Towards multi-faceted outcomes of participation-based interventions: mapping the PREP’s effects for children and youth with disabilities

Abstract

Purpose

Systematically organizing participation effects may guide participation-based research designs in rehabilitation. This perspective paper uses existing evidence on Pathways and Resources for Engagement and Participation (PREP) to showcase the multitude of effects from a single intervention and synthesize the magnitude of these effects.

Methods

An outcome matrix of participation effects comprising three dimensions (intermediate, instrumental, ultimate) and two levels (transient, enduring) was used to systematically map PREP’s effects. Forest plot demonstrated clinically important changes in the Canadian Occupational Performance Measure (COPM) across studies. Effect sizes were calculated.

Results

The majority of outcomes from 11 studies were mapped to ultimate-transient effects (e.g., changes in participation of self-chosen activities), followed by instrumental-transient effects (e.g., changes in motor body functions). Fewer outcomes were mapped to ultimate-enduring effects (e.g., changes of participation for a longer period or across settings) or intermediate-enduring effects (e.g., therapist-applied knowledge), demonstrating the gaps for investigating enduring effects. COPM changes in most studies (89%) showed clinical significance with small to large effects.

Conclusions

Systematic mapping from PREP example guides categorizing multidimensional outcomes. Future participation-based studies can employ individual-based mixed-methods designs to delve into the long-lasting enduring outcomes of youth capacity-building and the transformative process of pursuing meaningful participation goals.

IMPLICATIONS FOR REHABILITATION

• Systematically organizing participation effects according to the proposed matrix enhances understanding of multidimentisonal outcomes from a single participation-based intervention.

• Child/youth-engaging interventions like Pathways and Resources for Engagement and Participation (PREP) can offer a multitude of benefits that promote outcomes of participation and physical and mental health, enhancing efficient/effective rehabilitation services.

• It is essential that future intervention designs prioritize long-lasting/enduring effects across broad settings and capture underlying processes and capacity building of children/youth toward sustainable participation outcomes.

Keywords:

• Childhood-onset disabilities
• environment-based therapy
• outcome mapping
• participation
• pragmatic designs

Acknowledgement

The authors would like to thank Professor Mats Granlund at Jönköping University in Sweden for his valuable input on the outcome matrix and suggestions on mapping the participation effects of the PREP studies. The authors are grateful to Dr. Lisa Avery at Toronto University for her assistance in data analysis and input on outcome synthesis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.