title: A review of factors influencing participation in social and community activities for wheelchair users.
abstract: OBJECTIVE
  To systematically identify factors associated with participation in social and community activities for adult wheelchair users (WCUs).
  
  
  METHODS
  PubMed/MEDLINE, CINAHL, PsycINFO and EMBASE.
  
  
  METHODS
  Quantitative and qualitative peer-reviewed publications were included, which were written in English, reported original research and investigated factors associated with social and community participation in adult WCUs.
  
  
  METHODS
  The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Factors were organized using the International Classification of Functioning, Disability and Health (ICF).
  
  
  RESULTS
  Thirty-five studies were selected: two of power WCUs, 10 of manual WCUs and 23 of both. Six qualitative studies, ranging in quality from 8/10 to 9/10 and 29 quantitative studies were included, ranging in quality from 4/15 to 11/15. Fifteen body function, 4 activity, 5 participation, 15 environmental and 14 personal factors were found to be associated with social and community participation.
  
  
  CONCLUSIONS
  Social and community participation of WCUs is associated with factors from all ICF domains. Wheelchair factors, accessibility, skills with wheelchair use, pain, finances and education are modifiable factors frequently reported to be associated with participation. Experimental research focusing on modifiable factors is needed to further our understanding of factors influencing participation among WCUs. Implications for Rehabilitation Wheelchair factors, including comfort and durability, are associated with participation and may be targeted in clinical intervention. Wheelchair skills are clinically modifiable and have been shown to improve participation in manual wheelchair users. Body functions (e.g. confidence, depression and fatigue) and personal factors (e.g. finances and level of education) may be considered for clinical intervention.
authors.affiliation: a Graduate Program in Rehabilitation Sciences, University of British Columbia , Vancouver , BC , Canada .
authors.forename: Emma M
authors.initials: EM
authors.lastname: Smith
authors.affiliation: b Faculty of Health Sciences , Simon Fraser University , Vancouver , BC , Canada and.
authors.forename: Brodie M
authors.initials: BM
authors.lastname: Sakakibara
authors.affiliation: a Graduate Program in Rehabilitation Sciences, University of British Columbia , Vancouver , BC , Canada .|c Department of Occupational Science & Occupational Therapy , University of British Columbia , Vancouver , BC , Canada.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
mesh_terms: D006233:Persons with Disabilities / Q000534:rehabilitation*; D011211:Electric Power Supplies; D004777:Environment; D006801:Humans; D007398:Interpersonal Relations; D051346:Mobility Limitation; D011788:Quality of Life; D012649:Self Concept; D058992:Social Participation; D012959:Socioeconomic Factors; D014910:Wheelchairs / Q000523:psychology*
keywords: Community integration; experimental research; leisure activities; social participation; systematic review; wheelchairs