Hwang Ai-Wen, Yen Chia-Feng, Liou Tsan-Hon, Simeonsson Rune J, Chi Wen-Chou, Lollar Donald J, Liao Hua-Fang, Kang Lin-Ju, Wu Ting-Fang, Teng Sue-Wen, Chiu Wen-Ta
Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Department of Public Health, Tzu Chi University, Hualien, Taiwan.
PLoS One. 2015 May 11;10(5):e0126693. doi: 10.1371/journal.pone.0126693. eCollection 2015.
Independence and frequency are two distinct dimensions of participation in daily life. The gap between independence and frequency may reflect the role of the environment on participation, but this distinction has not been fully explored.
A total of 18,119 parents or primary caregivers of children with disabilities aged 6.0-17.9 years were interviewed in a cross-sectional nationwide survey with the Functioning Scale of the Disability Evaluation System - Child version (FUNDES-Child). A section consisting of 20 items measured the children's daily participation in 4 environmental settings: home, neighborhood/community, school, and home/community. Higher independence and frequency restriction scores indicated greater limitation of participation in daily activities. Scores for independence, frequency and independence-frequency gaps were examined across ages along with trend analysis. ANOVA was used to compare the gaps across settings and diagnoses for children with mild levels of severity of impairment.
A negative independence-frequency gap (restriction of frequency was greater than that of independence) was found for children with mild to severe levels of impairment. A positive gap (restriction of independence was greater than that of frequency) was found for children with profound levels of severity. The gaps became wider with age in most settings of children with mild impairment and different diagnoses. Widest negative gaps were found for the neighborhood/community settings than for the other three settings for children with mild to severe impairment.
Children's participation and independence-frequency gaps depend not only on the severity of their impairments or diagnoses, but also on their age, the setting and the support provided by their environment. In Taiwan, more frequency restrictions than ability restrictions were found for children with mild to moderate severity, especially in the neighborhood/community setting, and increased with age. Further identification of environmental opportunities that positively impact frequency of participation is needed.
独立性和频率是日常生活参与的两个不同维度。独立性和频率之间的差距可能反映了环境对参与的作用，但这种差异尚未得到充分探讨。
在一项全国性横断面调查中，使用残疾评估系统儿童版功能量表（FUNDES-Child）对18119名6.0至17.9岁残疾儿童的父母或主要照顾者进行了访谈。一个由20个项目组成的部分测量了儿童在4种环境中的日常参与情况：家庭、邻里/社区、学校和家庭/社区。较高的独立性和频率限制得分表明日常活动参与的限制更大。对不同年龄段的独立性、频率和独立性-频率差距得分进行了检查，并进行了趋势分析。方差分析用于比较轻度损伤严重程度儿童在不同环境和诊断中的差距。
发现轻度至重度损伤儿童存在负独立性-频率差距（频率限制大于独立性限制）。对于极重度损伤儿童，发现存在正差距（独立性限制大于频率限制）。在大多数轻度损伤和不同诊断的儿童环境中，差距随着年龄的增长而扩大。对于轻度至重度损伤儿童，邻里/社区环境中的负差距比其他三种环境中的负差距更大。
儿童的参与和独立性-频率差距不仅取决于其损伤的严重程度或诊断，还取决于他们的年龄、环境以及环境提供的支持。在台湾，发现轻度至中度严重程度的儿童频率限制多于能力限制，尤其是在邻里/社区环境中，且随着年龄增长而增加。需要进一步确定对参与频率有积极影响的环境机会。
