Important aspects of participation and participation restrictions in people with a mild intellectual disability

What are the barriers and facilitators to participation of people with Down syndrome? A scoping review

AIM

To determine the barriers and facilitators of active community participation of children, adolescents, and adults with Down syndrome.

METHOD

Searches were completed in five electronic databases to identify original studies about participation of children, adolescents (ages < 18 years), and adults (ages 18-59 years) with Down syndrome. Barriers and facilitators to participation were categorized into four factors: personal, social, environmental, and policy and programme. Findings were analysed and validated by a young adult with Down syndrome and a family member, using the public and patient involvement strategy.

RESULTS

Fourteen studies were included: eight with children and adolescents and six with adults. Of the 14 studies, 10 were qualitative and four quantitative. Most studies (n = 9) investigated participation in physical activities, while only a few examined participation in community/social activities (n = 3), daily activities (n = 2), and leisure activities (n = 1). The most commonly cited barriers and facilitators were the availability of programmes and specialized professionals, transportation, as well as attitudes and behaviours. Physical and psychological characteristics of people with Down syndrome and facilities were also frequently mentioned as barriers. On the other hand, the desire to stay active and personal interest in the activity were among the most frequently reported facilitators.

INTERPRETATION

The participation of people with Down syndrome is mainly influenced by physical or psychological factors, the support and attitudes of parents/caregivers, and the availability of specialized programmes. Given the scarcity of research investigating the participation of people with Down syndrome in community activities, daily activities, and leisure, especially in adults, more studies are still needed.

Quais são as barreiras e facilitadores para a participação de pessoas com Síndrome de Down? Uma Revisão de Escopo

Objetivo

Determinar as barreiras e facilitadores da participação ativa na comunidade de crianças, adolescentes e adultos com Síndrome de Down (SD). Métodos: Foram realizadas buscas em cinco bases de dados eletrônicas para identificar estudos originais sobre a participação de crianças, adolescentes (idades <18 anos) e adultos (idades de 18 a 59 anos) com SD. Barreiras e facilitadores para a participação foram categorizados em fatores: pessoais, sociais, ambientais e de políticas e programas. Os achados foram analisados e validados por um jovem adulto com SD e um membro da família, utilizando a estratégia de Envolvimento do Público e Paciente. Resultados: Quatorze estudos foram incluídos, oito com crianças e adolescentes e seis com adultos. Dos 14 estudos, dez eram qualitativos e quatro quantitativos. A maioria dos estudos (n = 9) investigou a participação em atividades físicas, enquanto apenas alguns estudos examinaram a participação em atividades comunitárias/sociais (n = 3), atividades diárias (n = 2) e atividades de lazer (n = 1). As barreiras e facilitadores mais frequentemente citados foram a disponibilidade de programas e profissionais especializados, transporte, bem como atitudes e comportamentos. As características físicas e psicológicas das pessoas com SD e as instalações também foram frequentemente mencionadas como barreiras. Por outro lado, o desejo de se manter ativo e o interesse pessoal na atividade estavam entre os facilitadores mais frequentemente relatados.

Interpretação

A participação de pessoas com SD é principalmente influenciada por fatores físicos ou psicológicos, o apoio e as atitudes dos pais/cuidadores e a disponibilidade de programas especializados. Dada a escassez de pesquisas investigando a participação de pessoas com SD em atividades comunitárias, atividades diárias e lazer, especialmente em adultos, mais estudos ainda são necessários.

The utility of goal attainment scaling in evaluating a structured water dance intervention for adults with profound intellectual and multiple disabilities

BACKGROUND

Adults with profound intellectual and multiple disabilities (PIMD) have problems to be actively involved in essential life activities that affect their health. The aim of this study was to explore the utility of goal attainment scaling (GAS) in evaluating an intervention for adults with PIMD, and to describe how the GAS goals were set according to the International Classification of Functioning, Disability and Health (ICF) domains of body function as well as activity and participation.

METHOD

As part of an aquatic intervention (Structured water dance), 28 adults with PIMD received GAS goals which were adapted to their individual needs and which the intervention could affect.

RESULT

Twenty of the goals were formulated within the ICF Activity/Participation domain and eight within the Body Functions domains. On average, participants improved by 1.25 levels on the five-level GAS scales.

CONCLUSION

GAS can be a useful tool for setting and evaluating individualized and meaningful goals, in body functions as well as in activity and participation, related to a healthpromoting activity for adults with PIMD.

Trajectories of participation, mental health, and mental health problems in adolescents with self-reported neurodevelopmental disorders

PURPOSE

Having a neurodevelopmental disorder (NDD) increases the risk of mental health problems and lower participation. We investigated the trajectories of mental health problems and participation in adolescents with NDD and compared these with trajectories for peers without NDD. In addition, the relationship between participation, mental health (well-being), and mental health problems were investigated.

MATERIALS AND METHODS

Data from a Swedish longitudinal survey study (LoRDIA) was used and adolescents with and without self-reported NDD were followed from 12/13 to 17 years, in three waves. Mental health problems were measured using the Strength and Difficulties Questionnaire, and well-being was measured with the Mental Health Continuum short form.

RESULTS

Adolescents with NDD experience more mental health problems than adolescents without NDD. Hyperactivity, a key feature of NDD, remains stable, while emotional problems and psychosomatic complaints, increase over time for girls, independent of NDD. Participation is stable over time but is more related to well-being than to NDD or mental health problems.

CONCLUSIONS

Gender is an important factor with girls exhibiting more problems. Mental health explains more of the variation in participation than mental health problems and NDD. Probably participation intervention can enhance mental health which may protect from mental health problems.Implications for rehabilitationMental health, i.e., emotional-, social-, and psychological well-being is more strongly related to participation and to reduced levels of mental health problems than having an NDD or not, thus assessing mental health separately from measuring NDD is important.Interventions focusing on participation may lead to higher mental health and having high mental health (flourishing) may facilitate participation.Girls with self-reported NDD seem to have a higher burden of mental health problems, especially if they also are languishing, i.e., having low mental health, therefore a strong focus on this group is needed both in research and clinical practice.Half of all adolescents are flourishing, independently of NDD or not, even if they are experiencing some symptoms of mental health problems, adolescents with NDD who are also languishing, have much higher ratings of mental health problems.

Voices of children with intellectual disabilities on participation in daily activities

Background

Participation in daily activities is expressed as a human right. Full participation of children with disabilities in daily activities creates optimal opportunities for learning and development. Previous studies have focused primarily on proxy ratings of participation of children with intellectual disabilities in daily activities. However, little is known about how the children rate barriers and facilitators to their participation in everyday activities.

Objectives

To identify barriers to and facilitators for everyday activities as experienced by children with intellectual disabilities from low- and middle-income countries and high-income countries. The research questions were as follows: 'what barriers to participation do children with disabilities experience in everyday activities?' and 'what facilitators to participation do children with disabilities experience in everyday activities?'

Method

A qualitative content analyses was used in this study, and individual interviews were conducted with 49 children with intellectual disabilities. The interviews were performed using pictures. The children also selected the most important activities and described in their own words the facilitators and barriers relevant to being able to perform the activities.

Results

The most important activities were organised leisure activities, formal learning at school, taking care of other family members and family mealtimes. Self-reported barriers identified were personal functioning, social exclusion and lack of resources. The identified facilitators included satisfaction, personal capability, being included and having access to resources.

Conclusion

These findings provide important knowledge about the factors to consider in the development of interventions, aimed at improving the participation of children with intellectual disabilities.

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.

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.

Agreement between participation ratings of children with intellectual disabilities and their primary caregivers

BACKGROUND

Participation of children with ID it is argued must be understood in relation to the fit with the environment. Since caregivers are a vital factor within the close environment of a child with intellectual disability, their perceptions are unequivocally important.

AIMS

The main aim of this study is to describe the self-reported participation of children with ID and the perceptions of their primary caregivers. Both frequency of attendance and perceived importance of activity was measured with self-reported and proxy-reports.

METHODS & PROCEDURES

A custom developed Picture my Participation (PmP) survey was utilised in an interview format with children with intellectual disability whilst their primary caregivers completed the survey independently.

RESULTS

Overall, the perceptions of children with intellectual disabilities and of primary caregivers showed similarities regarding attendance and activities considered important. On group level, both children and primary caregivers perceived the child to have a high level of attendance ofFormal learning in school, Family mealtime, Interacting with family and Celebrations. An overall poor agreement in perceived frequency of attendance was found. However, in child-primary cargiver-dyads poor agreement in perceived frequency of attendance was found.

CONCLUSIONS

While primary caregivers and children's ratings of attendance and selection of the most important activities appeared somewhat similar, there was a noted difference, in that primary caregivers' were uniform in their selection, whilst there was a diversity in the selection of activities amongst children.

From thinking to acting: occupational self-analysis tools for use with people with intellectual disability. A pilot study

BACKGROUND

Occupational self-analysis programmes have been developed to promote health, mainly in older adults. However, we have found no published studies dealing with this in people with intellectual disability (ID). The aim of this study was to examine the effectiveness of an occupational self-analysis programme in people with ID, focusing on the areas of subjective health perception and participation.

METHODS

This study explored the benefits of the 'Occupational Self-Analysis Programme' in people with ID. The intervention group comprised 12 participants and the control group comprised 13 participants. Outcomes were measured using the SF-36 Health Survey and the Role Checklist. The contents of participants' journals and a focus group discussion were also analysed.

RESULTS

Compared with the control group, the intervention group showed statistically significant improvements in role limitations because of physical health and role limitations because of emotional problems, social functioning and the cumulative scores of the mental component in the SF-36 Health Survey. The qualitative analysis revealed that participants in the intervention group increased their participation in activities related with daily living, leisure, employment seeking and acquisition, and social participation. These participants also became more aware of issues that lead to a greater engagement in meaningful occupations.

CONCLUSION

This programme allowed participants to engage in meaningful activities with other people and to increase their perceived health status by raising awareness of the strengths and difficulties of participation.

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.

Understandings of participation in daily activity services among people with intellectual disabilities: A pedagogical sociocultural perspective

This study sought to explore different understandings of participation in daily activity services among people with intellectual disabilities. Using a pedagogical sociocultural perspective, the research focused on individuals' perspectives and understandings as well as their account of social interaction, working and learning. In all, 17 people working in daily activity services were interviewed once, and, of these, 14 were interviewed a second time. Using qualitative content analysis, two themes and three categories were singled out. The results show that participation can be understood in two major ways: social interaction and performing work tasks.

The ICF has made a difference to functioning and disability measurement and statistics

AIMS

Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics.

METHODS

In a scoping review, we investigated research published 2001-2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge.

RESULTS

The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation.

CONCLUSION

The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes. Implications for Rehabilitation The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance. Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning. Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.

Participation, both a means and an end: a conceptual analysis of processes and outcomes in childhood disability

This review outlines a conceptual approach to inform research and practice aimed at supporting children whose lives are complicated by impairment and/or chronic medical conditions, and their families. 'Participation' in meaningful life activities should be an essential intervention goal, to meet the challenges of healthy growth and development, and to provide opportunities to help ensure that young people with impairments reach their full potential across their lifespan. Intervention activities and research can focus on participation as either an independent or dependent variable. The proposed framework and associated hypotheses are applicable to children and young people with a wide variety of conditions, and to their families. In taking a fresh 'non-categorical' perspective to health for children and young people, asking new questions, and exploring issues in innovative ways, we expect to learn lessons and to develop creative solutions that will ultimately benefit children with a wide variety of impairments and challenges, and their families, everywhere.

The Relationship Between Intelligence Quotient and Aspects of Everyday Functioning and Participation for People Who Have Mild and Borderline Intellectual Disabilities

BACKGROUND

This study explored the relationship between intelligence quotient (IQ) and aspects of everyday functioning/participation in individuals (age 16-40) who have a mild/borderline intellectual disability (IQ 55-85).

METHOD

Correlations were examined between IQ and (i) self-rated (n = 72) ability, participation as performance (how often an activity is performed), important participation restriction (not/seldom performing an activity perceived as important) and general well-being and (ii) proxy-rated (n = 41) ability and participation as performance.

RESULTS

No significant correlations between IQ and any of the explored measures were found. However, the effect sizes of the correlations between IQ and ability were considered as small but not negligible.

CONCLUSIONS

The results support the notion that IQ is a poor predictor of general aspects of everyday functioning in persons with mild/borderline intellectual disability. The result indicates that self-ratings partly generate other information than proxy ratings which may be important for assessments of supportive requirements and diagnosis.

Simplified bipartite concepts of functioning and disability recommended for interdisciplinary use of the ICF

PURPOSE

To argue for and propose bipartite concepts of functioning and disability, to tally with the structure of the ICF classification list, concepts of social models and clinical needs.

METHOD

The ICF concepts are discussed in relation to the history of ideas regarding disability concepts and the needs for such concepts in interdisciplinary rehabilitation.

RESULTS

Bipartite concepts are presented; they refer to actual functioning, simply body functions/structures and participation, including functioning in standardized environments. Participation refers to actually performed "activities", with "activities" simply denoting things that people may do. Bipartite concepts are congruent with the ICF classification and the structure of social models of disability, suitable for clinical and interdisciplinary use and easy to understand. The issue of standardized environments represents a methodological issue rather than the conceptual issue of defining functioning and disability. An individual perspective on activity and activity limitations, i.e. the middle part of the tripartite ICF concept, is somewhat similar to concepts of traditional language that were regarded as too generalizing already in 1912, when the interactional concept of "disability in a social sense" was introduced in rehabilitation practices.

CONCLUSION

Bipartite concepts of functioning and disability are recommended for interdisciplinary use of the ICF.

IMPLICATIONS FOR REHABILITATION

The ICF classification is useful, but the ICF concept of activities in an individual perspective is confusing. We suggest a use of the term "activities" simply to denote things that people may do and "participation" to denote actually performed activities. Estimations of ability should be explicit about how they are related to environmental factors.

Dilemmas of participation in everyday life in early rheumatoid arthritis: a qualitative interview study (The Swedish TIRA Project)

PURPOSE

To explore the experiences of today's patients with early rheumatoid arthritis (RA) with respect to dilemmas of everyday life, especially regarding patterns of participation restrictions in valued life activities.

METHODS

A total of 48 patients, aged 20-63, three years post-RA diagnosis were interviewed using the Critical Incident Technique. Transcribed interviews were condensed into meaningful units describing actions/situations. These descriptions were linked to ICF participation codes according to the International Classification of Functioning, Disability and Health (ICF) linking rules.

RESULTS

Dilemmas in everyday life were experienced in domestic life, interpersonal interactions and relationships, community, social and civic life. Most dilemmas were experienced in domestic life, including participation restrictions in, e.g. gardening, repairing houses, shovelling snow, watering pot plants, sewing or walking the dog. Also many dilemmas were experienced related to recreation and leisure within the domain community, social and civic life. The different dilemmas were often related to each other. For instance, dilemmas related to community life were combined with dilemmas within mobility, such as lifting and carrying objects.

CONCLUSIONS

Participation restrictions in today's RA patients are complex. Our results underline that the health care needs to be aware of the patients' own preferences and goals to support the early multi-professional interventions in clinical practice. Implications of Rehabilitation Today's rheumatoid arthritis (RA) patients experience participation restrictions in activities not included in International Classification of Functioning, Disability and Health (ICF) core set for RA or in traditionally questionnaires with predefined activities. The health care need to be aware of the patients' own preferences and goals to meet the individual needs and optimize the rehabilitation in early RA in clinical practice.

Outpatient physical therapy utilization for children and adolescents with intellectual disabilities in Taiwan: a population-based nationwide study

This study analyzed the utilization and utilization determinants of outpatient physical therapy (PT) among children and adolescents with intellectual disabilities (ID) in Taiwan. A cross-sectional study was conducted to analyze 2007 national health insurance (NHI) claim data from 35,802 eighteen-year-old and younger persons with intellectual disabilities. A total of 3944 (11.02%) claimants received outpatient physical therapy. Variables that affected PT utilization included age, residence urbanization level, ID level, copayment status and major co-morbidity. The average annual PT visit frequency was 25.4 ± 33.0; pre-school children, claimants suffering from catastrophic disease and ID co-occurring with cerebral palsy had a higher mean cost per visit. Age, ID level, copayment status and co-morbidity were factors that influenced expenditure. Pre-school children, males, individuals who resided in the lowest urbanization areas and individuals with a catastrophic disease tended to use hospital services. The point prevalence of epilepsy and cerebral palsy were 12.10% and 19.80%, respectively. Despite the NHI program and government regulations to provide special services, the use of physical therapy for children and adolescents with intellectual disabilities was low, and the utilization decreased as the subjects aged.