Content » Vol 50, Issue 8

Review article

Application of participation in clinical practice: Key issues

Dominique van de Velde, Marieke Coussens, Stijn De Baets, Lode Sabbe, Guy Vanderstraeten, Peter Vlerick, Lien Van Malderen, Ellen Gorus, Patricia De Vriendt
Faculty of Medicine and health sciences, Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy programme, Ghent University, BE-9000 Gent, Belgium. E-mail:
DOI: 10.2340/16501977-2363


Background: Rehabilitation services are increasingly targeting involvement in daily life. In the International Classification of Functioning, Disability and Health this is referred to as “participation”. How-ever, questions have arisen regarding the conceptualization of participation, and consensus is lacking.
Methods: The first phase of this study is a critical review of the literature to detect recurring conceptual problems in the application of participation and how researchers deal with these. The second phase is a systematic review to identify how participation measures are operationalized.
Results: The critical review found possible solutions to 4 recurring key limitations: (i) how to deal with ambiguity and vagueness regarding the term “participation”; (ii) how to differentiate between activity and participation; (iii) what is the current empirical knowledge about the subjective aspects of participation; (iv) what are the different ways to measure participation. The systematic review found 18 instruments operationalizing participation in different ways: (i) unidimensional: frequency of performing activities; (ii) unidimensional: limitations in experiencing participation when performing activities; (iii) multidimensional: multiple subjective dimensions when performing activities; and (iv) multidimensional: objective and subjective dimensions.
Discussion and conclusion: Notwithstanding an increasing body of knowledge, some issues remain unclear and how participation is measured is subject to debate. This results in difficulties in the use of participation in clinical practice. However, insight into the current body of knowledge and awareness of shortcomings might help clinicians who aim to apply participation in practice.

Lay Abstract

Participation is defined by the International Classification of Functioning, Disability and Health (ICF) as “involvement in a life situation”’. For this concept to be used in rehabilitation, some issues require clarification. When aiming to use this concept and to measure participation it is necessary: () to define the context (home, school, work, community, etc.) in which the patient (child, adult or older person) wants to participate; () to make clear in what dimension exactly one wants to measure participation: the frequency, the limitations, the subjective appraisal of activities, or combinations of these; and () to be aware of the level of power and autonomy the patient aims for in performing activities: from being informed about the activity to being involved in decision-making. Based on the results of this study, a more informed choice could be made about which measurement instrument to use. However, a clear single agreement on the concept of participation will foster clinical practice and action is required to reach consensus.

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