Exploring Quality Participation in Rehabilitation

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Lambert, Miles
Quality participation , Rehabilitation , Exercise , Disability , Neurological conditions
Background: Full participation (i.e., quantity and quality) is considered a vital outcome of rehabilitation care. The Quality Participation Framework (QPF) is a novel framework for exploring quality participation. The rapid proliferation of technology-mediated rehabilitation interventions creates an opportunity to explore how quality participation is considered and measured in rehabilitation. Objective: The overall purpose of this thesis was to explore quality participation in the rehabilitation domain. Methods: Guided by the QPF, two studies were conducted as part of this thesis. First, we conducted a scoping review to explore the extent to which technology-mediated exercise trials targeting persons with chronic neurological conditions (CNCs) consider and foster elements of quality participation. We also conducted a pilot cognitive interview study to examine the acceptability of a newly developed Measure of Experiential Aspects of Participation (MeEAP) in the rehabilitation domain. Results: We retrieved 71 studies in the scoping review, none of which explicitly used the term "quality participation" when describing the interventions. However, we identified quality participation elements (mean=2.91±1.2) across all the studies, with most interventions (n=60, 85%) fostering multiple elements. We also identified a total of 93 strategies for fostering quality participation across the studies. Our findings highlight an opportunity for increased utilization of the QPF in the context of technology-mediated exercise interventions in CNCs. Findings also indicate the need to examine possible interrelatedness between elements and the applicability of less utilized or novel strategies for fostering quality participation. Three people participated in the pilot cognitive interview study. The findings indicate that while participants felt confident in their responses to most items in the MeEAP, there was difficulty with ascribing the correct quality participation element to some items. Participants also identified a lack of clarity in some of the MeEAP items. Furthermore, findings suggest that the quality participation elements of "Autonomy", and "Meaning", as conceptualized in the QPF, may not apply to rehabilitation. These findings suggest that the MeEAP may require further refinement and modification before it can be used in the rehabilitation domain. Conclusion: Together, these findings indicate the need for future work to conceptualize and measure elements of quality participation in rehabilitation.
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