Article

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. METHOD: 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. RESULTS: 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. INTERPRETATION:
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. WHAT THIS PAPER
ADDS: 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.
CI - (c) 2018 Mac Keith Press.

Langue : ANGLAIS