School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
School of Rehabilitation, Science and CanChild Research Centre, McMaster University, Hamilton, ON, Canada.
Dev Med Child Neurol. 2018 May;60(5):513-519. doi: 10.1111/dmcn.13682. Epub 2018 Feb 6.
This study examined the effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention in improving the participation of adolescents in community-based activities.
Twenty-eight adolescents (14 males, 14 females), aged 12 to 18 years (mean 14y 6mo, SD 21.6mo) with moderate physical disabilities participated in a 12-week PREP intervention. An interrupted time series design with multiple baselines was employed, replicating the intervention effect across three chosen activities and all participants. An occupational therapist worked individually with adolescents and parents to identify and implement strategies to remove environmental barriers that impede participation in selected activities. Activity performance was repeatedly measured using the Canadian Occupational Performance Measure (COPM) at baseline, intervention, and follow-up (20wks). For each activity, the trajectory representing change in performance was analyzed descriptively. Segmented regression combined with a mixed-effects modeling approach was used to statistically estimate the overall effectiveness of the intervention within and across 79 activities.
A statistically significant improvement (B=2.08, p<0.001) was observed across all activities, 59 per cent of which also indicated a clinically significant change of more than 2 points on the COPM scale. Levels of performance were maintained during follow-up with an additional increase of 0.66 points on the COPM scale (t=3.04, p=0.004). Intervention was most effective for males and those with a higher number of functional issues.
Findings illustrate that participation can be improved by changing the environment only. Such evidence further supports emerging therapeutic approaches that are activity-based, goal-oriented, and ecological in nature.
Environment-based intervention strategies, guided by the Pathways and Resources for Engagement and Participation, are effective in improving and maintaining adolescent participation. Intervention was most effective for males and those with a higher number of functional issues. The study design serves as an example for future pragmatic studies accounting for individual-based changes and contexts.
本研究旨在检验途径和资源促进参与（PREP）干预在提高青少年参与社区活动方面的有效性。
28 名 12 至 18 岁（平均 14 岁 6 个月，标准差 21.6 个月）、中度身体残疾的青少年参与了为期 12 周的 PREP 干预。采用具有多个基线的中断时间序列设计，在三个选定的活动和所有参与者中复制干预效果。一名职业治疗师与青少年及其家长合作，确定并实施策略，以消除阻碍参与选定活动的环境障碍。使用加拿大职业表现量表（COPM）在基线、干预和随访（20 周）时反复测量活动表现。对于每项活动，使用描述性分析来分析表示性能变化的轨迹。分段回归结合混合效应模型方法用于统计估计干预在 79 项活动中的整体有效性。
所有活动的表现均有显著改善（B=2.08，p<0.001），其中 59%的活动也表明 COPM 量表上的变化超过 2 分，具有临床意义。在随访期间，COPM 量表上的成绩进一步增加了 0.66 分（t=3.04，p=0.004）。干预对男性和功能问题较多的青少年最为有效。
研究结果表明，仅通过改变环境就可以提高参与度。这种证据进一步支持了新兴的治疗方法，这些方法以活动为基础、以目标为导向且具有生态性。
通过途径和资源促进参与的基于环境的干预策略在提高和维持青少年参与度方面是有效的。干预对男性和功能问题较多的青少年最为有效。研究设计为未来考虑个体变化和背景的实用研究提供了范例。
