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

Figures & data

Figure 1. PRISMA flowchart showing article yield of included measures during searches.

PRISMA flowchart showing the studies included in this systematic review. This flowchart starts from initial database searches, and outlines reasons for exclusions at both title and abstract as well as full text review. This resulted in the inclusion of 7 participation-focused measures and 27 studies.

Figure 2. ICF domains covered across the seven participation-focused measures.

This figure provides a summary of how many participation-focused measures captured each of the ICF domains, with d9 mapped to all seven measures.

Table 1. Guide to synthesising levels of evidence in psychometric reviews as reported by Schellingerhout et al. [52] and derived from van Tulder et al. [53].

Level	Rating	Criteria
Strong	+++ or −−−	Consistent findings in multiple studies of adequate methodological quality OR in one study of very good methodological quality
Moderate	++ or −−	Consistent findings in multiple studies of doubtful methodological quality OR in one study of adequate methodological quality
Limited	+ or −	One study of doubtful methodological quality
Conflicting	+/−	Conflicting findings
Unknown	?	Only studies of inadequate methodological quality

+ = positive result; − = negative result.

This version has been modified to include the 2018 COSMIN checklist ratings of methodological quality for single studies in systematic reviews of outcome measures [47].

Figure 3. Family of Participation-Related Constructs covered across the seven participation-focused measures.

This figure provides a summary of how many participation-focused measures captured each of the fPRC constructs, with attendance mapped to all seven measures.

Table 2. Description of participation-focused measures used for young people with cerebral palsy.

Measure	Age range	Administration	Time	Cost	Description
CASP [80]	5–18 years	Self-report or Proxy-report	10 min	None stated	20 items across 4 subsections: Home Participation (6 items) Community Participation (4 items) School Participation (5 items) Home and community living activities (5 items) 5-point scale to rate extent of their participation (1: Not applicable to 5: Full participation)
CAPE/PAC [61]	6–21 years	Self-report or Proxy-report	30 to 45 min	$260	55 items across 2 domains: Informal (40 items), Formal (15 items) rating participation outside of school 5 activity-type subscales: Recreational (12 items) Social (10 items) Active-physical (13 items) Skill-based (10 items) Self-improvement (10 items) CAPE: 7-point scale for frequency (1: 1 time in the past 4 months to 7: 1 time a day or more) 5-point scale for enjoyment (1: Not at all to 5: Love it) PAC: 3-point scale (1: I would not like to do at all to 3: I would really like to do)
FPQ [81]	8–12 years (Used with older ages in included studies)	Proxy-report	5 to 10 min	None stated	14 items related to participation at: Home School Community 6-point scale about the frequency they attend activities (1: Never to 6: A few times a week)
PEM-CY [82]	5–17 years	Proxy-report	20 min	$99	25 items focused on participation in broad types of activities: Home (10 items), School (5 items) Community (10 items) 8-point scale - Attendance (1: Never to 8: Daily) 5-point scale - Involvement (1: Minimally involved to 5: Very involved)
PARTS/M [66]	17 years and older	Self-report	20 to 30 min	None stated	135 items measuring participation in major life activities. A range of scales rating: frequency, health-related barriers, importance, choice, satisfaction, the respondent’s usage of assistive technology devices and/or personal assistance. Scale specific for each item e.g., 4-point scale from (“4: Never” to “1: 5 or more times a week”)
QYPP [67]	13–21 years	Self-report or Proxy-report	20 to 30 min	None stated	45 items and 7 domains: Home life (5 items) Getting on with other people (8 items) School or college life (5 items) Work life (4 items) Recreation and leisure (14 items) Autonomy (4 items) Preparing for the future (5 items) Scale specific for each item e.g., 7-point scale from (“7: Never” to “1: Every day”)
SEAS [70]	13–23 years	Self-report	10 min	None stated	22 items with 5 subscales: Personal growth (6 items) Psychological engagement (4 items) Social belonging (4 items) Meaningful interactions (4 items) Choice and control (4 items) A range of 7-point scale rating experience in a recent recreation or leisure activity (−3 strongly disagree to +3 strongly agree)

CASP: Child and Adolescent Scale of Participation; CAPE: Children’s Assessment of Participation and Enjoyment; PAC: Preference for Activities of Children; FPQ: Frequency of Participation Questionnaire; PARTS/M: Participation Survey/Mobility; PEM-CY: Participation and Environment Measures for Children and Youth; QYPP: Questionnaire of Young People’s Participation; SEAS: Self-reported Experiences of Activity Settings.

Table 3. Participation-focused measures mapped to ICF and fPRC.

		fPRC: Participation constructs		fPRC: Related constructs
Measure	ICF domains	[A] Attendance	[I] Involvement	[C] Activity competence [S] Sense-of-self [P] Preferences [E] Environment [O] Other contextual factors
CASP [80]	20 items: participation at home, school, and in the community 4 subsections: Home participation (6 items), Community Participation (4 items), School Participation (5 items), and Home and community living activities (5 items) [d3] Communication, d310–d329 Communicating – receiving, d330–d349 Communicating – producing, and d350–d369 Conversation and use of communication devices and techniques [d4] Mobility: d450 Walking, d460 Moving around in different locations, and d470–d489 Moving around using transportation [d5] Self-care: d510 Washing oneself, d520 Caring for body parts, d530 Toileting, d540 Dressing, d550 Eating, and d5702 Maintaining one’s health [d6] Domestic life: d620 Acquisition of goods and services and d640 Doing housework [d7] Inter-personal Interactions and relationships: d760 Family relationships, d750 Informal social relationships, d740 Formal relationships and d730 Relating with strangers [d8] Major life areas: d810–d839 Education, d850 Remunerative employment (paid), and d855 Non-remunerative employment (volunteer) [d9] Community, Social and Civic life: d9100 Informal associations, d9101 Formal associations, d920 Recreation and Leisure, d9201 Sports, d9200 Play, d9202 Arts and culture, 9204 Hobbies, and d9205 Socializing	3 scoring levels: summary score, subsection scores, item scores [A] Frequency (5-point scale, from“5: Not applicable/4: Unable” and then from “3: Very limited – you participate in the activities much less than others your age” to “1: Full participation – you participate in the activities the same as or more than others your age”)		3 scoring levels: summary score, subsection scores, item scores [E] Availability Assistive devices or equipment (yes/no) [E] Accommodability Changes to environment (yes/no)
CAPE/PAC [61]	55 items: participation in activities outside of school 2 domains: Informal (40 items) and Formal (15 items) 5 activity type subscales: Recreational (12 items), Social (10 items), Active-physical (13 items), Skill-based (10 items), and Self-improvement activities (10 items) [d3] Communication: d310–d329 Communicating - receiving, d330–d349, Communicating – producing, and d360 Using communication devices and techniques [d4] Mobility: d450 Walking and d460 Moving around in different locations [d6] Domestic life: d620 Acquisition of goods and services, d630 Preparing meals, d640 Doing housework, and d698 Domestic life, other specified [d7] Interpersonal interactions and relationships: d750 Informal social relationships and d760 Family relationships [d8] Major life areas: d820 School education, d835 Education life, d850 Remunerative employment, d855 Non-remunerative employment, d9100 Informal associations, d9101 Formal associations, d920 Recreation and Leisure, d9201 Sports, d9202 Arts and culture, 9204 Hobbies, and d9200 Play [d9] Community, Social and Civic life: d9205 Socializing and d930 Religion and spirituality	3 scoring levels: overall, 2 domains, 5 activity types [A] Diversity (2 levels, scored as 0: No, or 1: Yes) [A] Frequency (7-point scale, from “1: 1 time in the past 4 months”, to “7: 1 time a day or more”) [I] Enjoyment (5-point scale, from “1: not at all”, to “5: love it”)		3 scoring levels: overall, 2 domains and 5 activity types [P] Desire to complete activity (3-point scale, from “1: I would not like to do at all”, to “3: I would really like to do”) [O] Contextual information With whom (5-point scale, from “1: alone” to “5: with others”) and Where (6 locations, from “1: at home”, to “6: beyond your community”)
FPQ [81]	14 items: participation in activities at home, school, and community [d3] Communication, d310–d329 Communicating – receiving, d330–d349 Communicating – producing [d4] Mobility: d470–d489 Moving around using transportation [d5] Self-care: d550 Eating [d6] Domestic life: d620 Acquisition of goods and services and d640 Doing housework [d8] Major life areas: d835 Education life [d9] Community, social and civic life: d9100 Informal associations, d9101 Formal associations, d920 Recreation and Leisure, d9201 Sports, d9200 Play, d9202 Arts and culture, 9204 Hobbies and d9205 Socializing	1 scoring level: summary score [A] Frequency (6-point scale, from “1: Never” to “6: A few times a week”)
PEM-CY [82]	25 items: participation across activities and environments 3 settings: Home (10 items), school (5 items) and community (10 items) [d3] Communication: d310–d329 Communicating – receiving, d330–d349 Communicating – producing and d350-d369 Conversation and use of communication devices and techniques [d4] Mobility: d460 Moving around in different locations [d5] Self-care: d510 Washing oneself, d520 Caring for body parts, d540 Dressing, d550 Eating, and d5702 Maintaining one’s health [d6] Domestic life: d640 Doing housework [d7] Interpersonal interactions and relationships: d740 Formal relationships, d750 Informal social relationships, and d760 Family relationships [d8] Major life areas: d810–d839 Education and d850 Remunerative employment [d9] Community, social and civic life: d9100 Informal associations, d9101 Formal associations, d920 Recreation and Leisure, d9200 Play, d9201 Sports, d9202 Arts and culture, 9204 Hobbies, d9205 Socializing, and d930 Religion and spirituality	6 scoring levels: frequency, involvement, desire for change, environmental supportiveness, supports, resources [A] Frequency (8-point scale from “1: Never” to “8: Daily”) [I] Involvement level (5-point scale from “1: Minimally involved” to “5: Very involved”)		6 scoring levels: frequency, involvement, desire for change, environmental supportiveness, supports, resources [E] Availability Equipment, resources, and supports (4-point scale from “1: Not needed” to “4: Usually no”) [E] Accessibility Environmental access (4-point scale from “1: Not needed” to “4: Usually no”) [E] Acceptability Attitudes (4-point scale “1: Not an issue” to “4: Usually makes it harder”) [E] Affordability Enough money and time to support community participation (3-point scale from “1: Usually yes” to “3: Usually no”) [O] Caregiver’s desire for change in their child’s participation (6-point scale from “1: Yes, be involved in a broader variety of activities” to “6: No change desired”)
PARTS/M [66]	135 items: participation in major life activities for a typical day 20 major life activities: Dressing (6 items), Bathing (6 items), Bladder care (6 items), Bowel care (6 items), Meals (6 items), Move around inside your home (6 items), Working inside your home (7 items), Exterior maintenance (7 items), Leaving your home (7 items), Active recreation (7 items), Leisure activities (7 items), Taking vacations (7 items), Socializing (7 items), Parenting (7 items), Intimacy (7 items), Religious activities (7 items), Community activities (7 items), Employment (7 items), Volunteering (7 items), Managing money (7 items) [d4] Mobility: d455 Moving around, d460 Moving around in different locations, and d470–d489 Moving around using transportation [d5] Self-care: d510 Washing oneself, d520 Caring for body parts, d530 Toileting, d540 Dressing, and d550 Eating [d6] Domestic life: d620 Acquisition of goods and services, d630 Preparing meals, d640 Doing housework and d650-d669 Caring for household objects and assisting others [d7] Interpersonal interactions and relationships: Informal social relationships, d760 Family relationships, and d770 Intimate relationships [d8] Major life areas: d8501 Part-time employment, d8502 Full-time employment, d855 Non-remunerative employment, and d860-d879 Economic life [d9] Community, social and civic life: d9100 Informal associations, d9101 Formal associations, d9201 Sports, d9200 Play, d9202 Arts and culture, 9204 Hobbies, d9205 Socializing, and d930 Religion and spirituality	2 scoring levels: summary score, 20 life activity scores [A] Frequency scales (Scale specific for each item e.g., 4-point scale from “4: Never” to “1: 5 or more times a week”)		2 scoring levels: summary score, 20 life activity scores [C] Independence Needed help from another person (4-point scale from “4: None” to “1: A great deal”) [S] Satisfaction with participation (4-point scale from “4: Dissatisfied” to “1: Very satisfied”) [P] Choice (4-point scale from “4: No choice” to “1: A lot of choice”) [P] Importance (4-point scale from “4: Not important” to “1: Very important”) [E] Availability Personal assistance (4-point scale from “4: None” to “1: A great deal”) [E] Accommodability Accommodations or adaptations scales (5-point scale from “5: Never” to “1: All of the time”) [O] Health-related barriers (5- point “check all that apply”: “Not limited”, “Illness”, “A physical impairment”, “Pain”, “Fatigue”)
QYPP [67]	45 items: participation across home and community domains 7 domains: Home life (5 items), Getting on with other people (8 items), School or college life (5 items), Work life (4 items), Recreation and leisure (14 items), Autonomy (4 items), Preparing for the future (5 items) [d3] Communication: d310–d329 Communicating – receiving, d330–d349 Communicating – producing, and d350-d369 Conversation and use of communication devices and techniques [d4] Mobility: d470–d489 Moving around using transportation [d5] Self-care: d550 Eating and d560 Drinking [d6] Domestic life: d620 Acquisition of goods and services, d630 Preparing meals, and d640 Doing housework [d7] Interpersonal interactions and relationships: d730 Relating with strangers, d740 Formal relationships, d750 Informal social relationships, d760 Family relationships, and d770 Intimate relationships [d8] Major life areas: d810–d839 Education, d8501 Part-time employment, d8502 Full-time employment, and d860–d879 Economic life [d9] Community, social and civic life: d9100 Informal associations, d9101 Formal associations, d9201 Sports, d9200 Play, d9202 Arts and culture, 9204 Hobbies, and d9205 Socializing	2 scoring levels: summary score, 7 domain scores [A] Frequency (Scale specific for each item e.g., 7-point scale from “7: Never” to “1: Every day”)		2 scoring levels: summary score, 7 domain scores [P] Autonomy items Decision making (5-point scale from “5: Never” to “1: All or almost all of the time”)
SEAS [70]	22 items: participation experiences in recreational or leisure activities Perform activity for at least 15 min before completing the measure 5 scales: Personal growth (6 items), Psychological engagement (4 items), Social belonging (4 items), Meaningful interactions (4 items), and Choice and control (4 items) [d9] Community, social and civic life: d920 Recreation and Leisure	2 scoring levels: summary score, 5 scale scores [A] Diversity (Open-ended question “What activity did you do”) [I] Psychological engagement items (7-point scale from “-3 strongly disagree” to “+3 strongly agree”) [I] Social belonging items (7-point scale from “-3 strongly disagree” to “+3 strongly agree”) [I] Meaningful interaction items (7-point scale from “-3 strongly disagree” to “+3 strongly agree”)		2 scoring levels: summary score, 5 scale scores [C] Challenged during activity (7-point scale from “-3 strongly disagree” to “+3 strongly agree”) [S] Personal growth (7-point Scale from “-3 strongly disagree” to “+3 strongly agree”) [P] Choice and control (7-point scales from “-3 strongly disagree” to “+3 strongly agree”) [E] Acceptability Valued, supported, and encouraged by others (7-point scale from “-3 strongly disagree” to “+3 strongly agree”)

CASP: Child and Adolescent Scale of Participation; CAPE (Children’s Assessment of Participation and Enjoyment)/PAC (Preference for Activities of Children); FPQ: Frequency of Participation Questionnaire; PARTS/M: Participation Survey/Mobility; PEM-CY: Participation and Environment Measures for Children and Youth; QYPP: Questionnaire of Young People’s Participation; SEAS: Self-reported Experiences of Activity Settings.

Table 4. Levels of evidence for included participation-focused measures reported for young people with CP.

	Content validity		Construct validity		Internal consistency		Reliability		Responsiveness
Measure	COSMIN	Level of evidence	COSMIN	Level of evidence	COSMIN	Level of evidence	COSMIN	Level of evidence	COSMIN	Level of evidence
CASP			2 Doubtful (+)	Moderate (++)	2 Doubtful (+)	Moderate (++)	1 Adequate (+)	Moderate (++)
CAPE/PAC	1 Doubtful (+)	Limited (+)	2 Very good (+) 3 Adequate (+) 5 Doubtful (+)	Strong (+++)	1 Doubtful (+)	Limited (+)			2 Doubtful (+)	Moderate (++)
FPQ			1 Inadequate (−)	? Unknown					1 Doubtful (−)	Limited (−)
PEM-CY			2 Very good (+) 1 Adequate (+) 2 Doubtful (+)	Strong (+++)	1 Doubtful (+)	Limited (+)	1 Doubtful (+)	Limited (+)	1 Doubtful (−)	Limited (−)
PARTS/M	1 Adequate (+)	Moderate (++)	1 Doubtful (+)	Limited (+)	1 Very good (+)	Strong (+++)	1 Doubtful (+)	Limited (+)
QYPP	1 Adequate (+)	Moderate (++)	2 Doubtful (+)	Moderate (++)	1 Doubtful (+)	Limited (+)	1 Doubtful (+)	Limited (+)
SEAS	1 Adequate (+)	Moderate (++)	2 Doubtful (+)	Moderate (++)	1 Doubtful (+)	Limited (+)	1 Adequate (+)	Moderate (++)

+++ or −−− strong evidence positive/negative result; ++ or −− moderate evidence positive/negative result; + or − limited evidence positive/negative result; ± conflicting evidence, ? unknown, due to poor methodological quality.

Table 5. Accessibility and inclusion of individuals with communication support needs.

Measure	Report	Accessible design features	Included studies	Number (%) of participants reported with communication support needs and included GMFCS Levels	Participants completed via proxy and/or self-report	Communication support strategies used to assist self-report
CASP	Self-report or proxy-report	Not stated	Bedell [60]	313 American youth with and without disabling conditions (61 with developmental disability, including CP), aged 3–22 years 24 (7.67%) that included children with language difficulties No GMFCS Levels reported	Self-report Not stated Proxy-report Yes, Caregiver	Not stated
			McDougall et al. [59]	409 Canadian and American youth with disabilities (142 with CP), aged 11–17 years 44 (10.76%) with communication difficulties and physical issues impacting communication (cleft lip) No GMFCS Levels reported	Self-report Yes Proxy-report Yes, Parent	Further explanation of questions Additional time to answer
CAPE/PAC	Self-report or proxy-report	Picture cards with illustrations of the activities, categories, and visual response pages.[61]	Cleary et al. [83]	19 Australian youth with CP, aged 8–18 years No communication support needs reported Included GMFCS Levels I–III	N/A	N/A
			Imms et al. [84]	93 Australian youth with CP, aged 10–21 years No communication support needs reported Included GMFCS Levels I–V	N/A	N/A
			Kang et al. [85]	209 American youths with CP, aged 13–21 years 82 (39.23%) with communication or speech issues Included GMFCS Levels I–V	Self-report Yes Proxy-report Yes, Parent	Parental assistance or proxy-report was used as necessary
			Kang et al. [86]	135 American youths with CP, aged 13–21 years 39 (28.89%) with communication or speech difficulties Included GMFCS Levels I–V	Self-report Yes Proxy-report Yes, Parent	Elaborated descriptions of the activity and response options Parental assistance to recall details (the number of times activity had been done in the last four months) as necessary
			King et al. [61]	427 Canadian youth with disabilities (217 with CP), aged 6–15 years No communication support needs reported No GMFCS Levels reported	N/A	N/A
			King et al. [87]	427 Canadian children with physical disabilities (including CP), aged 6–15 years No communication support needs reported No GMFCS Levels reported	N/A	N/A
			King et al. [88]	1076 youth with CP from Australia, Canada, United States, aged 6–20 years No communication support needs reported Included GMFCS Levels I–V	N/A	N/A
			King et al. [69]	26 Canadian youth with severe disabilities (including CP), aged 14–22 years 15 (57.69%) with complex communication needs using AAC Included GMFCS Levels II–V	Self-report Yes Proxy-report Not stated	Using communication assistant as necessary
			Palisano et al. [89]	500 American children and youth with CP, aged 6–21 years. 307 (61.4%) with speech and/or communication difficulties Included GMFCS Levels I–V	Self-report Yes Proxy-report Yes, Parent	Parental assistance to recall details (the number of times activities completed recently, where, and with whom) Researcher support (reading or entering responses) Or through parent proxy-report if needed
			Palisano et al. [90]	205 American youth with CP, aged 13–21 years 65 (31.7%) with speech difficulties Included GMFCS Levels I–V	Self-report Yes Proxy-report Yes, Parent	Parental assistance to recall details (number of times activity had been done in the last four months) Parent proxy-report as necessary
			Shikako-Thomas et al. [91]	187 Canadian adolescents with CP, aged 12–20 years No communication support needs reported Included GMFCS Levels I–V	N/A	N/A
			Shikako-Thomas et al. [76]	128 Canadian adolescents with CP, aged 12–19 years 47 (36.72%) with communication difficulties Included GMFCS Levels I–V	Self-report Yes Proxy-report Yes, Parent	Parent proxy-report as necessary
			Shikako-Thomas et al. [92]	175 Canadian adolescents with CP, aged 12–20 years. 90 (51.43%) with cognitive or language limitations Included GMFCS Levels I–V	Self-report Yes Proxy-report Yes, Parent	Parent proxy-report was used for participants with cognitive or language difficulties
FPQ	Proxy-report	Not stated	Boyer et al. [63]	51 American youth with CP, aged 8–21 years No communication support needs reported Included GMFCS Levels I–IV	N/A	N/A
			Munger et al. [62]	35 American youth with CP, aged 16–25 years No communication support needs reported Included GMFCS Levels I–IV	N/A	N/A
PEM-CY	Proxy-report	Not stated	Armstrong et al. [65]	21 Australian children with CP, aged 6–18 years 4 (19.05%) were non-verbal Included GMFCS Levels II–IV	Self-report Not stated Proxy-report Yes, Caregiver	Not stated
			Bedell et al. [93]	576 Canadian and American caregivers of young people with and without disabilities (including CP), aged 5–17 years 60 (10.42%) with speech or language difficulties GMFCS levels not collecteda	Self-report None stated Proxy-report Yes, Caregiver	Not stated
			Coster et al. [64]	576 Canadian and American caregivers of youth with and without disabilities (including CP), aged 5–17 years 60 (10.42%) with speech or language difficulties GMFCS levels not collected^a	Self-report Not stated Proxy-report Yes, Caregiver	Not stated
			Khetani et al. [94]	89 American caregivers of youth with disabilities (including CP), aged 5–17 years 19 (21.35%) with communication difficulties GMFCS levels not collected^a	Self-report Not stated Proxy-report Yes, Caregiver	Not stated
			Mitchell et al. [95]	102 Australian children with CP, aged 8–17 years No communication support needs reported Included GMFCS Levels I and II	N/A	N/A
			Zeidan et al. [96]	72 Canadian youth with CP, aged 2-16 years No communication support needs reported Included GMFCS Levels I-V	N/A	N/A
PARTS/M	Self-report	Online version can select font size and background colour	Gray et al. [66]	604 American people with mobility impairments (including 88 with CP), aged 17–92 years No communication support needs reported No GMFCS Levels reported	N/A	N/A
QYPP	Self-report or proxy-report	Not stated	Michelsen et al. [68]	667 adolescents with CP or their parents and 4666 adolescents from general population from England, Ireland, Sweden, Denmark, Germany, France, and Italy, aged 11–18 years No communication support needs reported Included GMFCS Levels I–V	N/A	N/A
			Tuffrey et al. [67]	107 British young people with CP (+540 young people from general population), aged 13–21 years 53 (49.53%) with communication difficulties Included GMFCS Levels I–V	Self-report Yes Proxy-report Yes, Caregiver	Caregiver proxy-report when necessary
SEAS	Self-report	Picture Communication Symbols (PCS) version for youth that benefit from graphic symbol support [72]	King et al. [70]	45 Canadian youth with and without disabilities (9 with CP), aged 13–23 years 8 (17.78%) with complex communication needs using AAC No GMFCS Levels reported	Self-report Yes Proxy-report Not stated	Reading the questions aloud Scribing responses Providing explanations
			King et al. [69]	26 Canadian youth with severe disabilities (including CP), aged 14–22 years 15 (57.7%) with complex communication needs using AAC Included GMFCS Levels II–V	Self-report Yes Proxy-report Not stated	Using communication assistant as necessary

CASP: Child and Adolescent Scale of Participation; CAPE (Children’s Assessment of Participation and Enjoyment)/PAC (Preference for Activities of Children); FPQ: Frequency of Participation Questionnaire; PARTS/M: Participation Survey/Mobility; PEM-CY: Participation and Environment Measures for Children and Youth; QYPP: Questionnaire of Young People’s Participation; SEAS: Self-reported Experiences of Activity Settings.

^aPersonal communication from author.

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