Cogan Alison M, Carlson Mike
a Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy , University of Southern California , Los Angeles , CA, USA.
Disabil Rehabil. 2018 Nov;40(22):2692-2703. doi: 10.1080/09638288.2017.1342282. Epub 2017 Jun 21.
Participation is widely recognized as an important outcome for rehabilitation. However, it lacks a universally accepted definition. The purpose of this review is to synthesize the literature about participation in rehabilitation in order to clarify the term and increase its usefulness for rehabilitation providers and researchers.
We undertook an interpretive synthesis of the literature, drawing from a broad and varied selection of the vast number of publications on the subject of participation. The search and analysis was iterative and continued until saturation of themes was achieved.
Seventy-six articles were included in our analysis. We argue that three essential dimensions - performance, subjective experience, and interpersonal connection - constitute participation. We further divide participation into community-based and interventional contexts. Interventional participation is circumscribed by the treatment setting, whereas community-based encompasses all other areas. Participation in either interventional or community-based contexts is largely determined by the available opportunities from which a person can choose, with such opportunities affected by conditions that are either internal or external to the individual. As defined in this framework, participation is not inherently good or bad; rather, its effect is determined by a person's unique life circumstances and the impact may not always be apparent. We posit this model as a resource for future research as well as clinical reasoning. Implications for Rehabilitation The often tacit assumption that increasing participation is a desirable outcome needs to be challenged and considered in each patient's life situation. Treatment settings constitute a unique context in which patients participate. Intervention goals should be clearly connected with patients' personal goals for community-based participation.
参与被广泛认为是康复的一项重要成果。然而，它缺乏一个被普遍接受的定义。本综述的目的是综合有关康复中参与的文献，以阐明该术语，并提高其对康复提供者和研究人员的实用性。
我们对文献进行了诠释性综合，从大量关于参与主题的广泛多样的出版物中选取资料。检索和分析是迭代进行的，持续到主题饱和。
我们的分析纳入了76篇文章。我们认为，参与由三个基本维度构成——表现、主观体验和人际联系。我们进一步将参与分为基于社区的背景和干预背景。干预性参与受治疗环境的限制，而基于社区的参与则涵盖所有其他领域。在干预性或基于社区的背景下的参与很大程度上取决于个人可选择的现有机会，这些机会受到个人内部或外部条件的影响。按照这个框架所定义的，参与本身并无好坏之分；相反，其效果由个人独特的生活环境决定，而且影响可能并不总是显而易见的。我们将这个模型作为未来研究以及临床推理的一种资源。对康复的启示增加参与是一个理想结果这一通常隐含的假设需要受到质疑，并应根据每个患者的生活状况加以考虑。治疗环境构成了患者参与的一个独特背景。干预目标应与患者基于社区参与的个人目标明确相关。
