Author
BULT M. K.; et al.;
What influences participation in leisure activities of children and youth with physical disabilities? A systematic review.
Journal citation/publication details
Research in Developmental Disabilities, 32(5), September-October 2011, pp.1521-1529.
Summary
A range of variables associated with participation in leisure activities was identified and reported in the 17 studies included in this systematic review. The bulk of the evidence comes from studies of young people with cerebral palsy, although similar variables seem to apply to children with other physical disabilities. Age was found to be an important factor that influences participation, but there is no evidence on the variables associated with different age groups. The need for more studies in more diverse populations, and a clearer definition and standardised measure of participation is emphasised.
Context
A range of variables influence the participation of children with a physical disability in leisure activities. Research in young people with cerebral palsy, who represent the largest group in paediatric rehabilitation, has identified child-related, family, and environmental factors as being important. The aim of this study was to systematically review the evidence on variables that effect participation in leisure activities for young people with a range of physical disabilities, and look at whether different variables are evident for various diagnoses and age groups.
Methods
What sources were searched?
The PubMed, Medline, Embase, PsycINFO, and CINAHL databases were searched from January 2001, when the International Classification of Functional Disability Children and Youth version (ICF-CY) was presented, to January 2010.
What search terms/strategies were used?
A range of terms specified in the text and used to identify children aged two to eighteen years were combined with ‘participation’ AND (‘leisure’ OR ‘recreation’ OR ‘activity’ OR ‘activities’). Searches were not limited to specific diagnoses so that no types of physical disability would be missed.
What criteria were used to decide on which studies to include?
Quantitative studies using objective measures of determinants of participation in children aged 2-18 years with a physical disability, and published in English, were eligible for inclusion. Studies were excluded if they were intervention studies, quantitative, focused on validating measures, or comparisons of children with and without physical disability. Also excluded were studies of young people with acquired brain injury.
Who decided on their relevance and quality?
Studies were initially selected on the basis of the title and abstract by the first author. The remaining studies were then screened by the second author and relevant papers were obtained and read in full. The final selection was made by both authors; disagreements were resolved by discussion. Study quality was not formally assessed.
How many studies were included and where were they from?
A total of 3,761 titles was retrieved from the database search. Following initial screening, 36 studies were obtained in full, 17 of which were selected for inclusion in the review. There is no indication of where the studies were set.
How were the study findings combined?
Data extraction was carried out by the first author and checked by the second author. This is a narrative review; the results are analysed according to the five ICF-CY domains: health condition; body structure and function; activities; personal factors, and; environmental factors, and presented in a flowchart of associated variables as a composite score of communication and cognitive functioning.
Findings of the review
There were ten studies of children with cerebral palsy, four studies of children with central nervous system or musculoskeletal disorders, and one study each of children with spinal cord injury, developmental coordination disorder, and polyarticular arthritis. Most studies included young people with a mean age of 10-11 years. Six studies focused exclusively on school children aged 6-12 years, and 11 studies included school-aged and adolescent children. There were no studies focusing exclusively on adolescents aged 13-18 years.
The level of gross motor function was associated with participation in six studies of children with cerebral palsy. The severity of the physical disability was also related to participation level, as was manual ability. Gross manual ability was also associated with more restrictions on participation by children with developmental coordination disorder and spinal cord injury.
Four studies reported lower rates of participation in those with cerebral palsy and learning disabilities. There were also reports that communication functioning and speech was an important variable associated with restricted participation, as was epilepsy. Better physical functioning, measured at an activity level using the GMFM and ASK scales, was associated with higher participation levels in six studies of cerebral palsy.
The personal factors of age and gender were both associated with levels of participation: increasing age was related to participation in fewer activities and less frequent participation, and; girls were more likely to participate than boys. Fewer than half of the studies found environmental variables associated with participation. Those that did, reported a range of parental factors, school- and peer-related factors, and the use of rehabilitation services as being important determinants of participation. Age was found to be an important variable in several studies but there was no evidence of associations for different age groups.
Authors' conclusions
‘The review showed gross motor function, manual ability, cognitive ability, communicative skills, age and gender to be the most important variables [associated with participation in leisure and social activities for young people with physical disabilities]. Evidence suggests that these same variables are applicable to different diagnostic groups. Although difference exists between different age groups, similar determinants of participation were identified for different age groups.’
Implications for policy or practice
None are discussed.