The Effect of Context-Based Interventions at the Systems-Level on Participation of Children with Disabilities: A Systematic Review

Abstract

Aims

To synthesize evidence on the impact of context-based interventions on the participation of children with disabilities in the community.

Methods

A systematic review was conducted using the American Academy for Cerebral Palsy and Developmental Medicine Guidelines for systematic reviews. Seven databases were searched; articles included were on children with developmental disabilities under the age of 19 years, describing systems-level, context-based interventions aimed to improve participation and Participation-related outcomes of the Family of Participation-related Constructs framework. Intervention characteristics were coded using the Community Wellbeing Framework (CWF).

Results

Eleven articles were included for knowledge synthesis. Four studies were level I, II, and III based on the Center for Evidence-Based Medicine hierarchy. All four showed that context-based interventions had a positive effect on participation and participation-related outcomes. All 11 studies had intervention properties that were coded to at least one domain on the CWF.

Conclusion

There is a scarcity of high-quality studies that focus on context-based interventions at the systems-level, as opposed to the individual-level. Albeit low-level quality, existing evidence emphasized the importance of using known facilitators to participation, such as staff training, peer mentorship, awareness-raising, and development of partnerships to change the system and promote participation.

Keywords:

• Children with disabilities
• context-based
• participation
• intervention
• systems-level
• policy

Acknowledgments

We thank and acknowledge Ms. Jill Boruff, librarian working at McGill University, and Ms. Ibtisam Mahmoud and the librarians working at McGill University Health Centre, who helped develop the search strategy and conduct the search within the databases.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This project is funded by the Canadian Institutes of Health Research through a Strategic Patient Oriented Research network: CHILD-BRIGHT and the Montreal Children’s Hospital Foundation– Operation Enfant Soleil. Infrastructural support is provided by the Center for Interdisciplinary Research in Rehabilitation (CRIR).

Notes on contributors

Paul Yejong Yoo

Paul Yejong Yoo, MSc, OT, is a PhD Candidate in Rehabilitation Science in the Faculty of Medicine and Health Sciences at McGill University.

Ebele R. I. Mogo

Ebele R. I. Mogo, PhD, is a Research Associate in the MRC Epidemiogy Unit at the University of Cambridge School of Clinical Medicine.

Janet McCabe

Janet McCabe, RN, PhD, is an Associate Dean of Nursing in the Faculty of Health Sciences at, Ontario Tech University.

Melanie Bergthorson

Melanie Bergthorson, OT, is an Occupational Therapist at the Lethbridge-Layton-Mackay Rehabilitation Centre.

Rose Elekanachi

Rose Elekanachiis PhD Candidatein Rehabilitation Science in the Faculty of Medicine and Health Sciences at McGill University.

Roberta Cardoso

Roberta Cardoso, RN, PhD, is a Research Associate at the McGill University Health Centre.

Mehrnoosh Movahed

Mehrnoosh Movahed, MD, PhD, is a Research Associate in the School of Phsical and Occupational Therapy at McGill University.

Annette Majnemer

Annette Majnemer, OT, PhD, FCAHS, is the Vice-Dean of Education in the Faculty of Medicine and Health Sciences at McGill University.

Keiko Shikako

Keiko Shikako, OT, PhD, is an Associate Professor in the School of Physical and Occupational Therapy at McGill University.