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PREP During COVID-19

Updated: Jan 24, 2022

Youth with physical disabilities often experience participation restrictions due to environmental barriers. The onset of the COVID-19 pandemic intensified barriers to participation which significantly impacted the health and well-being of this population, increasing risks associated with poor mental and physical health. The ASPIRE lab’s BEYOND project funded by the Canadian Institutes for Health Research, examining effectiveness of participation in community-based activities on improving body functions (i.e., cognitive, affective, and motor outcomes) for youth with physical disabilities was already underway when the COVID-19 pandemic started.

What did we do?

The Pathways and Resources for Engagement and Participation (PREP) approach, which addresses environmental barriers to enable participation of youth in self-chosen activities, was used in the current study and demonstrated that participation during a pandemic is challenging but possible. A 22-week individual-based interrupted time series design was used among 14 youth (9 female) with physical disabilities aged 17-24. An occupational therapist worked with each youth to remove environmental barriers in their own context. Activity performance and satisfaction were measured weekly using the Canadian Occupational Performance Measure (COPM).

What did we find?

All participants (n=14, 9 female and 5 male) identified a non-virtual participation goal, 7 started engaging in their selected activity with another individual and 7 have completed the intervention participating in their chosen leisure activity for 8 weeks. In our study, youth were particularly keen to pursue non-virtual activities with another individual (preferably around their same age) reinforcing the need for meaningful engagement during times of disruption, especially for those who are at increased risk of social isolation.

How Participation was Improved

Several strategies employing flexibility and creativity were used to jointly identify activities and develop solutions to make participation possible (Table 1). Youth chose various types of activities such as sports (badminton, football, horseback riding, swimming) music (playing the piano, singing), recreational (board games, cooking, painting, creative writing, sewing) and Work/Volunteer (radio station). Visual inspection of COPM data indicates improved performance and satisfaction for all participants, and clinically significant improvement (median score increase by > 2 points) in 10/14 trajectories. Figure 1 displays changes in COPM performance and satisfaction scores for two participants. Initial results for all participants can be viewed on this poster.

Table 1

Six environment-focused strategies to enable participation during the pandemic

Figure 1

Changes in COPM scores following PREP intervention for 2 participants


By drawing on existing resources and creating new pathways to participation, youth were equipped with solution-based strategies preparing them for real-life ongoing changing circumstances. Learn more about strategies and lessons learned documented in this commentary (Anaby et al., 2021) and the initial findings shared through the European Academy of Childhood Disability (EACD) Conference 2021 poster and presentation.

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