This review outlines a conceptual approach to inform research and practice aimed at supporting children whose lives are complicated by impairment and/or chronic medical conditions, and their families. ‘Participation’ in meaningful life activities should be an essential intervention goal, to meet the challenges of healthy growth and development, and to provide opportunities to help ensure that young people with impairments reach their full potential across their lifespan. Intervention activities and research can focus on participation as either an independent or dependent variable. The proposed framework and associated hypotheses are applicable to children and young people with a wide variety of conditions, and to their families. In taking a fresh ‘non‐categorical’ perspective to health for children and young people, asking new questions, and exploring issues in innovative ways, we expect to learn lessons and to develop creative solutions that will ultimately benefit children with a wide variety of impairments and challenges, and their families, everywhere.

ICFInternational Classification of Functioning, Disability and Health QOL Quality of life PODCI Pediatric Outcomes Data Collection Instrument RCT Randomized controlled trial AIM Improving participation of children with disabilities is a priority; however, the participation construct lacks clarity. This systematic review investigated how researchers defined 'participation' and the language used in participation intervention research.METHOD Nine health and education databases were searched for intervention studies of children with disabilities that included a participation outcome. Quantitative data were extracted using a customized form, and participation text data were extracted verbatim. Themes were derived using a thematic coding approach. These participation themes were applied to the outcome measures used in the included studies to compare participation language with the methods used to quantify participation changes. RESULTSOf the 2257 articles retrieved, 25 were included in this review. Five participation themes and nine subthemes were developed. Two themes, attendance and involvement, were directly related to the participation construct. Three additional themes described related concepts: preferences, activity competence, and sense of self.INTERPRETATION Attendance and involvement seem to describe the essence of the participation concept. The related themes may provide important avenues to enhance participation outcomes. This review highlighted the need for researchers to define the construct under investigation clearly and select measures carefully, as measurement choice is the mechanism through which the concept is operationalized in research.The publication of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) has resulted in an intensification of international interest in 'participation' as the ultimate health outcome. 1,2 The ICF defines participation as 'involvement in a life situation' 2 participation restriction is defined as 'problems an individual may experience in involvement in life situations'.2 Because there is no universal acceptance of the definition of participation, a discourse in the literature has developed about how to operationalize the concept. 3,4 This is critical, because without clarity about the concept, defining outcome goals and developing scales and measures to assess participation outcomes will remain open to question as to whether the measures are fit for purpose.One part of the complexity of the conceptual issue is the fact that the World Health Organization did not clearly distinguish between activity and participation within their classification system, offering authors four methods for determining when participation rather than activity was being classified.1,2 This lack of distinction provides ample opportunity for varied interpretations of the concept under investigation and hence varied approaches to measurement, 5 leading to imprecision and confusion in what is found and reported.Several authors describe particip...

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