Multifaceted interventions for supporting community participation among adults with disabilities: A systematic review

Gross, Judith M. S.; Monroe‐Gulick, Amalia; Nye, Chad; Davidson-Gibbs, Debbie; Dedrick, Devin

doi:10.1002/cl2.1092

Cited by 5 publications

(4 citation statements)

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“…One additional review involving people with any type of health condition included meta-analyses on work outcomes but insufficient information was provided to judge whether all studies included in the meta-analyses were relevant to the objectives of this overview. 33 Meta-analyses were not possible in the other reviews due to insufficient numbers of studies or fundamental differences in research aims or designs. More details on the characteristics of included reviews are reported in online supplemental file, appendix D .…”

Section: Resultsmentioning

confidence: 99%

Vocational interventions to help adults with long-term health conditions or disabilities gain and maintain paid work: an overview of systematic reviews

Levack

Fadyl

2021

BMJ Open

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ObjectiveTo conduct an overview of systematic reviews to examine the effectiveness of vocational interventions to help adults with long-term health conditions or disability gain and maintain new paid work and to analyse the spread and quality of evidence in this area.MethodsWe pre-published our protocol in PROSPERO (CRD42019132448). We searched Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, Proquest Dissertations and Theses database, NICE and Business Source Complete from inception to 21 August 2020. We included any systematic reviews of clinical trials on vocational interventions for adults with long-term health conditions or disability who were not in work or had recently gained work. We excluded reviews of vocational interventions for employed people on sick leave. Two researchers identified, critically appraised,using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2, and extracted data from included reviews. We used Grading of Recommendations Assessment, Development and Evaluation to evaluate strength of evidence underpinning overview findings.ResultsWe identified 26 reviews (5 high-quality and 21 critically low to moderate quality) that focused on vocational interventions for acquired brain injury, autism, intellectual disability, multiple sclerosis, mental health conditions, spinal cord injury and general disability populations. We identified moderate quality evidence that people with moderate to severe mental health conditions who participate in supported employment, particularly individual placement and support, are more likely to gain competitive employment compared with people who receive traditional vocational services (risk ratio 2.07; 95% CI 1.82 to 2.35; 27 studies, 6651 participants). We found only very low-quality to low-quality evidence on vocational intervention for people with any other health condition. We found little to no data on employer or employee satisfaction with work outcomes or the cost effectiveness of interventions.ConclusionGiven the importance placed on work opportunities for people with long-term health conditions or disability, there is urgent need for more high-quality research on vocational interventions for this population.Prospero registration numberCRD42019132448.

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Section: Resultsmentioning

confidence: 99%

Vocational interventions to help adults with long-term health conditions or disabilities gain and maintain paid work: an overview of systematic reviews

Levack

Fadyl

2021

BMJ Open

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“…Systematic reviews evaluating interventions for people with disabilities-a broad population including but not limited to different diseases and conditions-are scarce. For example, two systematic reviews have explored interventions to support community participation for people living with disabilities (Gross, 2020) and interventions to increase motor skills (Bishop, 2018). Recently published trials as well as ongoing trials (Chang, 2020), have the potential to be included in this current review and further deepen the evidence base for outdoor mobility interventions.…”

Section: Why It Is Important To Do This Reviewmentioning

confidence: 99%

Interventions to improve outdoor mobility among people living with disabilities: A systematic review

Ringsten,

Ivanic,

Iwarsson

et al. 2024

Campbell Systematic Reviews

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BackgroundAround 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization.ObjectivesTo assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components.Search MethodsStandard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries.Selection CriteriaOnly randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility.Data Collection and AnalysisStandard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health‐related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2‐tool and the GRADE‐framework were used to assess the certainty of the evidence.Main ResultsThe screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments.Skill training interventions versus control interventions (16 studies)The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health‐related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I2 = 7%; RD: 0.15; 95% CI: −0.02 to 0.32; I2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health‐related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I2 = NA; 118 participants; one study; low certainty evidence).Physical training interventions versus control interventions (five studies)The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health‐related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I2 = NA; 216 participants; one study; low certainty evidence).Comparison of different outdoor mobility interventions (one study)The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health‐related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions.Authors’ ConclusionsTwenty‐two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short‐ and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health‐related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.

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“…For this review, we considered participation in line with the Convention on the Rights of Persons with Disabilities (CRPD) ( 6 ), defined as the rights to: full inclusion and participation of people with disability in the community ( Article 28 ); effective and full participation in political and public life ( Article 29 ); participation in mainstream and disability-specific sporting and recreational activities at all levels to the fullest extent possible ( Article 30 ); and access to sporting, recreational and tourism venues or services for organizing recreational, tourism, leisure and sporting activities ( Article 30 ). Participation and related outcomes were conceptualized as activities that: (a) are ideally chosen or desired by the individual with a disability; (b) occur in a social, community or civic setting; and (c) enable people with disabilities to participate alongside and/or with people without disabilities, or to build the skills, self-efficacy, or social networks to enable participation alongside/with people without disabilities ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Interventions for social and community participation for adults with intellectual disability, psychosocial disability or on the autism spectrum: An umbrella systematic review

Giummarra

Randjelovic

O’Brien

2022

Front. Rehabilit. Sci.

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ObjectiveThis umbrella systematic review examined the effectiveness, facilitators, and barriers of interventions for social, community and civic participation for adults on the autism spectrum, or with intellectual or psychosocial disability.Data SourcesEight databases were searched to identify eligible reviews defined by the: Sample (≥50% adults on the autism spectrum or with intellectual or psychosocial disability), Phenomena of Interest (interventions in community settings that aimed to improve social, community or civic participation, or capacity to participate), Design (any), Evaluation (any method that evaluated impacts on participation or capacity to participate), and Research type (reviews as journal articles, dissertations or in grey literature, in English, published 2010-2020).Review MethodsRapid review methods were used. One researcher screened 27,890 records and 788 potentially eligible full texts. A second reviewer independently screened 20% of records, and ambiguous full text publications. Study quality was extracted, and review quality was assessed with the Assessing Methodological Quality of Systematic Reviews (AMSTAR) checklist. Data from 522 studies in 57 eligible systematic reviews were extracted for narrative synthesis. The Corrected Covered Area (CCA) was calculated to indicate overlap between reviews.ResultsThere was a pooled sample of 28,154 study participants, predominantly from studies in North America, the UK and Europe. There was very low overlap between reviews (CCA = 0.3%). Reviews were predominantly low quality: 77.2% of reviews met <50% of AMSTAR criteria. Most studies were low (45.4%) or moderate (38.3%) quality. Three broad intervention categories improved participation, inclusion and belonging outcomes: (1) interventions to help people identify and connect with participation opportunities (e.g., person centred planning); (2) participation opportunities or activities (e.g., joining a community group, sports or outdoor activities, or arts-based activities); and (3) supports to build skills and capacity to participate socially and in the community.ConclusionsThe evidence highlighted that improved social and community participation requires purposeful strategies that identify meaningful participation preferences (e.g., where, when, how, and with whom) and provide support to build capacity or enable ongoing participation. Community capacity building, peer support and advocacy may also be needed to make the community more accessible, and to enable people to exercise genuine choice.

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Multifaceted interventions for supporting community participation among adults with disabilities: A systematic review

Cited by 5 publications

References 69 publications

Vocational interventions to help adults with long-term health conditions or disabilities gain and maintain paid work: an overview of systematic reviews

Vocational interventions to help adults with long-term health conditions or disabilities gain and maintain paid work: an overview of systematic reviews

Interventions to improve outdoor mobility among people living with disabilities: A systematic review

Interventions for social and community participation for adults with intellectual disability, psychosocial disability or on the autism spectrum: An umbrella systematic review

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