Review article (meta-analysis)A Systematic Review of Instruments Assessing Participation: Challenges in Defining Participation
Section snippets
Defining Participation
Our definition of participation is based on definitions found in the literature.7, 8, 9, 11, 12 We defined participation as performing roles in the domains of social functioning, family, home, financial, work/education, or in a general domain. First, activities were distinguished from participation by stating that participation requires a social context, involving not just an environmental factor, but mainly involving other people. For example, we considered visiting friends as participation,
Screening Abstracts and Articles
The reviewers screened 4967 abstracts and 320 full-text articles including 222 instruments. Selected were 189 articles on 112 instruments that measured participation according to the authors of the included articles. The participation items were classified for 103 instruments because 9 instruments could not be retrieved. The selection process of abstracts and full-text articles is described in figure 1.
Number of participation items in the selected instruments
The 103 selected instruments contained 2445 items. Of the selected items 619 (25%) items were
Extent to Which Participation Items and Instruments Measure Participation
Based on a review of relevant literature, we used a definition of participation which was shared between the 2 raters and classified 25% of the items in our review as addressing participation, 66% as not addressing participation, and 9% of the items as undetermined items. According to our working definition of participation, only a few instruments (the Activity Participation Questionnaire [APaQ], the Global Assessment of Functioning [GAF], and the Personal and Social Performance [PSP] scale)
Conclusions
Our review shows that, according to our working definition of participation, most instruments that aim to measure participation do so only to a limited extent. Instruments differ in their content and operationalization of the concept participation. Most participation domains concerned the domains of work/study, social life, general participation, and home; fewer items concerned the domains family life and financial participation. Participation items mostly refer to participation problems and
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