Law Mary, Anaby Dana, Imms Christine, Teplicky Rachel, Turner Laura
CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.
Aust Occup Ther J. 2015 Apr;62(2):105-15. doi: 10.1111/1440-1630.12177. Epub 2015 Feb 9.
BACKGROUND/AIM: Youth with physical disabilities experience restrictions to participation in community-based leisure activities; however, there is little evidence about how to improve their involvement. This study examined whether an intervention to remove environmental barriers and develop strategies using a coaching approach improved youth participation in leisure activities.
An Interrupted Time Series design was employed, where replication of the intervention effect was examined across individualised participation goals and across participants. Six adolescents with a physical disability participated in a 12-week intervention. An occupational therapist worked with each youth and his/her family to set three leisure goals based on problems identified using the Canadian Occupational Performance Measure (COPM). A coaching approach was used to collaboratively identify and implement strategies to remove environmental barriers. Interventions for each goal were introduced at different time points. Outcomes were evaluated using the COPM.
Improvements in COPM performance scores were clinically significant for 83% of the identified activities; an average change of 4.5 points in the performance scale (SD = 1.95) was observed. Statistical analysis using the celeration line demonstrated that the proportion of data points falling above the line increased in the intervention phase for 94% of the activities, indicating a significant treatment effect.
This study is the first to examine an intervention aimed at increasing leisure participation by changing only the environment. The results indicate that environment-focussed interventions are feasible and effective in promoting youth participation. Such findings can inform the design of a larger study and guide occupational therapy practice.
背景/目的：身体残疾的青少年在参与社区休闲活动方面受到限制；然而，关于如何提高他们的参与度，几乎没有相关证据。本研究探讨了一项旨在消除环境障碍并采用指导方法制定策略的干预措施是否能提高青少年对休闲活动的参与度。
采用中断时间序列设计，在个性化参与目标和参与者中检验干预效果的重复性。六名身体残疾的青少年参与了为期12周的干预。一名职业治疗师与每位青少年及其家人合作，根据使用加拿大职业表现测量量表（COPM）确定的问题设定三个休闲目标。采用指导方法共同确定并实施消除环境障碍的策略。针对每个目标的干预措施在不同时间点引入。使用COPM评估结果。
83%已确定活动的COPM表现得分在临床上有显著改善；观察到表现量表平均变化4.5分（标准差=1.95）。使用加速度线进行的统计分析表明，在干预阶段，94%的活动中高于该线的数据点比例增加，表明有显著的治疗效果。
本研究首次检验了一项仅通过改变环境来提高休闲参与度的干预措施。结果表明，以环境为重点的干预措施在促进青少年参与方面是可行且有效的。这些发现可为更大规模研究的设计提供参考，并指导职业治疗实践。
