Identifying child functioning from an ICF-CY perspective: Everyday life situations explored in measures of participation

Child and adolescent participation measurement tools and their translations: A systematic review

BACKGROUND

Numerous participation measurement tools targeting children and youth have been developed. Despite the translation of these tools into specific languages and cultures, the reliability and validity of the translated versions remain uncertain. To address this gap in knowledge, this study aims to identify tools for assessing the participation of children aged 5-18 years and to appraise the psychometric properties of their translated versions.

METHODS

Four electronic databases were searched for peer-reviewed studies published in English. Preferred Reporting Items for Systematic Reviews guidelines was followed. Study titles and abstracts were screened by four independent reviewers. Data were extracted for both original and translated versions of eligible tools. Instrument quality assessments were performed using the Outcome Measures Rating Form Guidelines. Any discrepancies were resolved by consensus.

RESULTS

Out of the 31 measurement tools examined, 18 tools had at least one translated version available, and among those original measurement tools, a total of 58 translated versions were identified. The most widely translated tool was the Physical Activity Questionnaire for Children (12 languages), and the most frequently translated language was Chinese (7 tools). Most translated versions verified internal consistency and content validity. Only three translated versions were verified inter-rater reliability, and seven translated versions were tested criterion validity with the gold standard tools assessing participation of children (e.g., accelerometer, Pediatric Evaluation of Disability Inventory and four 24-h recalls). None of the translated versions were tested for intra-rater reliability and responsiveness.

CONCLUSIONS

These findings can support the selection of psychometrically sound tools for children with disabilities, given their culture and language, and tool quality.

The Impact of Complex Trauma on Occupations and Daily Functioning in Childhood: A Scoping Review

AIMS

To explore the impact of complex trauma on occupations and daily functioning in childhood through empirical studies and asses the extent and state of available evidence.

METHODS

The five-stage scoping review framework by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR: Tricco et al.) were followed. EMBASE, MEDLINE, CINAHL, PsychINFO, and Web of Science databases were systematically searched. Included studies were empirical research published in English up to December 2022, reporting on the impact of complex trauma on daily functioning or occupations in children experiencing such trauma, defined as prolonged exposure to interpersonal trauma arising within the primary caregiving system.

RESULTS

Eight studies were included. They reported impacts on personal and instrumental activities of daily living, sleep, education, work, play, leisure, and social participation. Some domains lacked comprehensive investigation, and studies lacked descriptions of specific effects on these areas.

CONCLUSIONS

The review reveals a lack of robust empirical evidence on the impact of complex trauma on occupations and daily functioning in childhood, with limited depth for comprehensive analysis on the extent of children's occupational life impact. Further research is warranted to address identified gaps.

Translation and cross-cultural adaptation of the young children participation and environment measure for its use in Austria, Germany, and Switzerland

Background

Concepts such as participation and environment may differ across cultures. Consequently, cultural equivalence must be assured when using a measure like the Young Children Participation and Environment Measure (YC-PEM) in other settings than the original English-speaking contexts. This study aimed to cross-culturally translate and adapt the YC-PEM into German as it is used in Germany, Austria, and Switzerland.

Methods

Following international guidelines, two translations were compared, and the research and expert team made the first adaptations. Twelve caregivers of children with and without disabilities from three German-speaking countries participated in two rounds of think-aloud interviews. Data were analyzed by content analysis to look for item, semantic, operational, conceptual, and measurement equivalence to reach a cultural equivalence version in German.

Results

Adaptations were needed in all fields but prominently in item, operational, and conceptual equivalence. Operational equivalence resulted in graphical adaptations in the instructions and questions to make the German version of YC-PEM, YC-PEM (G), more user-friendly.

Conclusion

This study presents a cross-cultural translation and adaptation process to develop a German version of the YC-PEM suitable for Germany, Austria, and Switzerland. A culturally adapted YC-PEM (G) is now available for research, practice, and further validation.

Parents' perceptions: Participation patterns and desires for change for children and adolescents with autism spectrum disorder-A descriptive population-based study from Switzerland

BACKGROUND

Low participation in youth with autism spectrum disorder (ASD) has been reported, but age-related and contextual information is rare.

OBJECTIVE

This study aimed to describe, from parental perspectives, two patterns of participation and parental desires for change of children (age: 5-11) and adolescents (age: 12-17) with ASD in Switzerland.

METHOD

A cross-sectional design used the German version of the Participation and Environment Measure-Child and Youth to describe and juxtapose the participation results of 60 children and 55 adolescents with ASD in 45 activities at home, school and in the community and parental desires for change.

RESULTS

Participation patterns differed between settings and age groups. Both groups were found to participate most at home, followed by school, whereas community participation was either low or nonexistent. Children were more involved at home than adolescents, while school involvement was higher than participation frequency in both age groups. Community participation frequency was generally low but higher in children than in adolescents, while involvement was similarly low in both groups. Half the parents expressed desire for change with three tendencies: (1) widespread desire for change at home due to high support needs, (2) parents of adolescents expressed more desire for change in all settings than those of children and (3) all parents mainly desired to increase participation frequency and involvement.

CONCLUSIONS

This study informs research and social, health and community service providers to further reshape their programmes to meet parental needs and increase the participation of youth with ASD.

Participation and Experiences in Extracurricular Activities for Autistic and Neurotypical Children

Participation in Organised Extracurricular Social Activities (OESA) can provide positive outcomes for children. This study investigated whether children aged 4 to 12 years diagnosed with autism differ in their OESA participation and experience compared to neurotypical peers. Parents of autistic children (n = 35) and those of neurotypical peers (n = 171) responded to questions that asked them to reflect on their child's participation and experiences in OESAs. Parents of autistic children reported significantly less OESA participation compared to parents of neurotypical children. Additionally, when evaluating factors that facilitated OESA participation, parents of autistic children rated their child's individual abilities and behaviour, the OESA's features, and the social environment less positively, compared to parents of neurotypical children. OESA participation and experiences differ for autistic and neurotypical children. This study identifies factors that can be adjusted to mitigate this difference.

Meaningful everyday life situations from the perspective of children born preterm: A photo-elicitation interview study with six-year-old children

AIM

The aim of the study was to explore meaningful everyday life situations as perceived by six-year-old children born preterm.

MATERIALS AND METHODS

The study had a descriptive qualitative design with an inductive approach. Ten, six-year-old children born preterm, not diagnosed with any disabilities, participated. Data was collected by photo-elicitation interviews to stimulate and help the children to describe their meaningful everyday life situations. A qualitative content analysis according to Elo and Kyngäs was applied.

RESULTS

The children's descriptions of meaningful everyday life situations can be understood as being in an active and dynamic process, representing the core category. The analysis resulted in three generic categories, as the children described the significance of having significant circumstances and doing things. The experiences the children gain when they do things create their desire for further development.

DISCUSSION

The results reveal that children born preterm are able to reflect on and give detailed descriptions of situations of importance to them. The study suggests that if six-year-old children born preterm are given the opportunity to share their views they can take an active role e.g. in planning and carrying through of interventions by health care services.

Barriers and facilitators to participation in everyday activities for children with intellectual disabilities in China

BACKGROUND

Children with intellectual disabilities (IDs) are vulnerable and participate less in everyday activities compared to their peers with typical development. This study aimed to identify barriers and facilitators related to the participation in everyday activities of children with IDs in China.

METHODS

Twenty semi-structured interviews were conducted with primary caregivers of children with IDs from special schools in Tianjin, China. The data were transcribed and analysed using inductive qualitative content analysis.

RESULTS

Four categories of barriers to participation in everyday activities for children with IDs were identified: insufficient knowledge, attitudes and skills in primary caregivers; ID-related characteristics of children; stigma and Chinese culture; and lack of support from society. Four categories describing facilitators of participation in everyday activities for children with IDs were also identified: the optimistic attitude of the primary caregiver; adequate family support; active environment in school and policy; and attractive characteristics of children with IDs.

CONCLUSIONS

The findings in this study add knowledge on important barriers and facilitators affecting the participation of children with IDs in everyday activities in China. The primary caregivers' voices need to be heard by government and society. Appropriate and effective changes in family-oriented services and the legal, social, political and economic context of the child welfare management system for the scale-up of improving participation should be implemented for children with IDs.

A pilot study of the impact of the electro-suit Mollii® on body functions, activity, and participation in children with cerebral palsy

Electrical stimulation has been used to treat spasticity in children with cerebral palsy. Building on the benefits of electrical stimulation, a new assistive device, electro-suit Mollii® with imbedded electrodes has been tested. The aim of the study was to evaluate the possible effect of Mollii® on body function, activity and participation in self-selected activities. Six children, five to ten years of age, used the electro-suit for one hour, every other day for three months. The impact was evaluated after four weeks and after three months by measuring passive range of motion (ROM), muscle tone, pain, gross motor function and participation. All participants improved in the total score for Canadian Occupational Performance Measure (COPM), three of them showed significant clinical improvements. Pain was reduced for children who estimated pain when the study started. There were also small changes in Electro-suit Mollii® had a positive impact on activity and participation in self-selected activities among the children in this study. Further studies with more children over a longer time are necessary to evaluate the impact and usefulness over time.

Exploring participation after paediatric acquired brain injury

This study aimed to explore the levels of participation in a UK sample of children and young people (CYP) with an acquired brain injury (ABI) at home, school and in the community through a cross-sectional study. The Child and Family Follow-Up Survey was distributed to parents/carers of 134 CYP with ABI (CYP-ABI) who received neuro-rehabilitation from 2014 to 2016. Access and recruitment were problematic resulting in a low response rate (4%). Widespread restrictions in participation were reported by four of the five respondents with community-structured events/activities and educational activities being the most restricted. Factors impacting on participation were cognitive-based and movement skills, family stress and lack of support/encouragement in the community. Study results provide information pertaining to the feasibility of undertaking research with this population while also highlighting the restrictions to participation experienced by CYP-ABI more than two years after injury.

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.

Cross-cultural adaptation of the Participation and Environment Measure for Children and Youth (PEM-CY) into German: a qualitative study in three countries

BACKGROUND

Concepts such as participation and environment may differ across cultures. Consequently, to use a measure like the Participation and Environment Measure for Children and Youth (PEM-CY) in other than the original English-speaking contexts, cultural adaptation needs to be assured. The aim of this study was to cross-culturally translate and adapt the PEM-CY into German as it is used in Germany, Austria and Switzerland.

METHODS

Fifteen parents of children and adolescents with disabilities from three German speaking countries participated in three rounds of think-aloud interviews. We followed the procedure of cultural equivalence guidelines including two additional steps. Data was analyzed by content analysis using semantic, idiomatic, experiential and conceptual equivalence.

RESULTS

Results show adaptations mainly focused on experiential and conceptual equivalence, with conceptual equivalence being the most challenging to reach. Examples of experiential equivalence included adapting the examples of activities in the PEM-CY to reflect those typical in German speaking countries. Conceptual equivalence mainly addressed aspects of "involvement" and "environment" of children and adolescents and was reached through adaptations such as enhanced instructions and structures, and additional definitions.

CONCLUSIONS

This study presents a cross-cultural translation and adaptation process to develop a German version of the PEM-CY that is suitable for Germany, Austria and Switzerland. Using a modified cultural adaptation process, a culturally adapted version of PEM-CY (German) is now available for research, practice and further validation.

I Want to Play: Children With Cerebral Palsy Talk About Their Experiences on Barriers and Facilitators to Participation in Leisure Activities

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.

Enhanced Steering and Drive Adaptations of Modified Ride-On Toy Cars for Improved Directional Control in Very Young Children With Severe Multiple Developmental Impairments

Background and Purpose: One emerging power mobility device (PMD) option that has gained recognition as a means for a cost-effective introduction to power mobility for young children is the battery powered modified ride-on toy car. Many groups, nationally and internationally, have been modifying battery powered ride-on toy cars by adding seating support and a large center placed push button switch for motor activation. The purpose of this technical report is to introduce an enhanced steering and drive system based on proportional control through a joystick. Key Points: This report offers (1) a technical description of these modifications that allow directional steering and programmable starting and driving velocity, (2) an example of a modified ride on toy, including common seating modifications, and (3) a short summary of results from a group of 7 children under the age of six with complex, severe disabilities. Clinical Impact: Although proportional joystick modifications are more complex than the common single switch activation, they allow children greater control to achieve self-initiated, self-directed movement that allow play, peer interaction, and exploration in their natural environments, even in the most highly complex cases. All seven children were able to intentionally self-initiate activation of the modified ride-on car and experience the subsequent movement.

Content Comparison of Aquatic Therapy Outcome Measures for Children with Neuromuscular and Neurodevelopmental Disorders Using the International Classification of Functioning, Disability, and Health

Currently, aquatic exercise is among the most common physical activity modalities for children with neuromuscular and neurodevelopmental disorders. However, the outcome measures that should be routinely used by therapists working in this specific health-care context have not been widely studied. The purpose of the study was to identify and compare the content of outcome measures used in aquatic physiotherapy for children, employing the International Classification of Functioning, Disability and Health (ICF) as a framework. A literature review was used to identify aquatic functioning outcome measures for children with neuromuscular and neurodevelopmental disorders. Content comparison of outcome measures identified was linked to the ICF following the linking guidelines, and content-related metrics were used to analyze them. Four outcome measures were identified (HAAR, Conatser, WOTA 1 and 2, and SWIM), which contained a total of 116 meaningful concepts and were linked to 35 ICF 2nd level categories. The greatest number of items assessed activity and participation categories. Large differences were found in reference to the density of content. For content diversity, the measures were all below 0.5. The identified outcome measurements showed homogeneity with respect to the theoretical foundation; however, some differences were found in terms of content analysis.

Preliminary Aquatic Physical Therapy Core Sets for Children and Youth With Neurological Disorders: A Consensus Process

PURPOSE

To report on the preliminary aquatic physical therapy core sets for children and youth with neurological disorders using the International Classification of Functioning, Disability and Health-children and youth version.

METHODS

A formal and structured consensus process was developed, integrating the findings of preparatory studies: a systematic literature review, expert survey with 69 participants, and a qualitative study with 43 participants.

RESULTS

Five preliminary aquatic physical therapy core sets were described: a Comprehensive Core Set (64 categories); a Common Brief (13 categories); and 3 age-specific Core Sets: infant (below 6 years, 18 categories), school-age (from 6 to <14 years, 22 categories), and youth (from 14 to 18 years, 19 categories).

CONCLUSIONS

Consensus among aquatic physical therapists' expert opinions identified the relevant intervention categories available when treating children and youth with neurological disorders. This list of intervention categories can be used in practice, research, education, and health administration.

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.

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.

Patient-Centered Medical Home and Receipt of Part C Early Intervention Among Young CSHCN and Developmental Disabilities Versus Delays: NS-CSHCN 2009-2010

Objective To determine, among a sample of young CSHCN with developmental conditions, (1) characteristics associated with receipt of both patient-centered medical home (PCMH) and Part C early intervention, (2) the association between each PCMH criterion and receipt of Part C generally, and (3) for CSHCN with disabilities versus delays. Methods Secondary data analysis of the 2009/10 National Survey of CSHCN. Sample included CSHCN (n = 755) birth to 3 years with a developmental disability or delay that affected their function. Adjusted ordinal regression analysis examined characteristics associated with receiving both PCMH and Part C. Stratified adjusted logistic regression examined the association between PCMH criteria and Part C, by disabilities versus delays. Results 19% of our sample received both PCMH and Part C. Black, non-Hispanic children had lower odds [OR 0.44, 95% CI (0.20, 0.97)] and CSHCN with more severe developmental conditions had higher odds [OR 2.13, 95% CI (1.22, 3.17)] of receiving both services. CSHCN with a PCMH were no more likely to be receiving Part C than those without a PCMH [OR 0.85, 95% CI (0.49, 1.49)]. Receiving any one of the PCMH criterion was not associated with receiving Part C, with one exception. Among CSHCN with delays, effective care coordination was associated with lower odds of Part C [OR 0.46, 95% CI (0.21, 0.97)]. Conclusion Concurrent PCMH and Part C access was low for young CSHCN with developmental conditions affecting their function. Given the overlapping mandates for PCMH and Part C, integrated efforts are warranted to identify if lack of concurrent services in fact reflects unmet service needs.

What areas of functioning are influenced by aquatic physiotherapy? Experiences of parents of children with cerebral palsy

OBJECTIVES

To explore the experiences regarding aquatic physiotherapy among parents of children with cerebral palsy and to identify a list of relevant intervention categories for aquatic physiotherapy treatments.

METHODS

We conducted semi-structured interviews and focus groups using the components of the International Classification of Functioning, Disability and Health (ICF) as a frame of reference to explore and code experiences regarding aquatic physiotherapy. A non-probabilistic purposive sampling strategy was used. Content analysis methods and ICF linking processes were used to analyze data.

RESULTS

From the parents' perspective (n = 34), both the Body Functions and Activities and Participation components were mainly influenced by aquatic physiotherapy. Also, parents described Environmental Factors acting as barriers affecting progress during therapy.

CONCLUSIONS

Parents identified a wide range of categories influenced by aquatic physiotherapy. Social and contextual aspects were highlighted, as well as a series of changes related to the illness as a result of treatment.

Development of the Pediatric Disability Inventory-Patient Reported Outcome (PEDI-PRO) measurement conceptual framework and item candidates

BACKGROUND

To address the gap in patient reported outcome measures (PROMs) of functional performance appropriate for youth and young adults with developmental disabilities (DD) we developed the Pediatric Evaluation of Disability Inventory-Patient Reported Outcome (PEDI-PRO).

AIM/OBJECTIVE

We used a participatory process to: (1) Develop the measurement conceptual framework; (2) Identify discrete functional tasks to include in the PEDI-PRO; and (3) Refine item candidates.

METHODS

We collaborated with eight youth with DD over 33 months. These youth and university researchers explored the construct of functional performance, developed and refined items, and collected and analyzed data. We also conducted focus groups with youth with DD (n = 62) and rehabilitation professionals (n = 26), and consulted with PEDI measurement experts (n = 3).

RESULTS

Youth's understanding of their functional performance is embedded in their experiences participating in everyday life situations. We developed 78 Daily Activities, 65 Social/Cognitive, and 52 Mobility item candidates that are linked to 11 everyday life situations to assess discrete functional tasks important to youth with DD and rehabilitation professionals.

CONCLUSION AND IMPLICATIONS

As a result of our participatory development process, the PEDI-PRO's proposed conceptual framework and item candidates are grounded in the lived experience of youth with DD.

Perceptions and attitudes towards the implementation of a disability evaluation system based on the international classification of functioning, disability, and health among people with disabilities in Taiwan

PURPOSE

To explore the perceptions and attitudes among people with disabilities towards the newly implemented International Classification of Functioning, Disability and Health-based disability evaluation system (the new system) in Taiwan.

METHOD

Using a self-administered questionnaire, we conducted a nationwide survey. The questionnaire focused on the domains of quality, satisfaction, and revision of the new system. In total, 1073 persons (age, ≥18 years) with disabilities or their primary caregivers, who experienced both the old and the new system, responded to the questionnaire.

RESULTS

Most participants were satisfied with the new system overall (58.7%) and the subscale of quality of structure (91.3%) and quality of outcome (63.6%). However, only 20.5% of the participants were favourable to the quality of process. The probability of being satisfied with the system overall was low for the quality of process subscale (adjusted odds ratio range, 0.3 ∼ 0.4) and its item of long interval (0.2 ∼ 0.6). Contrariwise, the probability was high for the other subscales (3.9 ∼ 13.7) and the item of identifying needs (21.9 ∼ 23.4).

CONCLUSIONS

Persons with disabilities and their primary caregivers have positive attitudes towards the new system. It is important to simplify the assessment tools and procedures to improve the system's quality of process and facilitate its usability. IMPLICATIONS FOR REHABILITATION Persons with disabilities have positive attitudes towards the newly implemented International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan. The system that provides comprehensive information about functioning and disability of persons with disabilities is able to capture the difficulties and needs of those individuals in their daily lives. The system hence helps people to mitigate the effects of disability and guide rehabilitation. The assessment items and processes of the system, however, were perceived to be complicated, time-consuming, and inconvenient. Simplifying the assessment items and processes, such as developing a short form version of the assessment tool and increasing the service time, may facilitate the usability of the system.

The uses of outcome measures within multidisciplinary early childhood intervention services: a systematic review

Purpose of the article: To review the use of outcome measures, across the domains of activity, participation, and environment, within multidisciplinary early childhood intervention services.

MATERIALS AND METHODS

A systematic literature search was undertaken that included four electronic databases: Medline, CINAHL, EMBASE, and the Cochrane Library and Cochrane Database of Systematic Review. Inclusion criteria were age 0-24 months, having or at risk of a developmental disability, in receipt of multidisciplinary early childhood intervention services, and included outcome measures across all domains of the International Classification of Functioning-Child & Youth (ICF-CY). Only peer-reviewed journal articles were considered. Eligible studies were coded using the Oxford Levels of Evidence. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) Scale for randomised controlled trials and the QualSyst for non-randomised control trials.

RESULTS

Of the total of 5764 records identified, 10 were considered to meet inclusion criteria.

CONCLUSION

Fourteen outcome measures were identified, addressing the domains of activity, participation, and environment. Of these, eight have been recommended in the early intervention literature. While the methodological quality of the 10 studies varied, these papers make a contribution to the body of research that acknowledges the role of routine and enriched environments. Implications for Rehabilitation Core practice elements of multidisciplinary early childhood intervention services indicate it is necessary to select outcome measures framed within the International Classification of Functioning-Child & Youth to inform clinical decision-making for measuring intervention effectiveness across the domains of activity, participation and environment. Of the identified measures, three (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory, and Goal Attainment Scaling) are well-established and identified in the literature as multidisciplinary outcome measures for children with developmental disability. The selection of an appropriate outcome measure depends on the age of the child, individual goals of the family, and the type of intervention. This requires the combination of measures as no one measure alone will capture all components of the International Classification of Functioning-Child & Youth.

Validation of the Chinese version of the Assessment of Preschool Children's Participation for children with physical disabilities

PURPOSE

To examine the psychometric properties of the Chinese version of the Assessment of Preschool Children's Participation (APCP-C).

METHOD

The APCP, a measure of participation in play, skill development, active physical, and social activities of preschool children, was translated into Traditional Chinese. Data on 94 Taiwanese children with physical disabilities aged 2 to 6 years were analyzed.

RESULTS

Internal consistency (Cronbach's α = 0.85 and 0.86) and test-retest reliability (ICCs = 0.79) were excellent for total scores, and varied from excellent to poor for activity type scores. Items were generally relevant to the Taiwanese culture. Correlations between scores for the APCP-C and the Chinese version of the Pediatric Evaluation of Disability Inventory Mobility and Social Functioning scales in general supported convergent validity (r = 0.33-0.68) but less support for discriminant validity.

CONCLUSIONS

The results provide evidence of reliability, cross-cultural validity, and limited support for construct validity of the APCP-C in measuring participation of children with physical disabilities.

Parents' Assessments of Disability in Their Children Using World Health Organization International Classification of Functioning, Disability and Health, Child and Youth Version Joined Body Functions and Activity Codes Related to Everyday Life

AIM

To help parents assess disability in their own children using World Health Organization (WHO) International Classification of Functioning, Disability and Health, Child and Youth Version (ICF-CY) code qualifier scoring and to assess the validity and reliability of the data sets obtained.

METHOD

Parents of 162 children with spina bifida, spinal muscular atrophy, muscular disorders, cerebral palsy, visual impairment, hearing impairment, mental disability, or disability following brain tumours performed scoring for 26 body functions qualifiers (b codes) and activities and participation qualifiers (d codes). Scoring was repeated after 6 months. Psychometric and Rasch data analysis was undertaken.

RESULTS

The initial and repeated data had Cronbach α of 0.96 and 0.97, respectively. Inter-code correlation was 0.54 (range: 0.23-0.91) and 0.76 (range: 0.20-0.92). The corrected code-total correlations were 0.72 (range: 0.49-0.83) and 0.75 (range: 0.50-0.87). When repeated, the ICF-CY code qualifier scoring showed a correlation R of 0.90. Rasch analysis of the selected ICF-CY code data demonstrated a mean measure of 0.00 and 0.00, respectively. Code qualifier infit mean square (MNSQ) had a mean of 1.01 and 1.00. The mean corresponding outfit MNSQ was 1.05 and 1.01. The ICF-CY code τ thresholds and category measures were continuous when assessed and reassessed by parents. Participating children had a mean of 56 codes scores (range: 26-130) before and a mean of 55.9 scores (range: 25-125) after repeat. Corresponding measures were −1.10 (range: −5.31 to 5.25) and −1.11 (range: −5.42 to 5.36), respectively. Based on measures obtained at the 2 occasions, the correlation coefficient R was 0.84. The child code map showed coherence of ICF-CY codes at each level. There was continuity in covering the range across disabilities. And, first and foremost, the distribution of codes reflexed a true continuity in disability with codes for motor functions activated first, then codes for cognitive functions, and, finally, codes for more complex functions.

CONCLUSIONS

Parents can assess their own children in a valid and reliable way, and if the WHO ICF-CY second-level code data set is functioning in a clinically sound way, it can be employed as a tool for identifying the severity of disabilities and for monitoring changes in those disabilities over time. The ICF-CY codes selected in this study might be one cornerstone in forming a national or even international generic set of ICF-CY codes for the benefit of children with disabilities, their parents, and caregivers and for the whole community supporting with children with disabilities on a daily and perpetual basis.

Identification of intervention categories for aquatic physical therapy in pediatrics using the International Classification of Functioning, Disability and Health-Children and Youth: a global expert survey

OBJECTIVE

To identify intervention categories encountered by physical therapists working in aquatic therapy with disabled children, using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY).

METHODS

Aquatic physical therapists were asked to describe concepts related to the functioning of disabled children and their contextual factors. Data were collected in three rounds using the Delphi technique. All answers were translated ('linked') to the ICF-CY and analyzed to determine the degree of consensus.

RESULTS

Answers were linked and organized into four diagnostic groups. Overall, in the four groups, 41 Body Functions, 8 Body Structures, 36 Activities and Participation, and 6 Environmental Factors categories were identified as intervention targets. In addition, 8 Environmental Factors that influence aquatic physical therapy were identified.

CONCLUSIONS

This study highlights the variety of intervention categories available to aquatic physical therapists when treating children in the water.

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.

Applying the International Classification of Functioning-Children and Youth Version to Pediatric Neuro-oncology

Given the increased survival rates in patients with pediatric central nervous system tumors, late effects such as treatment- and/or illness-related neurologic sequelae as well as neuropsychological deficits and social difficulties have moved into focus in follow-up care. In order to provide personalized treatment recommendations for pediatric brain tumor survivors, it is crucial not only to assess cognitive impairments but also to measure a patient's functional deficiencies, for example, restricted participation in everyday social activities. Thus, this article introduces the International Classification of Functioning-Children and Youth version (ICF-CY) as a conceptual framework for quantifying functional limitations and informing long-term care in pediatric neuro-oncology. A standardized self-report and proxy-report questionnaire for measuring participation is briefly discussed and specific recommendations based on so-called core sets for clinical practice in pediatric neuro-oncology are provided.

Exploring suitable participation tools for children who need or use power mobility: A modified Delphi survey

OBJECTIVES

To identify suitable tools for measuring important elements of participation for children, aged 18 months to 12 years, who need or use power mobility, and to indicate which tools should be considered for inclusion in a measurement toolkit.

METHODS

Parents, therapists and researchers with expertise in paediatric power mobility and participation (n = 70) completed an online modified Delphi survey, with consensus set a priori >80% agreement. Existing tools were matched against participation elements ranked most important for those in early childhood (18 months-5 years) and of school-age (6-12 years) by the panel.

RESULTS

Six out of 13 tools demonstrated potential, meeting at least three elements each, although none addressed all elements deemed important to measure by the panel. Only the Participation and Environment Measure for Children and Youth (PEM-CY) reached consensus for inclusion in a participation measure toolkit.

CONCLUSION

Further evaluation of these tools with this population is warranted.

Establishing the Cultural Equivalence of the Young Children's Participation and Environment Measure (YC-PEM) for Use in Singapore

AIMS

Establishing the cultural equivalence of clinical assessments is critical to ensuring culturally competent care. Developed in North America, the Young Children's Participation and Environment Measure (YC-PEM) is a caregiver questionnaire of participation in home, preschool, and community activities and perceptions of environmental impact on participation. The purpose of this study is to establish the cultural equivalence of YC-PEM content for use in Singapore.

METHODS

We conducted semi-structured interviews with ten early childhood and healthcare providers and cognitive interviews with ten parents in Singapore to examine the relevance of original YC-PEM content (activities, environmental factors, item wording). Interviews were transcribed, summarized, and categorized according to item, semantic, conceptual, and operational dimensions of the Applied Cultural Framework that served as a decision-making guide to keep, modify, or delete the items.

RESULTS

Providers and parents agreed on conceptual, item and semantic changes but less on operational changes. Significant changes were made to improve comprehension of the YC-PEM.

CONCLUSIONS

Despite using the same language, the majority of the YC-PEM items needed modification to be relevant to the Singapore culture. Cultural adaptation of the YC-PEM is important because there are cultural differences in children's participation and their environments, as well as the way people understand words.

Adolescents with Hearing Loss and the International Classification of Functioning, Health, and Disability: Children & Youth Version

In 2007, the World Health Organization published a set of International Classification of Functioning, Disability and Health (ICF) codes designed for children and youth (ICF-CY version). The ICF-CY considers typical developmental changes associated with childhood while describing health status and the effects of intervention. In this article we will describe how a specific intervention (transition planning for adolescents) can be documented with the ICF-CY. Transition planning in health care prepares adolescents and their families for the transfer from pediatric to adult health services and has been demonstrated to be an effective practice for adolescents with many types of chronic health conditions (e.g., cystic fibrosis, epilepsy, diabetes). Audiology has not yet addressed transition planning for adolescents with hearing loss; therefore, we propose using the ICF-CY to design a pathway of care. The ICF-CY can standardize transition planning to the benefit of both teen patients and audiologists: teens and their families would gradually acquire necessary knowledge and skills, and audiologists would develop a meaningful data set to help further inform our pediatric practices, as well as give more structure, depth, and accountability to our role in rehabilitation.

A descriptive study of the participation of children and adolescents in activities outside school

BACKGROUND

Knowledge about patterns of participation can be used to highlight groups of children and adolescents with low attendance, or low involvement in activities and who may therefore be at risk of mental or physical health concerns. This study used the Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activity of Children (PAC) to describe the patterns of participation of children and adolescents in activities outside mandated school in Victoria, Australia.

METHODS

A cross-sectional survey of Victorian children and adolescents was conducted. Eligible participants were aged 6 to 18 years, enrolled in mainstream schools, with sufficient English language skills to complete the questionnaires. Parents of participants completed a demographic questionnaire. Sample representativeness was assessed against Victorian population statistics for gender, school type, language spoken at home and socio-economic status. Data for the CAPE and PAC were summarised using descriptive statistics. Patterns of activity diversity by age were assessed using curve estimation, with additional analyses to describe differences between genders.

RESULTS

Of 9337 potential participants targeted through school advertising, 512 agreed (5.5 % consent rate), and 422 questionnaires were returned (82.4 % response rate). The sample was representative in terms of gender and language. Compared to the Victorian population, a slightly higher proportion of participants attended Government and Catholic schools and there was evidence of marginally greater socioeconomic resources than the population average. A broad range of recreational, active physical, social, skill-based and self-improvement activities were completed by all age groups. There was a reduction in the number and enjoyment of recreational activities with increasing age. In contrast, there was relative stability in intensity, frequency and preference scores across the age-groups for all activity types. Female participants typically took part in more activities (higher diversity scores), more intensely, with higher enjoyment and had higher preferences for each activity type than males, with the exception of active physical activities.

CONCLUSIONS

This study provides evidence of the participation patterns of typically developing children and adolescents in activities outside school. The findings have implications for researchers, clinicians and educators for comparative purposes and to inform future research.

Measurement of activity limitations and participation restrictions: examination of ICF-linked content and scale properties of the FIM and PC-PART instruments

PURPOSE

To explore the operationalization of activity and participation-related measurement constructs through comparison of item phrasing, item response categories and scoring (scale properties) for two separate instruments targeting activities of daily living.

METHOD

Personal Care Participation Assessment and Resource Tool (PC-PART) item content was linked to ICF categories using established linking rules. Previously reported ICF-linked FIM content categories and ICF-linked PC-PART content categories were compared to identify common ICF categories between the instruments. Scale properties of both instruments were compared using a patient scenario to explore the instruments' separate measurement constructs.

RESULTS

The PC-PART and FIM shared 15 of the 53 level two ICF-linked categories identified across both instruments. Examination of the instruments' scale properties for items with overlapping ICF content, and exploration through a patient scenario, provided supportive evidence that the instruments measure different constructs.

CONCLUSIONS

While the PC-PART and FIM share common ICF-linked content, they measure separate constructs. Measurement construct was influenced by the instruments' scale properties. The FIM was observed to measure activity limitations and the PC-PART measured participation restrictions. Scrutiny of instruments' scale properties in addition to item content is critical in the operationalization of activity and participation-related measurement constructs. Implications for Rehabilitation When selecting outcome measures for use in rehabilitation it is necessary to examine both the content of the instruments' items and item phrasing, response categories and scoring, to clarify the construct being measured. Measurement of activity limitations as well as participation restrictions in activities of daily living required for community life provides a more comprehensive measurement of rehabilitation outcomes than measurement of either construct alone. To measure the effects of interventions used in rehabilitation, it is necessary to select measures with relevant content and scale properties that enable evaluation of change in the constructs that are expected to change, as a result of the rehabilitation intervention.

[The application of the International Classification of functioning, disability and health for the evaluation of the effectiveness of rehabilitation: methodology, practical experience, results]

The article highlights the methodology, tools, conditions and limitations of the application of the International Classification of functioning, disability and health (ICF) for the evaluation of the effectiveness of medical rehabilitation. The results of the assessment of the initial level of the patients' functional abilities and their rehabilitation potential are presented with special reference to the selection of interventions and instruments for their realization as envisaged by ICF and allocation of the responsibilities among the professionals taking into consideration the AIM: of the rehabilitative treatment for specific patients. The advantages of the proposed approach are demonstrated on the example of the management of the patients presenting with osteoarthritis. Special attention is given to the information coding techniques and standards for the description of the patients' health conditions at various stages of rehabilitation.

Important elements of measuring participation for children who need or use power mobility: a modified Delphi survey

AIM

To identify and reach consensus on important elements of measuring participation in everyday life for children who need or use power mobility.

METHOD

A panel (n=74) of parents, therapists, and researchers with pediatric power mobility and participation expertise completed an online modified Delphi survey. Three rounds determined important elements of participation for two groups: early childhood (18mo-5y) and school-aged (6-12y). 'Elements of participation' defined the 'who, what, where, and how' of measuring participation, generated from a literature review and participants' suggestions. Consensus was set a priori as ≥80% agreement.

RESULTS

Consensus was reached on 21 out of 48 elements of participation important to measure for our population: eight elements for the younger group and 18 elements for the older group. When ranked by importance, four of the top five elements were common across both age groups.

INTERPRETATION

For children using power mobility, measuring participation in a variety of settings is critical, along with considering both the child's and family's participation. Evaluating child engagement and enjoyment of participation are priorities, as is measuring barriers and facilitators. For school-aged children, evaluating child and parent reports of participation are essential. These elements can guide tool selection and/or development.

A comparative ICF-CY-based analysis and cultural piloting of the assessment of preschool children's participation (APCP)

AIMS

The aim of this study was to assess and compare the content and measurement construct of a new measure, the Assessment of Preschool Children's Participation (APCP), with other participation measures that have previously been linked to the ICF-CY, and pilot the APCP item relevance in a Norwegian context.

METHODS

All meaningful concepts in the APCP were linked to the ICF-CY and compared with the links of eight other preschool measures. The analysis of measurement construct was based on the attending/doing and involvement/engagement dimensions of participation. The pilot study was a survey among 36 parents of typically developing children.

RESULTS

Like most measures, the APCP has a relatively high content intensity on recreation and play, but differs by excluding self-care activities and including some learning activities. All instruments use objective indicators to measure participation. The APCP was not among the few that assessed subjective aspects of participation. The APCP items were found highly relevant in a Norwegian context, with the exception of a few organized activities taking place outside home environments.

CONCLUSIONS

Differences in content and measurement constructs and the cultural equivalence should be considered when selecting a participation instrument for use among preschool children.

Measures of participation outcomes related to hand use for 2- to 12-year-old children with disabilities: a systematic review

Many interventions have been used to improve children's hand-related impairments or hand skill performance in functional activities so as to promote life participation. There is thus a need to have suitable instruments assessing children's participation in life situations that specifically require hand use in order to support and evaluate such interventions. This systematic review investigated the availability of potential instruments that can be used to assess children's participation specifically in life situations requiring hand use. Clinical utility and evidence for psychometric properties were also sourced. Database searches initially identified measures that were used to evaluate participation of children aged 2-12 years, involved self- or proxy report or interview administration and had generic application for a range of disabilities/diagnoses. These measures were further evaluated to determine if they fulfilled the above inclusion criteria and contained at least 60% of the items involving hand use. Further searches for psychometric evidence were undertaken for the eligible measures. Fourteen measures were identified and nine met the inclusion criteria. However, none of these measures, except for the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES), contained all items related to hand use. Most of the included measures had limited psychometric properties. Only the Children's Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC), the School Function Assessment-Participation section (SFA-P) and the Children Participation Questionnaire (CPQ) revealed sufficient evidence of validity and reliability. The findings suggest a need for adapting existing participation measures or developing new ones that specifically assess participation in life situations requiring hand use to support interventions.

Internal Structure of the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES) Measure

The purpose of this study was to examine the internal structure of the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES), an assessment of household task participation for children. Rasch analysis was used to examine patterns of item response and scale structure with data collected from caregivers of 132 children and youth ages 6–14 yr with and without disabling conditions. Internal consistency was strong for the total measure and the subscales. The items in both subscales fit the measurement model, and the item difficulty order matched the expected pattern from harder to easier household task performance and degree of caregiver assistance. The sample distribution in the hierarchical continuum showed that younger participants and those with physical disabilities tended to score lower. Some inconsistencies in rating scale use suggest a need for further clarification of the scoring criteria for measurement coherence.