Measurement properties of questionnaires assessing participation in children and adolescents with a disability: a systematic review

The application of the family of participation-related constructs (fPRC) framework to AAC intervention outcomes in children with complex communication needs: a scoping review

Participation is a fundamental human right, and being able to communicate is an essential component of participation in various life situations, such as at school, with peers, and in the community. Augmentative and alternative communication (AAC) interventions aim to facilitate communication and social interaction, independence, and participation in all aspects of life. The purpose of this study was to summarize and map the AAC intervention outcomes for children with complex communication needs onto the Family of Participation-Related Constructs (fPRC) framework. The scoping review identified 270 studies for inclusion, and the data gathered was extracted and mapped onto the fPRC framework. The results indicate that although many studies have reported on participation-related constructs such as activity competence and context, there is still insufficient focus on attendance and involvement, sense of self, and environment constructs. Hence, future research in the field of AAC is needed on the various constructs of participation proposed by the fPRC framework.

Factor structure of FUNDES-Child-SE measuring the participation and independence of children with disabilities

BACKGROUND

FUNDES-Child-SE is a proxy rating questionnaire for measuring participation and independence in children with disabilities in a Swedish context. It includes the components of frequency of attendance, engagement and independence. The original, Taiwanese FUNDES-Child 7.0, has previously been found to have a four-factor structure for frequency of participation and a two-factor structure for independence. The aim of this study was to test the factor structure in FUNDES-Child-SE. The factor structure is an important part of construct validity.

METHODS

Caregivers of 163 children with disabilities aged 6-18 years participated in this cross-sectional study. Exploratory factor analysis was used to find the factor structure for Engagement. Confirmatory factor analysis was used to test the factor structure for all three components.

RESULTS

The proposed factor structure for frequency of participation (daily living participation frequency, mobility participation frequency, learning participation frequency and community participation frequency) and independence (daily living independence and social participation independence) fit with data from FUNDES-Child-SE after excluding three to five items and adding two to five covariances of residuals. In the engagement component, two factors, named engagement in informal activities and engagement in formal activities, were found. After excluding one item and adding 10 covariances of residuals, the factor structure had an acceptable fit to data.

CONCLUSIONS

Differences in components' factor structure indicate that attendance and engagement are separate aspects of participation. Before using numeric scores from FUNDES-Child-SE in clinical settings, responsiveness and interpretability should be evaluated.

Participation measures that evaluate attendance and involvement for young people aged 15 to 25 years with cerebral palsy: a systematic review

PURPOSE

To identify participation-focused measures used for young people with cerebral palsy (CP), evaluate their psychometric evidence, and map item content to the International Classification of Functioning, Disability, and Health (ICF), and family of Participation-Related Constructs (fPRC) frameworks.

METHODS

Four databases (PubMed, Embase, Web of Science, CINAHL) were searched for papers that involved young people with CP aged 15 to 25 years and reported original data from a participation measure. Each measure was examined for validity, reliability, responsiveness (using the COSMIN checklist), clinical utility, the inclusion of accessible design features, self- and/or proxy-report from people with communication support needs, and item content according to ICF and fPRC.

RESULTS

Of 895 papers, 80 were included for review. From these, 26 measures were identified. Seven measures (27 papers/resources) were participation-focused, capable of producing a score for participation Attendance and/or Involvement. Of these, all measured Attendance (n = 7) but fewer than half measured Involvement (n = 3). Few included studies (37%) reported including some self-report of people with communication support needs.

CONCLUSIONS

Participation measures for young people with CP are evolving but require more: (i) emphasis on measurement of involvement; (ii) investigation of psychometric properties; and (iii) adaptation to enable self-report by young people with communication support needs.

The International Classification of Functioning Disability and Health Framework (ICF): a new approach to enhance sport and physical activity participation among people with disabilities in Scotland

This research provides a pilot study of the International Classification of Functioning Disability and Health Framework (ICF) involving persons with disabilities (PWD) with and without lived experience of sport participation in Scotland. National surveys in Scotland provide limited information on the nature of individual disability restricting the understanding of the relationship between disability and sport and physical activity participation. The ICF is a framework that aims to describe and classify functioning and thus can be used as a tool to provide a more detailed description of impairment for PWDs beyond their clinical condition. This knowledge has the potential to enhance the development of policies to increase the participation levels in this group. The ICF has also been used to inform the current IPC classification system at a competitive and elite level. As part of a larger study, 450 participants aged between 12 and 70 years completed an online questionnaire examining attitudes to, and participation in, sport and physical activity as well as completing the structural and functional components of the ICF. Subsequently, 18 people participated in focus groups aged between 13 and 61 years. The focus groups examined four meta-theme areas: physical, social, psychological, and sport-specific factors. The results confirm that the ICF provided a more detailed indicator of the key impairments that could have an impact on sport and physical activity participation. There was a clear lack of awareness of the links between the ICF and the classification system for competitive parasport. We concluded that a modified ICF-based assessment tool, incorporating social and environmental factors, has the potential to predict the likelihood of participation and offers a more comprehensive picture of both individual and national disability characteristics. This allows for the development of targeted policies and strategies to assist those with a disability to participate in sport. The overall framework presents a shift in thinking, in policy terms, for those in public health and in sport governance and delivery. The significance of this work is especially concerned with public health and wellbeing and sport development policy as pathways from recreational sport user to elite athlete parasport classification and performance.

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.

A new version of a measurement for presence and impact of pain in children and adolescents - Presence and impact of pain in Kids (PIP-KIDS) questionnaire: Translation, cross-cultural adaptation and measurement properties into Brazilian-Portuguese

BACKGROUND

Musculoskeletal pain in children and adolescents is prevalent and responsible for high levels of disability. Instruments to measure the presence and impact of pain in this population are needed.

OBJECTIVE

To translate, cross-culturally adapt, then test the measurement properties (structural validity, reliability and construct validity) of a questionnaire (Presence and Impact of Pain in Kids (PIP-Kids) questionnaire) to measure the presence and impact of pain in children and adolescents.

DESIGN

Measurement properties study.

METHODS

We conducted a measurement properties study. We translated and culturally adapted the PIP-Kids questionnaire into Brazilian Portuguese. The structural validity was measured by Confirmatory Factor Analysis. Reliability was measured by Kappa Coefficient. Measurement error was measured by the percentage of agreement. Construct validity was measured by Spearman Correlation.

RESULTS/FINDINGS

We included 656 children and adolescents from public and private schools. During the translation and cross-cultural adaptation no changes to wording were necessary. Structural validity confirmed two domains. Reliability by Kappa Coefficient ranges from 0.20 to 0.68. Measurement error by the percentage of agreement ranged from 60.2 to 92%. Construct validity was confirmed with 80.5% in accordance with prior hypotheses.

CONCLUSION

The PIP-Kids questionnaire translation and cross-cultural adaptation were adequate. The PIP-Kids questionnaire also has adequate structural validity with two dimensions (presence and impact), fair reliability, good agreement, and adequate construct validity.

Resilience among Parents and Children with Autism Spectrum Disorder

Resilience plays a pivotal role to offset stress among families of children with autism spectrum disorder (ASD). Although the majority of previous studies investigated resilience in parents, it is unclear what factors contribute to resilience in children. Thus, we aimed to explore resilience experienced by parents of children with ASD and how it affects children’s resilience. We invited 50 parents of a child with ASD, 13 years old or younger, across various Canadian provinces in an online survey. Parental resilience was positively associated with household income and negatively associated with parental stress. Resilience in children with ASD was positively associated with their social participation at home and community. Findings indicate a relationship between resilience in children with ASD and their participation, suggesting new ways to increase resilience in children with ASD by enhancing their participation.

Participation in preschool activities of children with autistic spectrum disorder and comparison to typically developing children

BACKGROUND

Participation is essential to children's development and is a major focus of intervention. This study aimed to describe the participation patterns of children with ASD, in comparison to typically developing (TD) children.

METHODS

70 preschoolers participated: 33 children with ASD, attending non-inclusive-education settings; and 37 TD children, attending mainstream educational settings. Two occupational therapists assessed their participation through structured observations in self-care activities, play, learning, and social participation areas; demographic and environmental questionnaires were also completed.

RESULTS

In the ASD group, frequency of participation was found to be significantly higher in ADL and learning than in other areas; level of performance was found to be significantly lower in social participation than in other areas. The TD group scored significantly higher than did the ASD group in most areas and scales. Initial findings tentatively showed that a structured educational environment for children with ASD may increase participation frequency.

CONCLUSIONS

The findings are consistent with recognized disabilities in play and social participation among children with ASD, and their limitations in participation, compared to their TD peers in most areas. Further studies are needed to evaluate additional psychometric properties of the different scales, and the impact of educational environments on participation.

Translation and cross-cultural adaptation of a Nepali version of the Dutch Participation and Activity Inventory for Children and Youth (PAI - CY) with visual impairment

Background

Visual impairment is an important cause of disability in children. There is a lack of information on rehabilitation needs and low vision support services for children with visual impairment in Nepal. This is a pilot study designed to translate, culturally adapt and pre-test the Dutch version of the Participation and Activity Inventory for Children and Youth (PAI-CY) with visual impairment aged 7–17 years to develop a Nepali version.

Questionnaires (PAI-CY versions for 7–12 and 13–17 years) were translated using standardized methods and were culturally adapted by a panel of experts. They were pretested to evaluate comprehensibility and relevance among six children with visual impairment and blindness. Finally, participants completed a questionnaire evaluation form.

Results

The translation and cultural adaptation process resulted in the adaptation of nine items to make them suitable for Nepali culture. Most children had comprehensibility problems with some specific items because of vocabulary, sentence structure and the composition of items. Most of the children were satisfied with the questionnaires.

Conclusion

The study resulted in the development of a Nepali version of the PAI-CY. We worked with a small group of content experts and a small but representative sample of children which allowed us to use rigorous translation procedures to address language and cultural differences. A population based study has been planned to investigate the psychometric properties of these questionnaires.

Quality of Life and Participation of Children With Visual Impairment: Comparison With Population Reference Scores

Purpose

The purpose of this study was to investigate quality of life and participation in children aged 3 to 17 years with visual impairment (VI) compared to reference groups and between subgroups with increasing severity levels of VI.

Methods

Parents of children aged 3 to 17 years (n = 500) and children aged 13 to 17 years (n = 75) completed the Child and Adolescent Scale of Participation (CASP). Children aged 7 to 17 years (n = 263) and their parents (n = 255) completed the KIDSCREEN-27 questionnaire to assess quality of life. Scores were compared to age and/or gender-appropriate population-based samples. For the CASP, a comparison was also made with children with chronic conditions or disabilities. The association between severity of VI and quality of life or participation was analyzed with linear regression models.

Results

Children reported significantly worse on Physical Wellbeing and Social Support & Peers, but better on the School Environment KIDSCREEN-27 subscales compared to reference groups. Parents additionally reported worse on Autonomy & Parent Relation. Children's participation was significantly worse compared to a population-based sample, but significantly better compared to children with chronic conditions and disabilities. Having moderate or severe VI/blindness was significantly associated with worse participation, as reported by parents relative to those with no VI.

Conclusions

Quality of life of children with VI is affected especially regarding Physical Wellbeing and Social Support & Peers compared to a reference population, and their participation is considerably worse. Participation was more affected in children with more severe VI. These results contribute to the understanding of the impact of VI. Interventions targeting physical health, social skills, and participation are warranted.

Structural validity and internal consistency of Picture My Participation: A measure for children with disability

Background

Picture My Participation (PMP) intended to measure participation, defined as attendance and involvement in everyday situations, of children with disabilities, particularly in low- and middle-income settings.

Objectives

To explore structural validity of PMP by identifying possible subcomponents in the attendance scale and examining internal consistency of the total score and each subcomponent.

Method

A picture-supported interview was conducted with 182 children, 7-18 years, with and without intellectual disability (ID). Frequency of attendance in 20 activities was rated on a four-point Likert scale (never, seldom, sometimes and always).

Results

An exploratory principal component analysis extracted four subcomponents: (1) organised activities, (2) social activities and taking care of others, (3) family life activities and 4) personal care and development activities. Internal consistency for the total scale (alpha = 0.85) and the first two subcomponents (alpha = 0.72 and 0.75) was acceptable. The two last subcomponents alpha values were 0.57 and 0.49.

Conclusion

The four possible subcomponents of PMP can be used to provide information about possible domains in which participation and participation restrictions exist. This study provided further psychometric evidence about PMP as a measure of participation. The stability and the utility of these subcomponents needed further exploration.

Participation Profile of Children and Youth, Aged 6-14, with and without ADHD, and the Impact of Environmental Factors

BACKGROUND

Children and youth with attention deficit hyperactivity disorder (ADHD) may experience difficulties in participation, but few studies examine their participation and the environmental factors affecting participation. This study explored the participation and the environmental factors of children and youth, with and without attention deficit hyperactivity disorder (ADHD), in the following three settings: home, school, and community.

MATERIALS AND METHODS

Parents of 65 participants aged 6-14 (M = 9.91, SD = 1.87) with and without ADHD completed the Participation and Environment Measure for Children and Youth (PEM-CY) questionnaire, which evaluates participation and environmental factors, along with demographic and screening questionnaires.

RESULTS

The ADHD group (n = 31) scored significantly lower than the non-ADHD group (n = 34) in "frequency" at home, "involvement", and overall environmental support in all settings, with parents expressing a greater desire to change their child's home and community participation. For the ADHD group, a relationship was found between environmental support and involvement in all three settings.

CONCLUSIONS

The findings demonstrated differences in the participation of children and youth with ADHD across different settings, compared to those without ADHD, and confirmed the effect of environmental factors on participation, especially involvement. It is essential to consider participation measures and environmental factors when designing interventions for children and youth with ADHD.

Participation Measures for Infants and Toddlers Aged Birth to 23 Months: A Systematic Review

AIMS

Participation is a key health outcome; however little is known specifically about how to measure participation of infants and toddlers. The aim of this review was to identify and examine the psychometric properties of participation measures for infants and toddlers aged birth to 23 months according to family of Participation-Related Constructs (fPRC).

METHODS

Four electronic databases were searched to identify (i) measures available in English, (ii) that quantify at least one participation concept of 'attendance' and/or 'involvement' according to the fPRC, (iii) with psychometric data for infants or toddlers aged from birth to 23 months published in a full text, peer reviewed journal. Psychometric quality was examined using the COSMIN checklist.

RESULTS

Four measures met the inclusion criteria: Child Engagement in Daily Life (CEDL) measure, Daily Activities of Infants Scale (DAIS), Test of Playfulness (ToP), and Young Children's Participation and Environment Measure (YC-PEM). All measured 'attendance' and three also measured 'involvement'. Measures showed unknown to moderate validity and unknown to moderate reliability, with the CEDL reporting the strongest psychometric properties.

CONCLUSION

There are few measures that evaluate infant and toddler participation. Further research is needed to develop psychometrically sound participation measures that evaluate 'attendance' and 'involvement' for this population.

Test-retest reliability of Picture My Participation in children with intellectual disability in South Africa

BACKGROUND

Picture My Participation (PmP) is a promising instrument for measuring the participation in everyday situations of children with intellectual disability (ID), particularly in low- and middle-income countries.

AIM

To explore test-retest reliability of PmP by comparing two repeated measurements of children with ID in an urban context in South Africa.

METHODS

A picture-supported interview with 31 children with ID, aged 7-17 years, was conducted twice, two weeks apart. The children rated their participation, operationalised as attendance and involvement, in 20 everyday activities. Analyses were completed for total scores, for the four subcomponents and at item level.

RESULTS

Test-retest agreement at an item level for both attendance and involvement showed slight/fair agreement for most activities (Kappa = 0.01-0.40), and moderate agreement for some activities (Kappa = 0.41-0.60). Moderate agreement was shown for the total scale and at component level (ICC = 0.5-0.75), except for (firstly) attendance of and involvement in 'Family Activities' (ICC = 0.26 for attendance, 0.33 for involvement), and (secondly) involvement in 'Personal Activities' (ICC = 0.33).

CONCLUSION

The result indicates that PmP can reliably be used at component level and as a screening tool for intervention planning to identify participation and participation restrictions in children with ID.

Participation of young people with disabilities and/or chronic conditions in low- and middle-income countries: a scoping review

AIM

The purpose of this scoping review was to describe and map the literature available on the participation of young people (0-21y) with disabilities and/or chronic conditions living in low- and middle-income countries (LMICs).

METHOD

A systematic search and selection process identified 78 publications. Descriptive data were extracted using a data-charting form, and studies were mapped using the family of participation-related constructs framework.

RESULTS

The findings demonstrated that, although the published evidence is steadily increasing, the participation research on this vulnerable population is still either absent or very scarce in the majority of LMICs, and very little is known about the participation of children with chronic health conditions. Most studies included in this review focused on attendance or 'being there'.

INTERPRETATION

Although attendance is an important aspect, more needs to be done to understand children's experiences or involvement while attending, thus capturing both dimensions of participation.

WHAT THIS PAPER ADDS

There is an increasing trend in research on participation patterns of children with disabilities in low- and middle-income countries. Most research focuses on children's attendance, or 'being there'. We know very little about children's involvement, or experience, while attending daily activities.

Transcultural adaptation, content validity and reliability of the instrument 'Picture My Participation' for children and youth with and without intellectual disabilities in mainland China

BACKGROUND

'Picture My Participation' (PMP) is a validated questionnaire for assessing participation in everyday activities by children with disabilities in low and middle income countries, but it is not yet available in simplified Chinese.

AIM

To describe the cross-cultural adaptation of the simplified Chinese version of 'Picture My Participation' (PMP-C; Simplified) and explore its validity and reliability.

METHODS

A cross-sectional study using convenience sampling was conducted using PMP-C (Simplified) with structured interviews supported by pictures for children and youth with and without intellectual disabilities (ID) in mainland China. The validity of the PMP-C (Simplified) was demonstrated by face validity and content validity while the reliability was evaluated for internal consistency and test-retest reliability.

RESULTS

Five items were slightly modified and eight pictures were revised to improve their fit with the culture of mainland China. All the items in PMP-C (Simplified) had excellent content validity, and face validity. The internal consistency, reliability coefficient and test-retest reliability of the subscale attendance for children and youth with and without ID were excellent.

CONCLUSION

Preliminary evidence of the content validity of PMP-C (Simplified) items and reliability of the subscale attendance for use with children and youth in mainland China has been gathered. However, psychometric properties in terms of construct validity for the whole instrument and reliability for the engagement subscale need further exploration.

The Participation of Children with Intellectual Disabilities: Including the Voices of Children and Their Caregivers in India and South Africa

There is a shortage of research on the participation of children with intellectual disabilities from middle-income countries. Also, most child assessments measure either the child’s or the caregiver’s perceptions of participation. Participation, however, is an amalgamation of both perspectives, as caregivers play a significant role in both accessing and facilitating opportunities for children’s participation. This paper reports on both perceptions—those of children with intellectual disabilities and those of their caregiver, in India and South Africa. A quantitative group comparison was conducted using the Children’s Assessment of Participation and Enjoyment (CAPE) that was translated into Bengali and four South African languages. One hundred child–caregiver dyads from India and 123 pairs from South Africa participated in the study. The results revealed interesting similarities and differences in participation patterns, both between countries and between children and their caregivers. Differences between countries were mostly related to the intensity of participation, with whom, and where participation occurred. Caregiver and child reports differed significantly regarding participation and the enjoyment of activities. This study emphasises the need for consideration of cultural differences when examining participation and suggests that a combined caregiver-and-child-reported approach may provide the broadest perspective on children’s participation.

Assessing participation of children with acquired brain injury and cerebral palsy: a systematic review of measurement properties

AIM

To examine which instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) align with attendance and/or involvement constructs of participation; and to systematically review measurement properties of these instruments in children with ABI or CP, to guide instrument selection.

METHOD

Five databases were searched. Instruments that quantified 'attendance' and/or 'involvement' aspects of participation according to the family of participation-related constructs were selected. Data on measurement properties were extracted and methodological quality of the studies assessed.

RESULTS

Thirty-seven instruments were used to assess participation in children with ABI or CP. Of those, 12 measured attendance and/or involvement. The reliability, validity, and responsiveness of eight of these instruments were examined in 14 studies with children with ABI or CP. Sufficient measurement properties were reported for most of the measures, but no instrument had been assessed on all relevant properties. Moreover, most psychometric studies have marked methodological limitations.

INTERPRETATION

Instruments to assess participation of children with ABI or CP should be selected carefully, as many available measures do not align with attendance and/or involvement. Evidence for measurement properties is limited, mainly caused by low methodological study quality. Future studies should follow recommended methodological guidelines.

WHAT THIS PAPER ADDS

Twelve instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) aligned with attendance/involvement. Seven instruments have some psychometric evidence supporting their use with children with CP. For children with ABI, only the Child and Adolescent Scale of Participation has shown preliminary evidence of measurement properties.

Participation in Everyday Activities of Children with and without Specific Learning Disorder

AIM

To evaluate the participation in everyday activities of school-aged children with and without Specific Learning Disorder (SLD) in two samples using two different standardized measures of participation.

METHODS

Study 1 comprised 60 children between 8 and 12 years (M = 10.2, SD = 1.2), 30 of them with and 30 without SLD. Participation was assessed by the LIFE-H questionnaire. Study 2 comprised 30 children between 8 and 12 years (M = 10.1, SD = 1.3), 14 of them had SLD, and 16 were typically developing children. Participation was assessed using the Child Participation Questionnaire.

RESULTS

As expected, the participation of children with SLD was significantly decreased in the learning domain compared with children without SLD as well as most other occupational domains. Parents of children with SLD reported lower child's enjoyment and lower parental satisfaction compared to parents of children without SLD.

CONCLUSIONS

Participation and satisfaction of children and families was lower in children with SLD. We suggest measuring participation and addressing it in evaluations and interventions with this population in order to support their engagement in daily activities beyond school participation and to focus on additional needs of this population.

The effect of motor and physical activity intervention on motor outcomes of children with autism spectrum disorder: A systematic review

Difficulty performing age-appropriate motor skills affects up to 83% of children with autism spectrum disorder. This systematic review examined the effect of motor and physical activity intervention on motor outcomes of children with autism spectrum disorder and the effect of motor learning strategies on motor skill acquisition, retention, and transfer. Six databases were searched from 2000 to 2019. Forty-one studies were included: 34 intervention studies and 7 motor learning studies. The overall quality of the evidence was low. Participants included 1173 children with autism spectrum disorder ranging from 3 to 19 years. Results from level II and III intervention studies supported that participation outcomes improved with a physical education intervention; activity outcomes improved with aquatic, motor activity, motor skill, and simulated horse riding interventions; and body structure and function outcomes improved with aquatic, exergaming, motor activity, motor skill, and simulated horse riding interventions. Results from level II and III motor learning studies supported that motor skill acquisition improved with visual, versus verbal, instructions but was not influenced by differences in instructional personnel. More rigorous research on motor intervention is needed with well-controlled study designs, adequate sample sizes, and manualized protocols. In addition, research on motor learning strategies is warranted as it generalizes across motor interventions.

Psychometric evaluation of the Participation and Activity Inventory for Children and Youth (PAI-CY) 0-2 years with visual impairment

Purpose

To identify and monitor the developmental and participation needs of visually impaired (VI) children, the Participation and Activity Inventory for Children and Youth (PAI-CY) has recently been developed involving end-users as stakeholders. The aim was to investigate psychometric properties of the PAI-CY for children between 0 and 2 years.

Methods

Responses from 115 parents were included in item analyses, after which a combination of classical test theory and item response theory (IRT) was used. Internal consistency, known-group validity, and test–retest reliability at item and scale level were investigated.

Results

After deleting four items, the PAI-CY met IRT assumptions, i.e., unidimensionality, local independence, and monotonicity, and satisfactory model fit was obtained. Participants with more severe VI and comorbidity scored significantly worse than those with less severe VI and without comorbidity, supporting known-group validity. Satisfactory internal consistency and test–retest reliability were obtained (Cronbach’s alpha 0.95, kappa 0.60–0.91, ICC 0.920).

Conclusions

The PAI-CY 0–2 years has acceptable psychometric properties and can be used to systematically assess and monitor developmental and participation needs of very young children with VI from parents’ perspectives in low vision practice and research. Confirmation of psychometric properties is necessary, possibly facilitating further item reduction, increased precision, and improved user-friendliness.

Psychometric evaluation of a new proxy-instrument to assess participation in children aged 3-6 years with visual impairment: PAI-CY 3-6

PURPOSE

The Participation and Activity Inventory for Children and Youth 3-6 years (PAI-CY 3-6) was recently developed to assess the participation needs of children with visual impairment (VI) by means of parent-proxy report. This study reports on its psychometric properties.

METHODS

Parents of children aged 3-6 years registered at two low vision rehabilitation centers in the Netherlands were invited to participate and completed the 52-item PAI-CY. Satisfaction with the PAI-CY 3-6 was determined using an evaluation form. Basic item analyses was conducted, after which an item response theory (IRT) model (i.e. the graded response model, GRM) was fitted. Deletion of items was informed by results of item analyses, fulfillment of IRT assumptions, differential item functioning, fit to the GRM and item information content. Face and content validity were considered; professionals from low vision rehabilitation centers were asked for their opinion in the item deletion process. After obtaining a satisfactory set of items, known-group validity, concurrent validity and test-retest reliability were also investigated.

RESULTS

Data of 237 parents were included in the analyses. Various aspects of the PAI-CY 3-6 were perceived as neutral to positive by over 85% of the respondents. After removing 17 items, the remaining 35 items reflected satisfactory fit to the GRM. Known-group validity was supported, since participants with more severe VI and comorbidity scored significantly worse than those with less severe VI and without comorbidity after correcting for potential confounders. Test-retest reliability was adequate, and the PAI-CY showed to have good concurrent validity. Feedback from professionals motivated the maintenance of 3 of the 17 deleted items, although not included in the scoring. Furthermore, two new items were added, resulting in a 40-item instrument.

CONCLUSIONS

The PAI-CY 3-6 has sound psychometric properties and can now be used to assess the participation needs of children aged 3-6 years with VI by means of proxy. Implementation in routine low vision rehabilitation care enables further optimization and investigation of its acceptability and feasibility.

Content validity and usefulness of Picture My Participation for measuring participation in children with and without intellectual disability in South Africa and Sweden

Background: Participation comprises attendance and involvement in everyday situations. Picture My Participation (PmP) is an instrument intended to measure participation in children with disabilities, particularly in low and middle income countries.Aim: To investigate content validity and usefulness of PmP for measuring participation in children with intellectual disability (ID) in South Africa and Sweden.Methods: A picture supported interview with 149 children, 6-18 years, with and without ID. Twenty everyday activities were provided. The three most important activities were selected by the child. Attendance was rated on all activities. Involvement was rated on the most important.Results: All activities were selected as important by at least one child with ID in both countries. There were similarities in perceived importance between the children with and without ID from South Africa. The children from South Africa with ID were the only subgroup that used all scale points for rating attendance and involvement.Conclusion: The 20 selected activities of PmP were especially relevant for children with ID in South Africa. The usefulness of the scales was higher for the children with ID in both countries. PmP is promising for assessing participation across different settings but psychometrical properties and clinical utility need further exploration.

Measuring Cognitive Reserve (CR) - A systematic review of measurement properties of CR questionnaires for the adult population

Aim

The aim of this systematic review was to summarize and critically appraise the quality of published literature on measurement properties of questionnaires assessing Cognitive Reserve (CR) in adults (>18 years).

Methods

We systematically searched for published studies on MEDLINE, PsycINFO, and Web of Science through August 2018. We evaluated the methodological quality of the included studies and the results on measurement properties based on a consensus-based standard checklist.

Results

The search strategy identified 991 publications, of which 37 were selected evaluating the measurement properties of six different questionnaires. Construct validity of the Cognitive Reserve Index questionnaire was most extensively evaluated, while evaluation of the remaining measurement properties of this questionnaire was scarce. Measurement properties of the Cognitive Reserve Questionnaire and the Cognitive Reserve Scale were assessed more completely. While the Lifetime of Experience Questionnaire seems to be the most thorough instrument, a finale recommendation for one specific questionnaire cannot be drawn, since about half of the measurement properties for each questionnaire were poorly or not assessed at all.

Conclusions

There is a need of high quality methodological studies assessing measurement properties of CR questionnaires, especially regarding content validity, structural validity, and responsiveness.

Trial registration

PROSPERO Registration number CRD42018107766.

Development and psychometric evaluation of the Chinese version of the Participation and Environment Measure for Children and Youth

Purpose: To adapt the Participation and Environment Measure for Children and Youth for use with Chinese children and youths, and to investigate its psychometric properties.Materials and methods: The Participation and Environment Measure for Children and Youth was translated into Chinese using a cultural adaptation process. Parents of 69 children aged 5-12 years with disabilities and 319 children without disabilities completed the questionnaires. Internal consistency, test-retest reliability, factorial structure, and known-group validity were examined using Cronbach's alpha, intraclass correlation coefficient, confirmatory factor analysis and t-test, respectively.Results: We added and/or replaced activities with culturally-relevant activities in the Chinese version. Internal consistency was acceptable for most of the scales (0.55-0.86). Test-retest reliability of the summary scores was moderate to high (0.70-0.84). Data-model fit was confirmed in a one-factor structure for the participation scales and a two-factor structure for the environment scales. There were also significant differences in the summary scores between 65 gender- and age-matched pairs of children with and without disabilities on the school participation scales and all the environment scales.Conclusion: This study provides psychometric evidence supporting the use of the Participation and Environment Measure for Children and Youth to assess Chinese children's participation and environmental supports/barriers.Implications for rehabilitationThe Chinese version of the Participation and Environment Measure for Children and Youth was developed through a rigorous translation and cultural adaptation process.There is evidence for the reliability (internal consistency and test-retest reliability) and construct validity (factorial structure and known-group validity) of the Chinese version of the Participation and Environment Measure for Children and Youth.The Chinese version of the Participation and Environment Measure for Children and Youth can be used to assess children's participation in home, school and community settings and to identify environmental barriers that require further intervention.

Measuring social participation in children with chronic health conditions: validation and reference values of the child and adolescent scale of participation (CASP) in the German context

Background

While ICF-CY-based models of care are promising avenues for improving participation of children with chronic health conditions, feasible and valid instruments to assess participation as an outcome in routine are still needed. We aimed to validate a German parent-report version of the Child and Adolescent Scale of Participation (CASP) in children with chronic health conditions of different severity.

Methods

Cross-sectional data were collected in 327 children (mean age 7.8 years, 55% boys) from two paediatric centres (n = 112) and one population-based sample (n = 215). Cronbach’s alpha, factor analyses, face validity assessments, correlation analyses, receiver operating characteristics (ROC) curves, and parent-reported health-related quality of life (HRQoL: KINDL) were used to examine internal consistency, test-retest reliability, and capacity to differentiate between disease severity groups. Disease severity was operationalized according to ICD-diagnosis groups and/or parent-reports on health problems, medical and educational support, and medication. A newly developed item “overall perceived participation” was added to the CASP and evaluated.

Results

We found good to excellent content validity, excellent internal consistency, and good-to-excellent test-retest reliability of the instrument. While children with mild disease had a significantly greater extent of participation (higher CASP scores) than children with severe disease, they did not differ from healthy children. Children with mild compared to severe disease much more differed in participation as measured by the CASP compared to the KINDL (area under the ROC curve: 0.92 vs. 0.75). In addition, the item “overall perceived participation” was highly correlated (r = 0.86) with the CASP total score, indicating the potential value of this specific single item. Finally, we provided preliminary reference values for the CASP obtained in a population-based sample of children without chronic health conditions.

Conclusions

The German version of the CASP and the new item are efficient, valid and reliable measures of social participation in childhood. The CASP-measured participation focuses more on attendance than on involvement into social circumstances of everyday life. To detect children with a high burden of disease on everyday life, the CASP may be more accurate than HRQoL instruments such as the KINDL. As outcome measurement, the CASP may facilitate the implementation of patient-centred paediatric health care.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1495-6) contains supplementary material, which is available to authorized users.

Measures for social support in raising a child with a disability: A scoping review

BACKGROUND

The benefits of social support for caregivers raising a child with a disability have been identified in the literature. These benefits include the improvement of the mental and physical well-being of the caregivers, improvement in caregiving styles, and overall improvement of family quality of life. Whilst the benefits of social support are widely reported, the definitions and measures of social support in the literature are varied.

METHOD

A scoping review was therefore undertaken to identify and describe the tools used to measure social support of primary caregivers (i.e., parents or grandparents) raising a child (0-18 years) with a congenital disability in international studies. Ten databases were systematically searched.

RESULTS

Sixteen studies were included in the review, from which nine social support measures were identified. Attributes of the measures were searched from their referenced papers and described in terms of their reported psychometric properties.

CONCLUSIONS

Through the identification of the measures of social support and ensuring its accurate measurement, direction can be provided for intervention by allowing professionals to detect and address social support available. Future recommendations for research are made.

Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice

INTRODUCTION

Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.

METHODS

An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).

RESULTS

A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.

DISCUSSION

Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.

Development and psychometric testing of an instrument for measuring social participation of adolescents: study protocol of a prospective mixed-methods study

INTRODUCTION

Social participation is an important part of a young person's life. It influences the social experience, social-emotional development and dimensions of competence experience. This applies to people with or without physical disabilities or chronic diseases. Currently, there is no reliable assessment tool for measuring social participation of adolescents in Germany although social participation is a central goal of rehabilitation. The aim of this study is to develop, test and pilot an instrument that assesses social participation for adolescents between the ages of 12 and 17 years and to start a psychometric test.

METHODS AND ANALYSIS

In a sequential mixed-methods study, adolescents with and without physical disabilities or chronic diseases are asked about their experiences with social participation as well as the individual significance of self-determination through semistructured interviews. The perspective of adolescents is supplemented by focus groups that will be conducted first with experts from social paediatric care and second with legal guardians. Based on this, an assessment instrument will be developed, evaluated and implemented in exemplary social paediatric centres (SPCs) and rehabilitation clinics and psychometrically tested in a pilot study.

ETHICS AND DISSEMINATION

The study will be conducted in accordance with the principles of the revised Helsinki Declaration. The study was approved by the Ethics Review Committee at the Martin-Luther-University Halle-Wittenberg. The developed assessment instrument can be used in science to identify disadvantaged groups and to compensate for the disadvantages that could impair development. For this purpose, the results will be presented at scientific conferences and published in international peer-reviewed journals. In practice, the instrument can be used to determine the goals of rehabilitation together with the adolescents and to evaluate the achievement of these goals. For this, implementation workshops and further training will be organised and carried out in children's rehabilitation clinics and SPCs.

TRIAL REGISTRATION NUMBER

DRKS00014739; Pre-results.

Interventions to improve functioning, participation, and quality of life in children with visual impairment: a systematic review

Visual impairment in childhood often has life-long implications. To aim for the highest levels of functioning, participation, and quality of life and to ensure children's well-being, children should be entitled to the most effective rehabilitation programs. We review evidence for the effectiveness of rehabilitation interventions for children with visual impairment to improve skills and behavior, thereby improving participation and quality of life as an ultimate goal. Of the 441 potentially relevant articles identified, 66 studies met our inclusion criteria (i.e., 28 randomized controlled trials, 18 nonrandomized controlled trials, and 20 before-after comparisons). The results suggest that sports camps, prescription and training in the use of low vision devices, and oral hygiene programs might be effective in improving functioning and elements of participation and quality of life in children with visual impairment. Other interventions showed mixed or negative results. The results should be interpreted with caution because of moderate to high risk of bias and suboptimal reporting. Heterogeneity of results and the use of over 50 different outcome measures prevented a meta-analysis. Future studies should focus on promising interventions for which effectiveness is still unclear (e.g., mobility, social skills), with adequately designed methodology.

Health state utility values among children and adolescents with disabilities: protocol for a systematic review

INTRODUCTION

Increasingly, assessment of healthcare technologies and interventions requires the assessment of both costs and utilities. Health state utility values (HSUVs) are measured using a range of generic and condition-specific measures. While reviews have identified that generic measures of HSUVs may lack validity in adults with conditions that result in physical disability, there is little information available on the methods used to obtain HSUVs in children and adolescents with disabilities. The objectives of this systematic review are to describe the methods used to obtain HSUVs, including mode of administration and psychometric properties, and provide summary statistics for HSUVs among children and adolescents with disabilities.

METHODS AND ANALYSIS

The following databases will be searched from inception for English-language studies of any design: PubMed, PsychInfo, Medline, Scopus, CINAHL Plus, Econlit and EMBASE databases. Two reviewers will independently screen titles, abstracts and full text articles for studies reporting HSUVs and/or data on the psychometric properties of preference-based measures for children and adolescents with disabilities aged up to 19 years. Two reviewers will independently extract data items including descriptors of the study methods and sample, instruments used to capture HSUVs, summary statistics for HSUVs and items relating to the quality of reporting. A descriptive summary of results from included studies and summary statistics for HSUVs will be presented. If sufficient data is identified, we will pool summary statistics for HSUVs according to the method used to obtain the HSUV using a random effects model. In addition, we will explore the determinants of the HSUVs using a meta-regression.

ETHICS AND DISSEMINATION

Ethical approval will not be required as no original data will be collected as part of this review. The completed review will be submitted for publication in a peer-reviewed journal and presentation at conferences.

PROSPERO REGISTRATION NUMBER

CRD42018086574.

ParticiPAte CP: a protocol of a randomised waitlist controlled trial of a motivational and behaviour change therapy intervention to increase physical activity through meaningful participation in children with cerebral palsy

INTRODUCTION

Children with cerebral palsy (CP) participate in leisure-time physical activities (PA) less often, with less intensity and reduced diversity than their typically developing peers. Participation in leisure-time physical activities may be an important source of habitual physical activity (HPA) for children with CP, who as a group have lower levels of HPA and increased sedentary time compared with their typically developing peers. The proposed study aims to compare the efficacy of a participation focused therapy (ParticiPAte CP) to usual care in a pragmatic, randomised waitlist controlled trial.

METHODS AND ANALYSIS

Thirty-six children with CP (18 in each group), classified as Gross Motor Function Classification System levels I to III, aged between 8 and 12 years will be recruited across South East Queensland, Australia. Children will be randomised to receive either ParticiPAte CP or waitlist usual care using concealed allocation. ParticiPAte CP is an individually tailored, goal-directed intervention model of pragmatic participation-focused therapy using a toolbox of evidence-based strategies in the treatment of children with CP. This will include goal-setting; identification of barriers and facilitators to participation goals, strategy formation and planning and communication guided by principles of Self-Determination Theory using strategies of Motivational Interviewing. The intervention comprises 8 weekly sessions of 1 hour duration conducted by a physiotherapist in the child's home or community.

TRIAL REGISTRATION NUMBER

ACTRN12615001064594.

Feasibility of the Participation and Activity Inventory for Children and Youth (PAI-CY) and Young Adults (PAI-YA) with a visual impairment: a pilot study

BACKGROUND

Having a visual impairment affects quality of life, daily functioning and participation. To assess rehabilitation needs of visually impaired children and young adults, the Participation and Activity Inventory for Children and Youth (PAI-CY) and Young Adults (PAI-YA) were developed. The PAI-CY comprises four questionnaires for different age categories: 0-2 years, 3-6 years, 7-12 years and 13-17 years. This pilot study assesses the feasibility and acceptability of the PAI-CY and PAI-YA, and the relevance of the content of the questionnaires.

METHODS

In addition to the regular admission procedure, the PAI-CY and PAI-YA were completed by 30 participants (six per questionnaire). For the PAI-CY, parents completed the questionnaire online prior to admission. From age 7 years onwards, children completed the questionnaire face-to-face with a rehabilitation professional during the admission procedure. Young adults completed the PAI-YA online. Subsequently, participants and professionals administered an evaluation form.

RESULTS

Overall, 85% of the parents rated all aspects of the PAI-CY neutral to positive, whereas 100% of all children and young adults were neutral to positive on all aspects, except for the duration to complete. The main criticism of professionals was that they were unable to identify actual rehabilitation needs using the questionnaires. Minor adjustments were recommended for the content of questions.

CONCLUSIONS

Parents, children and young adults were mostly satisfied with the questionnaires, however, professionals suggested some changes. The adaptations made should improve satisfaction with content, clarification of questions, and satisfaction with the questionnaires in compiling a rehabilitation plan. Although face and content validity has been optimized, a larger field study is taking place to further develop and evaluate the questionnaires.

An exploration of the relationship between two measures of children's participation

PURPOSE

To investigate the relationship between the Children Participation Questionnaire and the Children's Assessment of Participation with Hands.

MATERIALS AND METHODS

Two researchers classified the item contents independently using the International Classification of Functioning, Disability and Health-Child and Youth version as a guide. Parents of 51 children with intellectual and developmental disabilities completed both measures within one month.

RESULTS

The linking results indicated that the two participation measures covered a broad range of life domains, which corresponded well to the conceptually matched Activities and Participation categories/chapters of the International Classification of Functioning, Disability and Health-Child and Youth version. A significant moderate link (Spearman's ρ coefficient = 0.68, p < 0.01) between the two measures was found, and all of their matched domains (except for the educational domain) also revealed small to moderate associations (ρ = 0.47-0.71, p < 0.01). The paired items that asked identical or similar life situations between the two measures demonstrated varying correlation levels.

CONCLUSION

This study provides evidence for the content and construct validity of the two children's participation measures. The findings also offer important insights about the similarities and differences between the two measures. This knowledge will assist clinicians in selecting outcome measures. Implications for rehabilitation The Children Participation Questionnaire and Children's Assessment of Participation with Hands demonstrate good content and convergent validity. The two measures capture distinctive aspects and/or degrees of children's participation. Clinicians and researchers need to be aware of the similarities and differences between the two measures before selecting outcome measure.

Participation of adults with visual and severe or profound intellectual disabilities: Definition and operationalization

BACKGROUND

The available opinions regarding participation do not appear to be applicable to adults with visual and severe or profound intellectual disabilities (VSPID). Because a clear definition and operationalization are lacking, it is difficult for support professionals to give meaning to participation for adults with VSPID.

AIMS

The purpose of the present study was to develop a definition and operationalization of the concept of participation of adults with VSPID.

METHODS

Parents or family members, professionals, and experts participated in an online concept mapping procedure. This procedure includes generating statements, clustering them, and rating their importance. The data were analyzed quantitatively using multidimensional scaling and qualitatively with triangulation.

RESULTS

A total of 53 participants generated 319 statements of which 125 were clustered and rated. The final cluster map of the statements contained seven clusters: (1) Experience and discover; (2) Inclusion; (3) Involvement; (4) Leisure and recreation; (5) Communication and being understood; (6) Social relations; and (7) Self-management and autonomy. The average importance rating of the statements varied from 6.49 to 8.95. A definition of participation of this population was developed which included these seven clusters.

CONCLUSIONS

The combination of the developed definition, the clusters, and the statements in these clusters, derived from the perceptions of parents or family members, professionals, and experts, can be employed to operationalize the construct of participation of adults with VSPID. This operationalization supports professionals in their ability to give meaning to participation in these adults. Future research will focus on using the operationalization as a checklist of participation for adults with VSPID.

Reliability of the German version of the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC)

BACKGROUND

The introduction of the International Classification of Functioning, Disabilities and Health of the World Health Organization in 2001 made social participation a major rehabilitation outcome and the ultimate goal of rehabilitation services. There is no available instrument to measure the youth participation in leisure activities apart from asking the youth themselves. The goal of this study was to present a German version of the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC).

METHODS

The CAPE/PAC questionnaire was translated into German, a cultural adaptation process was designed and a reliability study was conducted. One hundred and fifty-two youths with and without disabilities, with a mean age of 15.2 years (standard deviation 1.7), participated in the study. The participants completed CAPE and PAC twice within 4 weeks. Reliability was examined by intraclass correlation coefficients, standard error of measurement, smallest detectable change and Cronbach's alpha.

RESULTS

The absolute values of participation differ between the typically developed youth group and those with impairments; the reliability of the CAPE/PAC is comparable in both groups. Intraclass correlation coefficients ranged from 0.43 to 0.74 for the CAPE and from 0.71 to 0.83 for the PAC in all participants. The alpha values for internal consistency ranged from 0.42 to 0.82 for the CAPE and from 0.65 to 0.92 for the PAC.

CONCLUSIONS

The German version of the PAC showed satisfactory reliability; however, reliability was not satisfactory for all scores of the CAPE, but comparable with versions in other languages. The need for newly developed participation measurements requires further discussion.

The effect of interventions aimed at improving participation outcomes for children with disabilities: a systematic review

AIM

Enhancement of participation has been described as the ultimate outcome for health and educational interventions. The goal of this systematic review was to identify and critically appraise studies that aimed to improve the participation outcomes of children with disabilities.

METHOD

Nine databases that index literature from the fields of health, psychology, and education were searched to retrieve information on research conducted with children with disabilities aged between 5 years and 18 years. Articles were included if the author(s) reported that participation was an intended outcome of the intervention. The articles included were limited to those reporting high-level primary research, as defined by Australia's National Health and Medical Research Council evidence hierarchy guidelines. No restrictions were placed on the type of intervention being investigated.

RESULTS

Seven randomized controlled or pseudo-randomized studies were included. Only three of these studies identified participation as a primary outcome. Both individualized and group-based approaches to enhancing participation outcomes appeared to be effective. Studies of interventions with a primary focus on body function or activity level outcomes did not demonstrate an effect on participation outcomes.

INTEPRETATION

Few intervention studies have focused on participation as a primary outcome measure. Approaches using individually tailored education and mentoring programmes were found to enhance participation outcomes, while exercise programmes, where participation was a secondary outcome, generally demonstrated little effect.