title: Improving the participation of youth with physical disabilities in community activities: An interrupted time series design.
abstract: OBJECTIVE
  Youth with physical disabilities experience restrictions to participation in community-based leisure activities; however, there is little evidence about how to improve their involvement. This study examined whether an intervention to remove environmental barriers and develop strategies using a coaching approach improved youth participation in leisure activities.
  
  
  METHODS
  An Interrupted Time Series design was employed, where replication of the intervention effect was examined across individualised participation goals and across participants. Six adolescents with a physical disability participated in a 12-week intervention. An occupational therapist worked with each youth and his/her family to set three leisure goals based on problems identified using the Canadian Occupational Performance Measure (COPM). A coaching approach was used to collaboratively identify and implement strategies to remove environmental barriers. Interventions for each goal were introduced at different time points. Outcomes were evaluated using the COPM.
  
  
  RESULTS
  Improvements in COPM performance scores were clinically significant for 83% of the identified activities; an average change of 4.5 points in the performance scale (SD = 1.95) was observed. Statistical analysis using the celeration line demonstrated that the proportion of data points falling above the line increased in the intervention phase for 94% of the activities, indicating a significant treatment effect.
  
  
  CONCLUSIONS
  This study is the first to examine an intervention aimed at increasing leisure participation by changing only the environment. The results indicate that environment-focussed interventions are feasible and effective in promoting youth participation. Such findings can inform the design of a larger study and guide occupational therapy practice.
authors: CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.
authors: Mary
authors: M
authors: Law
authors: Dana
authors: D
authors: Anaby
authors: Christine
authors: C
authors: Imms
authors: Rachel
authors: R
authors: Teplicky
authors: Laura
authors: L
authors: Turner
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002170:Canada; D002648:Child; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D004777:Environment; D005260:Female; D006801:Humans; D065186:Interrupted Time Series Analysis; D007899:Leisure Activities; D008297:Male; D009788:Occupational Therapy / Q000379:methods*; D058992:Social Participation
keywords: environment; intervention; leisure; occupational therapy