. Road vehicle transportation of children with physical and behavioral disabilities: A literature review. Scand J Occup Ther 2019; 27:309-322. [PMID: 30856035 DOI: 10.1080/11038128.2019.1578408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: A literature review in 2001 found that children with disabilities were frequently transported in unsafe conditions and further research was required to investigate the gap between regulations, standards and actual transportation practices.Objectives: To synthesize available evidence on the transportation of children with disabilities in road vehicles.Methods: Four databases were systematically searched: CINAHL; Medline; National Transport Library Catalogue (Sweden); and Transport Research International Documentation.Results: Nineteen studies ranging in methodological quality from poor to excellent were included in the review. The findings are presented under the following six major themes: child safety restraints, wheelchairs, vehicles, travel habits, parental and professional knowledge. The results are mapped onto two groups of children, those with behavioral problems and those with physical disabilities.Conclusion: The literature reflected little change across the six major themes since the previous review. Children with disabilities continue to be inappropriately restrained in vehicles, constituting an ongoing road safety problem. There is a strong need to increase parent knowledge, upskill health professionals and provide families with financial assistance to enable them to ensure the safe transportation of children with disabilities to minimize the risk of injury and fatalities on the road, and enhance their participation in the community.
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Affiliation(s)
- Angela Downie
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Angela Chamberlain
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Rebecca Kuzminski
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Sharmila Vaz
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Belinda Cuomo
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Torbjörn Falkmer
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia.,Long Pocket Brisbane, Cooperative Research Centre for Living with Autism (Autism CRC), Queensland, Australia.,Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Life Satisfaction and Psychological Status of Mothers with Disabled Children: A Descriptive Study. Community Ment Health J 2018; 54:102-106. [PMID: 28364299 DOI: 10.1007/s10597-017-0135-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 03/25/2017] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to determine the life satisfaction, general health conditions, and depression levels of mothers with disabled children and the problems they experienced. This descriptive study was conducted between 1 and 30 December 2014 in a rehabilitation center that renders services for totally 254 physically and mentally-disabled children in Turkey. 184 mothers participated in the study. The data were collected by using an information form, the life satisfaction scale, the general health questionnaire, and the Beck depression inventory. General Health Questionnaire scores of the mothers who had another disabled child and Beck Depression Inventory scores of the working mothers were significantly high. In addition, a significant difference was found between the scores of Life Satisfaction Scale, General Health Questionnaire, and Beck Depression Inventory by mothers who had difficulties regarding care of their children, were worried for their children, and experienced uncertainty with regard to the future.
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Bassett-Gunter RL, Ruscitti RJ, Latimer-Cheung AE, Fraser-Thomas JL. Targeted physical activity messages for parents of children with disabilities: A qualitative investigation of parents' informational needs and preferences. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 64:37-46. [PMID: 28334638 DOI: 10.1016/j.ridd.2017.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/23/2017] [Accepted: 02/28/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND AIM Physical activity (PA) has myriad benefits for children with disabilities (CWD). Information and messaging campaigns can promote PA among CWD. The overall purpose of the study was to gain an understanding of the development of PA information and messages targeting parents of CWD. The specific objectives were to identify parents' preferences regarding PA information and messaging content and preferred methods and sources of communication. METHOD Focus groups were conducted with parents of CWD (N=28). Qualitative data were collected and transcribed. Inductive content analyses were employed to identify key themes. RESULTS Three key thematic areas were identified: 1) Preferred content (e.g., targeted information, self-regulatory strategies, inclusive images), 2) Challenges (e.g., lack of information and language clarity), 3) Preferred sources (e.g., other parents, reliable organizations, central information hub). CONCLUSIONS AND IMPLICATIONS Parents' needs and preferences regarding PA information could be incorporated into campaigns to enhance parent PA support and PA among CWD. Stakeholders (e.g., PA organizations, programs and practitioners) can employ these strategies in campaigns and resources targeting parents of CWD. Research is necessary to empirically develop and evaluate PA information and messaging campaigns targeting parents of CWD.
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Affiliation(s)
- R L Bassett-Gunter
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
| | - R J Ruscitti
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - A E Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - J L Fraser-Thomas
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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Badia M, Begoña Orgaz M, Gómez-Vela M, Verdugo MA, Ullán AM, Longo E. Do environmental barriers affect the parent-reported quality of life of children and adolescents with cerebral palsy? RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:312-321. [PMID: 26788697 DOI: 10.1016/j.ridd.2015.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 12/12/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
Physical, social, and attitudinal environment may affect the quality of life (QoL) of children and adolescents with cerebral palsy (CP). Participants in this study included parents of 206 children and adolescents with CP (55.8% males) aged 8-18 years (M=11.96, SD=3). Distribution according to the Gross Motor Function Classification System (GMFCS) was 24.3% level I, 18% level II, 18% level III, 12.6% level IV, and 27.2 level V. Environmental barriers were assessed with the Spanish version of the European Child Environment Questionnaire (ECEQ), and QoL was assessed with the KIDSCREEN parents' version. The results of the correlation analysis revealed that GMFCS level, IQ, and type of schooling are significantly correlated with QoL. Barriers were also associated with QoL. A series of hierarchical regression analyses indicated that, after controlling for the effect of child and parent's variables, barriers at home and at school significantly contribute to QoL. These findings underscore the importance of providing interventions to produce environmental changes that contribute to the improvement of QoL.
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Affiliation(s)
- Marta Badia
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Salamanca, Spain.
| | - M Begoña Orgaz
- Faculty of Psychology, University of Salamanca, Salamanca, Spain.
| | - María Gómez-Vela
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Salamanca, Spain.
| | - Miguel A Verdugo
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Salamanca, Spain.
| | - Ana M Ullán
- Department of Social Psychology, University of Salamanca, Spain.
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Law M, Anaby D, Imms C, Teplicky R, Turner L. Improving the participation of youth with physical disabilities in community activities: An interrupted time series design. Aust Occup Ther J 2015; 62:105-15. [PMID: 25678151 DOI: 10.1111/1440-1630.12177] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Youth with physical disabilities experience restrictions to participation in community-based leisure activities; however, there is little evidence about how to improve their involvement. This study examined whether an intervention to remove environmental barriers and develop strategies using a coaching approach improved youth participation in leisure activities. METHODS An Interrupted Time Series design was employed, where replication of the intervention effect was examined across individualised participation goals and across participants. Six adolescents with a physical disability participated in a 12-week intervention. An occupational therapist worked with each youth and his/her family to set three leisure goals based on problems identified using the Canadian Occupational Performance Measure (COPM). A coaching approach was used to collaboratively identify and implement strategies to remove environmental barriers. Interventions for each goal were introduced at different time points. Outcomes were evaluated using the COPM. RESULTS Improvements in COPM performance scores were clinically significant for 83% of the identified activities; an average change of 4.5 points in the performance scale (SD = 1.95) was observed. Statistical analysis using the celeration line demonstrated that the proportion of data points falling above the line increased in the intervention phase for 94% of the activities, indicating a significant treatment effect. CONCLUSIONS This study is the first to examine an intervention aimed at increasing leisure participation by changing only the environment. The results indicate that environment-focussed interventions are feasible and effective in promoting youth participation. Such findings can inform the design of a larger study and guide occupational therapy practice.
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Affiliation(s)
- Mary Law
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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Mei C, Reilly S, Reddihough D, Mensah F, Green J, Pennington L, Morgan AT. Activities and participation of children with cerebral palsy: parent perspectives. Disabil Rehabil 2015; 37:2164-73. [DOI: 10.3109/09638288.2014.999164] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Longo E, Badia M, Orgaz B, Verdugo MA. Cross-cultural validation of the Children's Assessment of Participation and Enjoyment (CAPE) in Spain. Child Care Health Dev 2014; 40:231-41. [PMID: 23210505 DOI: 10.1111/cch.12012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite growing interest in the topic of participation, the construct has not yet been assessed in children and adolescents with and without cerebral palsy (CP) in Spain. As there are no available instruments to measure participation in leisure activities which have been adapted in this country, the goal of this study was to validate a Spanish version of the Children's Assessment of Participation and Enjoyment (CAPE). METHOD The sample comprised 199 children and adolescents with CP and 199 without CP, between 8 and 18 years of age, from seven regions in Spain. The adaptation of the original version of CAPE was carried out through translation and backward translation, and the validity of the instrument was analysed. Construct validity was assessed through the correlation of the diverse CAPE domains and the quality of life domains (KIDSCREEN questionnaire). Discriminant validity was established by comparing children and adolescents with CP and typically developing children and adolescents. For test-retest reliability, the children and adolescents with and without CP completed the CAPE questionnaire twice within 4 weeks. RESULTS The correlations found between the CAPE domains and the quality of life domains show that the CAPE presents construct validity. The CAPE discriminated children and adolescents with CP from those without any disability in the results of participation. According to most CAPE domains, typically developing children and adolescents engage in a greater number of activities than children and adolescents with CP. Test-retest reliability for the Spanish version of CAPE was adequate. CONCLUSION The study provides a valid instrument to assess the participation of children and adolescents with and without CP who live in Spain.
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Affiliation(s)
- E Longo
- INICO, Faculty of Psychology, University of Salamanca, Spanish Agency of International Cooperation - MAEC - AECID, Salamanca, Spain
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Anaby D, Hand C, Bradley L, DiRezze B, Forhan M, DiGiacomo A, Law M. The effect of the environment on participation of children and youth with disabilities: a scoping review. Disabil Rehabil 2013; 35:1589-98. [PMID: 23350759 DOI: 10.3109/09638288.2012.748840] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The study’s purpose was to identify and synthesize research evidence regarding the effect of the environment on community participation of children with disabilities. METHODS A scoping review of peer-reviewed studies published from 1990 to 2011 was performed. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria for studies were: participants with a disability, aged 5–21 years, whose environment was examined in relation to participation in out-of-school activities. Data were organized and synthesized based on environmental domains within the International Classification of Functioning, Disability and Health (ICF): Natural Environment/Products and Technology; Support and Relationships; Attitudes; and Services, Systems and Policies. RESULTS Searching identified 1232 articles and 31 met the inclusion criteria. Each domain of the environment within the ICF influenced participation as a facilitator and/or barrier. The most common facilitators involved social support of family and friends and geographic location. The most common barriers included attitudes, physical environment, transportation, policies and the lack of support from staff and service providers. CONCLUSIONS Knowledge derived from this review can assist practitioners in addressing the specific environmental domains that influence children's participation. Such awareness can also foster new research questions and assist policy makers in identifying the factors influencing participation. IMPLICATIONS FOR REHABILITATION All domains of the environment, suggested by the ICF, have an influence on children’s participation.Evidence regarding the effect of the environment on participation is focused primarily on children with physical disabilities; more studies are needed involving various health conditions and age groups. Practitioners and decision-makers can focus attention on specific aspects of the environment, e.g. attitudinal challenges and social support, in order to foster inclusion and participation-based communities.
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Affiliation(s)
- Dana Anaby
- School of Physical and Occupation Therapy, McGill University, Montreal, QC, Canada.
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Longo E, Badia M, Orgaz BM. Patterns and predictors of participation in leisure activities outside of school in children and adolescents with Cerebral Palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:266-275. [PMID: 22989575 DOI: 10.1016/j.ridd.2012.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 08/20/2012] [Accepted: 08/21/2012] [Indexed: 06/01/2023]
Abstract
This study analyzed the patterns and predictors of participation in leisure activities outside of school of Spanish children and adolescents with Cerebral Palsy (CP). Children and adolescents with CP (n = 199; 113 males and 86 females) participated in this cross-sectional study. Their mean age was 12.11 years (SD = 3.02; range 8-18 years), and they were evaluated using the Spanish version of the Children's Assessment of Participation and Enjoyment (CAPE). Means, standard deviations and percentages were used to characterize the profile of participation, and linear regression analyses were employed to assess associations between the variables (child, family and environmental factors) and the diversity, intensity and enjoyment of participation. Children and adolescents with CP reported low diversity and intensity of participation and high levels of enjoyment. Participation in leisure activities outside of school was determined more by child and environmental factors than by family ones.
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Affiliation(s)
- Egmar Longo
- INICO, Faculty of Psychology, University of Salamanca, Spanish Agency of International Cooperation - MAEC - AECID, Avda de la Merced 109-131, 37005 Salamanca, Spain
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Colver A, Thyen U, Arnaud C, Beckung E, Fauconnier J, Marcelli M, McManus V, Michelsen SI, Parkes J, Parkinson K, Dickinson HO. Association between participation in life situations of children with cerebral palsy and their physical, social, and attitudinal environment: a cross-sectional multicenter European study. Arch Phys Med Rehabil 2012; 93:2154-64. [PMID: 22846455 PMCID: PMC3826325 DOI: 10.1016/j.apmr.2012.07.011] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/15/2012] [Accepted: 07/10/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate how participation of children with cerebral palsy (CP) varied with their environment. DESIGN Home visits to children. Administration of Assessment of Life Habits and European Child Environment Questionnaires. Structural equation modeling of putative associations between specific domains of participation and environment, while allowing for severity of child's impairments and pain. SETTING European regions with population-based registries of children with CP. PARTICIPANTS Children (n=1174) aged 8 to 12 years were randomly selected from 8 population-based registries of children with CP in 6 European countries. Of these, 743 (63%) agreed to participate; 1 further region recruited 75 children from multiple sources. Thus, there were 818 children in the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Participation in life situations. RESULTS For the hypothesized associations, the models confirmed that higher participation was associated with better availability of environmental items. Higher participation in daily activities-mealtimes, health hygiene, personal care, and home life-was significantly associated with a better physical environment at home (P<.01). Mobility was associated with transport and physical environment in the community. Participation in social roles (responsibilities, relationships, recreation) was associated with attitudes of classmates and social support at home. School participation was associated with attitudes of teachers and therapists. Environment explained between 14% and 52% of the variation in participation. CONCLUSIONS The findings confirmed the social model of disability. The physical, social, and attitudinal environment of disabled children influences their participation in everyday activities and social roles.
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Affiliation(s)
- Allan Colver
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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Rosenberg L, Ratzon NZ, Jarus T, Bart O. Perceived environmental restrictions for the participation of children with mild developmental disabilities. Child Care Health Dev 2012; 38:836-43. [PMID: 21902709 DOI: 10.1111/j.1365-2214.2011.01303.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM In light of the International Classification of Functioning, and Health (ICF) model, to assess whether parents of children with mild developmental disabilities perceived various environmental factors as barriers to their child's participation, and whether these factors have a unique contribution to the total explained variance of participation, beyond personal factors. METHODS Seventy-nine kindergarten children (mean age 5.20 ± 0.52 years old) with mild developmental disabilities and their parents participated in the study. Three questionnaires measuring the child's participation, performance skills and environmental factors were completed by the parents. RESULTS Parents perceived environmental factors as slightly restricting to their child's participation. Associations were found between home and education factors and the dimensions of child participation - independence, enjoyment and parental satisfaction. Although parents perceived human environmental factors as more restricting than physical factors at home, regression analysis revealed that the latter was found to affect the child participation dimension of independence beyond the contribution of personal factors. INTERPRETATION These findings are the first, to our knowledge, to support the contribution of environmental factors to the participation of young children with mild developmental disabilities. The results show that environmental factors have significant slight contribution to child's independence in participation beyond other predictors (i.e. personal factors). Therefore, it is recommended to include environmental restrictions measurement in the child evaluation process to facilitate effective intervention programs.
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Affiliation(s)
- L Rosenberg
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Ziviani J, Desha L, Feeney R, Boyd R. Measures of Participation Outcomes and Environmental Considerations for Children With Acquired Brain Injury: A Systematic Review. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.11.2.93] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis systematic review examined the psychometric properties and application of assessments used to evaluate participation outcomes and environmental factors for children with acquired brain injury (ABI). An electronic search of eight databases for articles published up to June 2009 revealed reference to 98 outcome measures. According to inclusion criteria based on the International Classification of Functioning, Disability and Health (ICF: Child and Youth version), five were identified as measures of participation (Children's Assessment of Participation and Enjoyment [CAPE], Child and Adolescent Scale of Participation [CASP], Assessment of Life Habits for Children [LIFE-H], Participation Index of the Mayo-Portland Adaptability Index [M2PI], and the Participation Subscale of the School Function Assessment [SFA-PS]). Six were identified as measures of environment (Child and Adolescent Scale of Environment [CASE], Craig Hospital Inventory of Environmental Factors [CHIEF], European Child Environment Questionnaire [ECEQ], Family Inventory of Life Events and Changes [FILE], HOME Inventory, and the Multidimensional Scale of Perceived Social Support Scale [MSPSS]). The measures were critiqued in relation to content, validity, reliability, clinical utility, responsiveness, and overall strengths/weaknesses. These measures need to be evaluated more extensively with children who have ABI to further determine their psychometric properties and clinical usefulness with this population.
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Coster W, Law M, Bedell G, Khetani M, Cousins M, Teplicky R. Development of the participation and environment measure for children and youth: conceptual basis. Disabil Rehabil 2011; 34:238-46. [DOI: 10.3109/09638288.2011.603017] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bedell GM, Khetani MA, Cousins MA, Coster WJ, Law MC. Parent perspectives to inform development of measures of children's participation and environment. Arch Phys Med Rehabil 2011; 92:765-73. [PMID: 21530724 DOI: 10.1016/j.apmr.2010.12.029] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/09/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To obtain parents' perspectives on children's participation and environment to inform the development of new measures. DESIGN Descriptive design using qualitative methods with focus groups and semistructured interviews. SETTING Focus groups and interviews with parents of children with disabilities were held on campus, in the home, and at community agencies; interviews with parents of children without disabilities were conducted in their homes. PARTICIPANTS Parents (N=42): parents of children with disabilities (n=25) from the United States (n=14) and Canada (n=11) and parents of children without disabilities (n=17) from the United States. Most children (93%) were aged 5 to 16 years. Children with disabilities had diagnoses characterized by psychosocial, learning, attention, and sensory-processing difficulties. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Not applicable. RESULTS Parents described common life activities and environmental factors that were similar to and expanded on categories currently reported in the literature. Differences identified among parents mainly focused on impairments and challenges of children with disabilities and concerns related to activities and programs designed for them. Parents spontaneously talked about participation and environmental factors together. Their descriptions consistently included information about features of the physical and social environment and other factors that influenced their child's participation, such as demands of the activity, parent strategies, and the child's age, preferences, and abilities. Parents' standards and expectations for their child's participation often varied depending on the specific setting, activity, and situation. CONCLUSIONS Findings have informed the development of a parent-report measure that explicitly links participation and environmental factors specific to home, school, and community settings. Having 1 measure to assess participation and environment rather than using distinct tools to assess each construct separately should situate the child's participation in real-life contexts.
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Affiliation(s)
- Gary M Bedell
- Department of Occupational Therapy, Tufts University, 26 Winthrop St., Medford, MA 02155, USA.
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Vargus-Adams JN, Martin LK. Domains of importance for parents, medical professionals and youth with cerebral palsy considering treatment outcomes. Child Care Health Dev 2011; 37:276-81. [PMID: 20637027 PMCID: PMC2974798 DOI: 10.1111/j.1365-2214.2010.01121.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study was to assess the domains of importance in therapeutic intervention for cerebral palsy (CP) using categories of the International Classification of Functioning, Disability, and Health - Children and Youth Version (ICF-CY). METHODS A total of 17 youth, 19 parents and 39 medical professionals responded to the open-ended query: 'What are the things you find most important to consider when you evaluate the effects of an intervention for yourself/your child/your patient with cerebral palsy?' Surveys were either mailed or conducted on-line. Responses were coded by two reviewers using the ICF-CY and discrepancies were resolved. RESULTS Responses were distributed across the ICF-CY domains of Body Functions and Structures, Activities and Participation, and Environmental Factors, as well as non-ICF-CY concepts including quality of life. The most common responses overall were pain, motor function, mobility, community life and public services. Youth identified strength, gait pattern, hand/arm use and use of assistive technologies as priorities whereas parents were concerned with motor function, communication, mobility and provision of public services. Medical professionals listed pain, function, mobility, community life and participation most often. CONCLUSIONS All surveyed groups indicate a desire to see changes in body functions and structures (pain, mental function, strength, movement), activities and participation (communication, hand/arm use, walking, school, recreation/community life) and quality of life following therapeutic interventions for CP. These results demonstrate the multiple, varied concerns regarding CP across the spectrum of functioning and health.
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Affiliation(s)
- Jilda N. Vargus-Adams
- Correspondence to first author at Cincinnati Children’s Hospital Medical Center, Division of Pediatric Rehabilitation, MLC 4009, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, 513/636-7360 fax,
| | - Lauren K. Martin
- Cincinnati Children’s Hospital Medical Center, Division of Pediatric Rehabilitation, Cincinnati, Ohio
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Colver AF, Dickinson HO. Study protocol: determinants of participation and quality of life of adolescents with cerebral palsy: a longitudinal study (SPARCLE2). BMC Public Health 2010; 10:280. [PMID: 20504349 PMCID: PMC2885989 DOI: 10.1186/1471-2458-10-280] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 05/26/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children and adults with impairments such as cerebral palsy have lower participation in life situations than able-bodied people. Less is known about their subjective perception of their lives, called their quality of life.During adolescence, rapid physical and psychological changes occur; although these may be more difficult for disabled than for able-bodied adolescents, little research has examined the lives of disabled adolescents.In 2003-4 a European Union funded project, SPARCLE, visited 818 children aged 8-12 years with cerebral palsy, sampled from population-based registers in nine European regions. The quality of life reported by these disabled children was similar to that of the general population but their participation was lower; levels of participation varied between countries even for children with similar severity of cerebral palsy.We are currently following up these children, now aged 13-17 years, to identify (i) to what extent contemporaneous factors (pain, impairment, psychological health and parental stress) predict their participation and quality of life, (ii) what factors modify how participation and quality of life at age 8-12 years are associated with participation and quality of life in adolescence, and (iii) whether differences between European countries in participation and quality of life can be explained by variations in environmental factors. METHODS/DESIGN Trained researchers will visit families to administer questionnaires to capture the adolescents' type and severity of impairment, socio-demographic characteristics, participation, quality of life, psychological health, pain, environmental access and parental stress. We will use multivariable models (linear, logistic or ordinal) to assess how adolescent participation, quality of life, psychological health, pain, environmental access and parental stress, vary with impairment and socio-demographic characteristics and, where possible, how these outcomes compare with general population data. For participation and quality of life, longitudinal analyses will assess to what extent these are predicted by corresponding levels in childhood and what factors modify this relationship. Structural equation modelling will be used to identify indirect relationships mediated by other factors.
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Affiliation(s)
- Allan F Colver
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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Dickinson HO, Colver A. Quantifying the physical, social and attitudinal environment of children with cerebral palsy. Disabil Rehabil 2010; 33:36-50. [PMID: 20455710 DOI: 10.3109/09638288.2010.485668] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To develop an instrument to represent the availability of needed environmental features (EFs) in the physical, social and attitudinal environment of home, school and community for children with cerebral palsy. METHOD Following a literature review and qualitative studies, the European Child Environment Questionnaire (ECEQ) was developed to capture whether EFs needed by children with cerebral palsy were available to them: 24, 24 and 12 items related to the physical, social and attitudinal environments, respectively. The ECEQ was administered to parents of 818 children with cerebral palsy aged 8-12 years, in seven European countries. A domain structure was developed using factor analysis. RESULTS Parents responded to 98% of items. Seven items were omitted from statistical models as the EFs they referred to were available to most children who needed them; two items were omitted as they did not fit well into plausible domains. The final domains, based on 51 items, were: Transport, Physical - home, Physical - community, Physical - school, Social support - home, Social support - community, Attitudes - family and friends, Attitudes - teachers and therapists, Attitudes - classmates. CONCLUSION ECEQ was acceptable to parents and can be used to assess both the access children with cerebral palsy have to the EFs that they need and how available individual EFs are.
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Affiliation(s)
- Heather O Dickinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Colver AF, Dickinson HO, Parkinson K, Arnaud C, Beckung E, Fauconnier J, Marcelli M, McManus V, Michelsen SI, Parkes J, Thyen U. Access of children with cerebral palsy to the physical, social and attitudinal environment they need: a cross-sectional European study. Disabil Rehabil 2010; 33:28-35. [PMID: 20446803 DOI: 10.3109/09638288.2010.485669] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The UN Convention on the Rights of Persons with Disabilities requires states 'to ensure to persons with disabilities access, on an equal basis with others, to the physical environment, transportation, information and communications.' We explored whether this convention was respected for disabled children in Europe. METHOD One thousand one-hundred and seventy-four children aged 8-12 years were randomly selected from population-based registers of children with cerebral palsy in eight European regions. 743 children joined the study; one further region recruited 75 children from multiple sources. Researchers visited these 818 children and administered the European Child Environment Questionnaire, which records parents' perceptions of availability of the physical, social and attitudinal environment needed in home, school and community. Multilevel, multivariable regression related child access on these domains to their impairments and socio-demographic characteristics. RESULTS Children with more impaired walking ability had less access to the physical environment, transport and social support they needed than other children. They also experienced less favourable attitudes from family and friends. However, attitudes of teachers and therapists were similar for children with all levels of impairment. The access of children, across all impairment severities, to their needed environment showed significant variation between regions (p ≤ 0.0001), some regions consistently providing better access on most or all domains. CONCLUSION European states need to substantially improve environmental access for disabled children in order to meet their obligations under UN Conventions. In some regions, many environmental factors should and realistically could be changed. Legislation and regulation should be directed to making this happen. Local environmental planners and health and social service providers should listen carefully to parents to address mismatches between policy intentions and parental experience.
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Affiliation(s)
- Allan F Colver
- Department of Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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Conti-Becker A. Between the ideal and the real: Reconsidering the International Classification of Functioning, Disability and Health. Disabil Rehabil 2009; 31:2125-9. [DOI: 10.3109/09638280902912509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Angela Conti-Becker
- Doctoral Program in Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
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Frequency of participation of 8-12-year-old children with cerebral palsy: a multi-centre cross-sectional European study. Eur J Paediatr Neurol 2009; 13:165-77. [PMID: 18571944 DOI: 10.1016/j.ejpn.2008.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 03/27/2008] [Accepted: 03/29/2008] [Indexed: 11/22/2022]
Abstract
Participation in home, school and community is important for all children; and little is known about the frequency of participation of disabled children. Frequency of participation is a valuable outcome measure for evaluating habilitation programmes for disabled children and for planning social and health services. We investigated how frequency of participation varied between children with cerebral palsy and the general population; and examined variation across countries to understand better how the environmental factors such as legislation, public attitudes and regulation in different countries might influence participation. We undertook a multi-centre, population-based study in children with and without cerebral palsy. Working from the Life-H instrument, we developed a questionnaire to capture frequency of participation in 8-12-year-old children. In nine regions of seven European countries, parents of 813 children with cerebral palsy and 2939 children from the general populations completed the questionnaire. Frequency of participation for each question was dichotomised about the median; multivariable logistic regressions were carried out. In the general population, frequency of participation varied between countries. Children with cerebral palsy participated less frequently in many but not all areas of everyday life, compared with children from the general population. There was regional variation in the domains with reduced participation and in the magnitude of the differences. We discuss how this regional variation might be explained by the different environments in which children live. Attending a special school or class was not associated with further reduction in participation in most areas of everyday life.
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Law M, Petrenchik T, King G, Hurley P. Perceived Environmental Barriers to Recreational, Community, and School Participation for Children and Youth With Physical Disabilities. Arch Phys Med Rehabil 2007; 88:1636-42. [DOI: 10.1016/j.apmr.2007.07.035] [Citation(s) in RCA: 176] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 07/24/2007] [Accepted: 07/26/2007] [Indexed: 11/28/2022]
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Forsyth R, Colver A, Alvanides S, Woolley M, Lowe M. Participation of young severely disabled children is influenced by their intrinsic impairments and environment. Dev Med Child Neurol 2007; 49:345-9. [PMID: 17489807 DOI: 10.1111/j.1469-8749.2007.00345.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A prospective study of the families of young severely disabled children applying to a non-governmental organization for financial support examined the respective contributions of a child's intrinsic impairment and the family's environment to their participation. The study population comprised the families of 600 children of median age 2 years 8 months (range 1y-12y 1mo), of whom 46% had autistic or severe behaviour difficulties, 12% other learning disabilities, 6.8% cerebral palsy, and 10% non-neurological causes of severe disability. Intrinsic impairment was measured with the Health Utilities Index (HUI); environmental factors using a novel instrument, the European Child Environment Questionnaire (ECEQ); and participation of child and family using the Lifestyle Assessment Questionnaire. Principal components analysis was used to examine interrelationships. A five-component model explains 50% of the variance in the ECEQ. The first component, ECEQ1, reflects the support a family receives from professional services and family. HUI and ECEQ1 were independently associated with participation (p<0.0001) with comparable effect sizes. We conclude that the participation of young severely disabled children is affected to similar extents by intrinsic impairment and environmental factors such as services, support, and attitudes.
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Affiliation(s)
- Rob Forsyth
- School of Clinical Medical Sciences, University of Newcastle upon Tyne, UK.
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Assessment of data quality in a multi-centre cross-sectional study of participation and quality of life of children with cerebral palsy. BMC Public Health 2006; 6:273. [PMID: 17087828 PMCID: PMC1636041 DOI: 10.1186/1471-2458-6-273] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 11/06/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SPARCLE is a cross-sectional survey in nine European regions, examining the relationship of the environment of children with cerebral palsy to their participation and quality of life. The objective of this report is to assess data quality, in particular heterogeneity between regions, family and item non-response and potential for bias. METHODS 1,174 children aged 8-12 years were selected from eight population-based registers of children with cerebral palsy; one further centre recruited 75 children from multiple sources. Families were visited by trained researchers who administered psychometric questionnaires. Logistic regression was used to assess factors related to family non-response and self-completion of questionnaires by children. RESULTS 431/1,174 (37%) families identified from registers did not respond: 146 (12%) were not traced; of the 1,028 traced families, 250 (24%) declined to participate and 35 (3%) were not approached. Families whose disabled children could walk unaided were more likely to decline to participate. 818 children entered the study of which 500 (61%) self-reported their quality of life; children with low IQ, seizures or inability to walk were less likely to self-report. There was substantial heterogeneity between regions in response rates and socio-demographic characteristics of families but not in age or gender of children. Item non-response was 2% for children and ranged from 0.4% to 5% for questionnaires completed by parents. CONCLUSION While the proportion of untraced families was higher than in similar surveys, the refusal rate was comparable. To reduce bias, all analyses should allow for region, walking ability, age and socio-demographic characteristics. The 75 children in the region without a population based register are unlikely to introduce bias.
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Colver A. Study protocol: SPARCLE--a multi-centre European study of the relationship of environment to participation and quality of life in children with cerebral palsy. BMC Public Health 2006; 6:105. [PMID: 16638126 PMCID: PMC1459857 DOI: 10.1186/1471-2458-6-105] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 04/25/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SPARCLE is a nine-centre European epidemiological research study examining the relationship of participation and quality of life to impairment and environment (physical, social and attitudinal) in 8-12 year old children with cerebral palsy. Concepts are adopted from the International Classification of Functioning, Disability and Health which bridges the medical and social models of disability. METHODS/DESIGN A cross sectional study of children with cerebral palsy sampled from total population databases in 9 European regions. Children were visited by research associates in each country who had been trained together. The main instruments used were KIDSCREEN, Life-H, Strength and Difficulties Questionnaire, Parenting Stress Index. A measure of environment was developed within the study. All instruments were translated according to international guidelines. The potential for bias due to non response and missing data will be examined. After initial analysis using multivariate regression of how the data captured by each instrument relate to impairment and socio-economic characteristics, relationships between the latent traits captured by the instruments will then be analysed using structural equation modelling. DISCUSSION This study is original in its methods by directly engaging children themselves, ensuring those with learning or communication difficulty are not excluded, and by studying in quantitative terms the crucial outcomes of participation and quality of life. Specification and publication of this protocol prior to analysis, which is not common in epidemiology but well established for randomised controlled trials and systematic reviews, should avoid the pitfalls of data dredging and post hoc analyses.
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Affiliation(s)
- Allan Colver
- Northumbria Healthcare NHS Trust, School of Clinical Medical Sciences (Child Health), University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
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