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Abstract

Objective

Modern clinical rehabilitation practice aligned to the International Classification of Functioning, Disability and Health and the Convention on the Rights of Persons with Disabilities highlights the importance of attention to participation in the rehabilitation formulation. This systematic review investigates the efficacy of rehabilitation interventions evaluated in common neurological disorders reported to influence participation outcomes.

Data sources

PubMed, Web of Science and PsycINFO databases were searched from inception to 25 April 2023. Only randomised controlled trials were considered for inclusion.

Review methods

The data were extracted by two independent reviewers in the following categories: characteristics of the included study publications, description of intervention and outcome measures.

Results

A total of 1248 unique article records were identified through the databases. Twenty-eight randomized controlled trials were included with 15 publications having participation as a primary outcome measure. Articles were related to multiple sclerosis (N = 4), spinal cord injury (N = 2), stroke (N = 16) and traumatic brain injury (N = 6). Four publications showed significant differences in pre- and post-intervention within experimental groups. All four articles described participation as primary outcome measure.

Conclusion

There is a limited evidence of the identified rehabilitation interventions to improve participation in common neurological conditions. However, there was a paucity of articles involving individual with Parkinson's disease that met the inclusion criteria.

Keywords

Neurological conditions participation rehabilitation outcomes

Introduction

In 2001, the World Health Organization (WHO) published the International Classification of Functioning, Disability and Health with the overall aim to provide an unified and standard language permitting communication over various disciplines and sciences in conjunction with a framework coding health and health-related components of well-being.¹ In addition, the International Classification of Functioning, Disability and Health offers a biopsychosocial model, established due to a paradigm shift away from the criticized biomedical model,² mapping the interaction of biological, psychological and social dimensions in order to serve as a holistic view on disability.³ Participation is recognized as a component of this framework and is subject to impairments on body function-level and activity limitations modulated by personal and environmental factors.^{1, 4–6}

According to the WHO, participation is defined as ‘involvement in a life situation’,¹ and the Convention on the Rights of Persons with Disabilities emphasizes that rehabilitation services and programs should enable persons with disabilities to attain and maintain full participation in all life aspects in order to support their human rights and dignity.⁷ There is an increasing focus on interventions regarding participation also due to associations with life satisfaction, depressive symptoms and health-related quality of life.^{4, 8, 9} Consequently, there is a growing interest into valid and reliable participation-related outcome measures serving as guiding principles through rehabilitation.^10–15 Rehabilitation is considered as one of the core health strategies of the WHO.^{16, 17} In the World Report on Disability, the WHO defines rehabilitation as ‘a set of measures that assist individuals, who experience or are likely to experience disability, to achieve and maintain optimum functioning in interaction with their environments.’¹ The focus of rehabilitation is directed to improving impairments and reducing activity limitations while addressing participation restrictions and taking into account the contextual factors. Altogether, the interaction between the components supposes a comprehensive approach in which multiple disciplines coordinate their services and combine their expertise in order to enhance an effective therapy.¹⁸ Despite recommendations and the importance of the concept, there is lack of knowledge concerning effective interventions targeting participation in clinical practice.

While global trends in years of life lost reflect an epidemiological transition, with decreases in total years of life lost from endemic infections, respiratory infections and tuberculosis, neurological disorders are increasingly recognised as major causes of death and disability worldwide. They are the leading cause of disability-adjusted life-years and second leading cause of deaths.^{19, 20} Moreover, their significance in public health is expected to increase as many countries are undergoing population aging and health transitions associated with economic development. Notably, stroke remains the second leading cause of death worldwide and the first leading cause of acquired disability in adults.²¹ Traumatic brain injury and spinal cord injury are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they induce.²² Multiple sclerosis is the most common inflammatory neurological disease in young adults,²³ while the global burden of Parkinson's disease has more than doubled over the past two decades as a result of the increasing number of older people and environmental pollution.²⁴ Consequently, the purpose of this systematic literature review was to investigate the efficacy of rehabilitation interventions evaluated in stroke, spinal cord injury, multiple sclerosis, Parkinson's disease, and traumatic brain injuries reported to influence participation outcomes. The goal is to provide clinicians with an overview of applied participation-oriented rehabilitation approaches and their effectiveness.

Methods

This study was performed in accordance with a protocol registered in the international prospective register of systematic reviews, Prospero, (https://www.crd.york.ac.uk/PROSPERO/; registration number: CRD42020212537).

This literature search was conducted up to 30 April 2022 with an update on 25 April 2023. The scientific databases PubMed, Web of Science and PsycINFO were purposefully screened for articles published in English or French languages. The search included terms relating to or describing rehabilitation interventions evaluated in stroke, spinal cord injury, multiple sclerosis, Parkinson's disease and traumatic brain injuries. The search strategy combined keywords and Medical Subject Headings terms using stroke, spinal cord injury, multiple sclerosis, Parkinson's disease, traumatic brain injury, rehabilitation, exercise, participation, etc. The Boolean Operators AND/OR were used for building the search equations. The full search string is given in Supplemental Material 1.

The identified articles were inserted into Rayyan®, and the duplicates were removed. Then articles were screened by two researchers on title/abstract.²⁵ Subsequently the remaining articles were screened on full text by the same researchers. In case of doubt, a third independent researcher was consulted.

Articles were included if they fulfilled the following inclusion criteria: (1) study population consists of participants affected by Parkinson's disease, multiple sclerosis, stroke, traumatic brain injury or spinal cord injury; (2) a rehabilitation intervention meeting the definition of the WHO¹; (3) a randomized controlled trial; and (4) outcome measures meeting two of the following three eligibility criteria were included and considered valid. These three specific eligibility criteria require that the measurement instrument is (I) classified on ‘Shirley Ryan AbilityLab’ (https://www.sralab.org), the former ‘RehabMeasures’ database, with ICF-component ‘participation’ and without a connection with the ICF-component ‘body function’; (II) included in the systematic reviews of Ballert et al. (2019);²⁶ and (III) included in the systematic reviews of Van de Velde et al. (2018).¹³ Ballert et al. applied the refined International Classification of Functioning, Disability and Health linking rules to categorize, compare and examine existing instruments measuring participation. Van de Velde et al. (2018) was involved due to providing an overview of the operationalization linked with the nine International Classification of Functioning, Disability and Health domains and construction of the mentioned instruments. All three sources used the International Classification of Functioning, Disability and Health as starting point for further research and composed a list of valid questionnaires with regard to participation.

Conversely, articles were excluded based on several criteria in the following order: (1) studies involving participants aged <16 years or participants with cognitive impairments; (2) interventions not in line with the definition of the WHO pertaining rehabilitation (WHO, 2011) such as invasive interventions and pharmacological interventions; (3) all outcome measures only related to ICF-components different from participation and not fulfilling above-mentioned specific eligibility criteria; (4) study designs different from randomized controlled trial, with the exception of mixed-methods studies; (5) articles consisting of a sample size less than five patients per treatment arm; and finally (6) incomplete data concerning pre- and/or post-test scores.

Assessment of the methodological quality of the included studies was evaluated using the Cochrane RCT checklist by two independent researchers. The items were scored with yes, no or not reported if there was limited information retrievable in the included studies related to one of these items. Disagreement in the quality assessment was resolved in the presence of a third researcher.

The data were extracted by two independent researchers in the following categories: information on the publication (authors, year of publication, etc.) and on the interventions and outcome measures. Effect size was calculated by the Hedges’ g, an effect size of <0.2 was considered as a ‘small’ effect size, 0.2–0.5 represents a ‘medium’ effect size and >0.8 indicates a ‘large’ effect size.²⁷ Disagreement between the two researchers during the data extraction or interpretation of the results was resolved with a third researcher (PF).

Results

The search identified 566 articles in PubMed, 1174 in Web of Science and 32 in PsycINFO. Subsequently, a total of 1772 articles were reduced to 1248 articles after removing duplicates. The screening on title/abstract resulted in 272 articles for further screening on full text. Finally, 28 articles met the inclusion criteria and were analysed (Figure 1).

Figure 1.

Inclusion flow chart of inclusion.

The assessment of the methodological quality of the included studies is given in Supplemental Material 2. Almost all of the included studies had a positive outcome (‘Y’) relating to items 1 (randomization), 4 (blinding of assessors), 5 (comparability of groups), 7 (intention to treat analysis), 8 (similarity of interventions) and 9 (selectivity of publication). The results of items 2 (concealment of allocation), 6 (proportion of follow-up) and 10 (exclusion of conflicts of interests) varied largely between the studies.

Table 1 provides an overview of the participation outcome measures used for the measurement of participation within the included studies supplemented with the number of times an instrument is used, a short summary about the content and the link of the instruments with the International Classification of Functioning, Disability and Health components of activity and participation according to Ballert et al. (2019).²⁶

Table 1.

Overview of outcome measures included in the studies.

Instrument	Abbreviation	Prim	Sec	Pop	Content	Domains ICF
Impact of Participation and Autonomy Questionnaire⁵⁶	IPA	3	1	MS	Items and score: 41, 5-point scale Subscales: autonomy indoors, family role, autonomy outdoors, social life and relations, work and education	d3–d9
Participation Assessment With Recombined Tools—Objective⁵⁷	PART—O	0	1	SCI	Items and score: 17, varying response formats Subscales: productivity, social relations, out and about	d3, d4, d6, d7, d8, d9
ICF Measure of participation and ACTivities⁵⁸	IMPACT-S	2	0	SCI, stroke	Items and score: 33, 3-point scale Subscales: learning and applying knowledge, general tasks and demands, communication, mobility, self-care, domestic life, interpersonal interactions and relationships, major life areas, community, social and civic life	d6, d7, d8, d9
Reintegration to Normal Living Index⁵⁹	RNLI	2	3	Stroke	Items and score: 11, visual analogue scale (10 cm) Subscales: none	d4–d9
Utrecht Scale for Evaluation of Rehabilitation—Participation⁶⁰	USER—P	3	1	Stroke	Items and score: 32, varying response formats Subscales: none Rating scales: frequency, restrictions, satisfaction	d4, d5, d6, d9
Community Integration Questionnaire⁶¹	CIQ	3	3	Stroke, TBI	Items and score: 15, varying response formats Subscales: home integration, social integration, productive activities	d6–d9
Frenchay Activity Index⁶²	FAI	2	0	Stroke	Items and score: 15, 4-point scale Subscales: leisure and work, outdoors, domestic	d1, d4, d6, d8, d9
Sydney Psychosocial Reintegration Scale⁶³	SPRS	0	2	TBI	Items and score: 12, 5-point scale Subscales: occupational activity, interpersonal relationships, independent living skills	d3–d9
Assessment of Life Habits⁶⁴	Life—H	0	1	Stroke	Items and score: 77, varying response formats Subscales (domains): nutrition, fitness, personal care, communication, housing, mobility, responsibilities, interpersonal relationships, community life, education, employment, recreation	d1–d9

MS: multiple sclerosis; SCI: spinal cord injury; TBI: traumatic brain injury.

The included 28 studies used nine different participation outcome measures. Out of the 28 studies, 15 studies implemented an eligible participation questionnaire as primary outcome measure. The most frequent reported questionnaires were the Community Integration Questionnaire (N = 6) and the Reintegration to Normal Living Index (N = 5).^{59, 61} Only the Community Integration Questionnaire and International Classification of Functioning, Disability and Health Measure of Participation and Activities Questionnaire—screener part were applied for measuring participation in multiple populations.^{58, 61}

The objectives and patient characteristics of the included studies are described in Supplemental Material 3. Four out of the 28 included articles were related to multiple sclerosis, 2 to spinal cord injury, 16 to stroke and 6 to traumatic brain injury. The sample sizes of the included studies ranged from 16 participants to 361 participants. The average time since diagnosis ranged from 12 days to 16.4 years with an average age ranging from 34.5 to 75.8 years.

Type of interventions, healthcare providers and the training parameters are listed in Table 2. There are a total of 33 experimental interventions recognized with a large variety of applied intervention strategies. Therefore five clusters were developed in order to group the included experimental interventions: (1) cognitive behavioural therapy (N = 10), (2) education (N = 6), (3) exercise intervention (N = 6), (4) combination of cognitive behavioural therapy and exercise intervention (N = 3) and (5) multidisciplinary rehabilitation (N = 1). The study that executed the multidisciplinary rehabilitation intervention consisted of a combination of exercise intervention and education. However, most common healthcare providers of the included experimental interventions were occupational therapists (N = 12), a cooperation of three or more healthcare providers (N = 3), physiotherapists (N = 5) and a combination of occupational therapist and psychologist (N = 3). Further, the majority of the reported interventions were executed individually or in groups of participants (Table 2). The setting differed largely between included studies. Besides, Table 2 provides an overview of the training parameters. The duration of the interventions varied from 2 weeks to 12 months. The number of sessions of the reported interventions ranged from three to 72 sessions with training frequencies that varied largely. Additionally, 18 of the included studies provided a follow-up measurement that ranged from 2 months to 12 months post-treatment.

Table 2.

Intervention modalities of included studies.

Article		Intervention	Setting	HC provider	I/G	Dur	Dur F-U	Frequency	Ses (n)
Cluster 1: Cognitive behavioural therapy (CBT)
Adamit et al. (2021)²⁸	Exp Con	Cognitive and behavioural strategies Standard care	Community-based healthcare service	OT OT	I I	10 w 10 w	3 m 3 m	60 m/w 60 m/w	10 10
Harel-Katz et al. (2020)³⁰	Exp Con	Improving participation after stroke self-management Standard care only	Rehabilitation centre NR	OT NR	G NR	12 NR	NR NR	1 d/w, 2,5 h NR	13 NR
Coker et al. (2019)³³	Exp Con	Replicable, manualized, educationally based group therapeutic intervention No intervention	Rehabilitation centre + home /	Group facilitators /	I + G /	6 w /	24 w /	1 d/w, 120 m /	6 /
Blikman et al. (2017)³⁵	Exp Con	Individual energy conservation management Information-only control condition	Outpatient rehabilitation department	OT MS-nurse	G I	4 m 4 m	36 w 36 w	120 m, 1 d/w 45 m/ses	12 3
Kessler et al. (2017)³⁷	Exp Con	Occupational performance coaching + usual care Usual care	Home NR	OT NR	I I	16 w 16 w	2 m 2 m	±1 h NR	10 NR
Nooijen et al. (2017)⁴²	Exp Con	Regular rehabilitation + behavioural intervention promoting physical activity Regular rehabilitation	Rehabilitation centre	Trained coach NR	I NR	8 m 8 m	4 m 4 m	NR NR	13 NR
van de Ven et al. (2017)⁴⁰	Exp Con1 Con2	Cognitive flexibility training Mock training Waiting-list cognitive flexibility training	Home	NeuroPsyT NR NeuroPsyT	I I I	12 w 12 w 12 w	12 w 12 w 12 w	5 d/w, 30 m NR 5 d/w, 30 m	58 NR 58
van den Akker et al. (2017)⁴¹	Exp Con	Cognitive behavioural training MS-nurse	Rehabilitation centre	CBT therapist MS-nurse	I I	4 m 4 m	8 m 8 m	Spread Spread	12 3
Cicerone et al. (2008)⁴⁹	Exp Con	Intensive cognitive rehabilitation program Standard neurorehabilitation program	Rehabilitation centre	OT, PT, speech therapist and neuroPsyT	I + G I + G	16 w 16 w	6 m 6 m	15 h/w 15 h/w	NR NR
McDonald et al. (2008)⁵¹	Exp1 Con1 Con2	Social skills treatment Social activity alone (placebo) Waitlist	NR NR NR	OT + PsyT NR NR	I + G NR NR	12 w NR NR	/ / /	1 d/w, 3 h + 1 h NR NR	12 NR NR
Egan et al. (2007)⁵³	Exp Con	Client-centred occupation-based approach Usual care	NR NR	OT NR	I NR	2–4 m NR	/ /	NR NR	8 NR
Cluster 2: Education (Edu)
Ownsworth et al. (2017)³⁹	Exp1 Exp2	Error-based learning Errorless learning	Home Home	OT OT	I I	8 w 8 w	6 m 6 m	90 m/w 90 m/w	8 8
Burton et al. (2005)⁵⁵	Exp Con	Stroke nurse role expansion (F-U visit) Usual care (no F-U visit)	Home	Stroke nurse Stroke nurse	I I	NR NR	2 m 2 m	NR NR	3 NR
Tielemans et al. (2015)⁴³	Exp Con	Self-management intervention Education intervention	Outpatient rehabilitation centre	Psychologist + OT	G G	10 w 10 w	3, 9 m 3, 9 m		74
Rochette et al. (2013)⁴⁶	Exp1Exp2	You callWe call	HomeHome	Trained healthcare professional	II	6 m6 m	12 m12 m	NRNR	NR9
Vas et al. (2011)⁴⁷	ExpCon	Strategic memory and reasoning trainingBrain health workshop	Outpatient, location NR	Speech pathologist + OTSpeech pathologist + OT	I + GI + G	8 w8 w	4 m4 m	NRNR	1212
Dahlberg et al. (2007)⁵²	ExpCon	Social communication skillsDeferred intervention	Rehabilitation centre	Co-group leaders	I + GI + G	12 w12 w	9 m6 m	1 d/w, 90 m1 d/w, 90 m	1212
Cluster 3: Exercise intervention (EX)
de Rooij et al. (2021)²⁹	ExpCon	Training on the Gait Real-time Analysis Interactive Lab (GRAIL)Treadmill training and functional gait exercises without virtual reality	Rehabilitation centre	PTPT	II	6 w6 w	3 m3 m	30 m×2/w30 m×2/w	1212
Lewthwaite et al. (2018)³⁴	Exp1Exp2Con	Accelerated skill acquisition programDose-equivalent usual occupational therapyUsual therapy	Outpatient, location NR	PT or OTPT or OTNone	III	16 w16 w16 w	8 m8 m8 m	1 h/ses1 h/ses1 h/ses	3030NR
Heine et al. (2017)³⁶	ExpCon	Aerobic trainingMS-nurse	Outpatient rehab centre + home	PTNurse	II	16 w16 w	8 m8 m	30 m, 3 d/w3 × 45 m	483
Combs-Miller et al. (2014)⁴⁴	ExpCon	Body weight supported treadmill trainingOverground walking training	University and community settings	NR	II	2 w2 w		5 d/w, 30 m5 d/w, 30 m	1010
Hassett et al. (2009)⁴⁸	ExpCon	Supervised fitness centre-based exercise programUnsupervised home-based exercise program (UC)	Fitness centreHome	Personal trainerIndependently	II	12 w12 w	3 m3 m	3 d/w, 60 m3 d/w, 60 m	3636
Hornby et al. (2008)⁵⁰	ExpCon	Robotic assistanceTherapist assisted	Rehabilitation institute	OTOT	II	NRNR	6 m6 m	30 m/ses30 m/ses	1212
Chan et al. (2006)⁵⁴	ExpCon	Motor relearningConventional therapy	Hospital	OTOT	II	6 w6 w	//	3 d/w 2 h3 d/w 2 h	1818
Cluster 4: Combination CBT and EX (CBT ± EX)
Song et al. (2019)³¹	ExpCon	Cognitive orientation to daily occupational performanceTask-specific UE training group	NRNR	OTOT	II	4 w4 w	//	5 d/w, 30 m5 d/w, 30 m	2020
Yeh et al. (2019)³²	ExpCon	Sequential combination training: Aerobic exercise + cognitive trainingActive control	Hospital-based rehab. units	OTOT	II	12–18 w12–18 w	//	2–3 d/w, 60 m2–3 d/w, 60 m	3636
Kootker et al. (2017)³⁸	ExpCon	CBT + occupational therapy/movement therapyComputerized cognitive training	Ambulatory rehab.Centre home	PsyT + OT + PTIndependently	II	4 m4 m	8 m8 m	1 h/sesNR	13–16NR
Cluster 5: Multidisciplinary rehabilitation (MDR)
Rietberg et al. (2014)⁴⁵	ExpCon	Multidisciplinary rehabilitation programMS-nurse consultation	Outpatient, location NR	PT, OT, SWNurse	I + GI	12 w12 w	12 w12 w	2 d/w, 45 m1 h/3 w	>284

HC: healthcare; I/G: individual/group; Dur: duration; F-U: follow-up; ses: session; Exp: experimental group; Con: control group; CBT: cognitive behavioural therapy; Edu: education group; MDR: multidisciplinary rehabilitation; EI: exercise intervention; PT: physiotherapist; OT: occupational therapist; PsyT: psychotherapist; d: day; w: week; m: month; y: year; min: minute; h: hour; NR: not reported; /: not available or applicable.

The results of each intervention regarding the included participation outcome measures are summarized in Supplemental Material 4. This table provides an overview of pre-, post- and follow-up intervention values, p-values and effect sizes. Four studies^{30, 31, 49, 54} demonstrated significant differences in the within-group pre- and post-intervention. Only one⁴⁹ of these four indicated a significant difference of p < 0.05 on the within-group pre- and follow-up intervention. Also, all four studies described participation as primary outcome measure.

Significant between-group differences related to pre- and post-intervention were reported in two articles.^{34, 54} Both studies were categorized within the cluster of exercise intervention (Cluster 3). Moreover, the first article⁵⁴ consisted of a motor relearning program and reported a significant difference (p < 0.001) on the social integration (SI) component of the Community Integration Questionnaire. In this article the Community Integration Questionnaire was used as the primary outcome measure. The second article³⁴ applied an accelerated skill acquisition program or dose-equivalent usual occupational therapy. The authors investigated participation as a secondary outcome measure using the Reintegration to Normal Living Index. The Reintegration to Normal Living Index showed a significant difference (p < 0.05) from the experimental group 1 over the experimental group 2 as well as a significant difference (p < 0.01) from the experimental group 1 over the control group.

Supplemental Material 4 indicates that only two studies showed a significant between-group difference of p < 0.01 on the ICF Measure of Participation and ACTivities questionnaire between pre- and follow-up-intervention.^{42, 47} Nooijen et al. (2017) described participation as a primary outcome measure. The intervention consisted of regular rehabilitation in combination with behavioural intervention promoting physical activity (Cluster 1). Conversely, Vas et al. (2011) examined participation as a secondary outcome, while the intervention consisted of strategic memory and reasoning training (Cluster 2). The other included articles were unable to detect any significant within- or between-group differences. The Hedges’ g effect sizes varied in range from small to large (0 ≤ ES ≤ 2.5).

Discussion

This systematic review collected and analyzed rehabilitation interventions evaluated in common neurological disorders reported to influence participation outcomes. A total of 28 randomized controlled trials were analysed with a large variety of applied strategies. Overall, only fifteen studies described participation as primary outcome. Among these fifteen studies four demonstrated significant differences in pre- and post-intervention in experimental groups.

The wide variety of the population, experimental design, applied intervention and outcome measure required us to group them into clusters based on pathology and intervention types in order to attempt to mitigate the heterogeneity. Within the intervention clusters, there was no tendency observed in favour of a specific type of intervention and a specific pathology group. However, most of the research as well as the most variety in the applied interventions are reported in the stroke population. Most studies investigated the effect of their interventions on patients within the chronic stage of the reported disease. Very few interventions were conducted with patients within the acute or subacute stage (<3 months after onset).³⁴ Therefore, future studies are encouraged at the earlier stage after the onset of the disease in order to test the efficacy in improvement of participation.⁶⁵

With regard to the intervention clusters, cognitive behavioural therapy was the only type of intervention retrievable in all pathology clusters. This intervention consisted mainly of client-centred approaches focusing on self-identified and personally meaningful daily activities.⁶⁶ Despite promising findings, interventions showed a limited amount of effectiveness regarding the management of participation challenges. However, several other interventions likely assumed to improve participation through a possible treatment effect registered on body-functioning level or pertaining the contextual factors. This could be seen as a poor interpretation of the concept participation whereby the emphasis should be on the interaction of all International Classification of Functioning, Disability and Health components displayed in the International Classification of Functioning, Disability and Health Model. Therefore, it can be supposed that interventions within the cluster of multidisciplinary rehabilitation (5) and the cluster combining exercise intervention and cognitive behavioural therapy (4) might be more appropriate.

Fifteen studies investigated the effectiveness of interventions on participation as a primary outcome. Among these studies four demonstrated significant improvement in within-group pre- and post-interventions. In addition to the use of inappropriate participation outcome measure, these relatively inconclusive results of interventions to manage participation challenges may be mediated by factors as participation being often a secondary outcome. The latter explanation may be linked to the limitations of our search strategy in identifying all interventions directed to the improvement of participation as the main endpoint. Indeed, it has been demonstrated that statistical testing of secondary outcomes is associated with an increased risk of both false-positive and false-negative errors,⁶⁷ while achievement of statistical significance for the primary outcome is typically a necessary prerequisite for the adoption of a new therapy.⁶⁸ Therefore, we suggest that future studies are exclusively devoted to the assessment of interventions aiming at improving participation as primary outcome in common neurological disorders.

The present study provides a review of the rehabilitation interventions evaluated in common neurological conditions, specifically in stroke, spinal cord injury, multiple sclerosis, Parkinson's disease and traumatic brain injuries that reported participation outcome measures. Our methodology complies with the Cochrane's guidelines for systematic reviews of interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statements. Only randomized controlled trials were included in this review, and most of the included studies were of good methodological quality. Furthermore, the development of specific eligibility criteria regarding outcome measures provided an overview of the most appropriate questionnaires to measure participation. As a result, certain articles were excluded based on these specific eligibility criteria, despite involving an intervention focusing on participation. Also, these specific eligibility criteria were a potential limitation to identify studies related to patients affected by Parkinson's disease. Restriction of the search to RCTs was also a potential limitation because we may miss some alternative study designs that may be better suited approaches in the earlier stages of the diseases and that may be effective at improving participation outcomes. Besides, because we restricted our search to studies published in English and French languages, relevant studies in other languages may have been missed.

This systematic review provides a new insight into rehabilitation interventions evaluated in common neurological conditions that reported participation outcome measures. Multidisciplinary rehabilitation interventions and combination of physical exercises and cognitive behavioural therapy were the most widely used. Fifteen out of the 28 included studies investigated the effectiveness of interventions on participation as a primary outcome, which may reflect some limitations of our research question and search strategy. Among the 15 studies, four demonstrated significant improvement in pre- and post-interventions in experimental groups. Therefore, we concluded that there is a limited evidence of the identified rehabilitation interventions to improve participation. We suggest that future studies be devoted to the assessment of interventions aiming at improving participation as primary outcome in neurological disorders.

Clinical messages

There is limited evidence of the identified rehabilitation interventions to improve participation in common neurological conditions.

Multidisciplinary rehabilitation interventions and combination of exercise interventions and cognitive behavioural therapy might be more appropriate for improving participation in common neurological conditions.

Administration of appropriate participation outcome measures and implementation of participation-orientated interventions are important to manage participation challenges.

Supplemental Material

sj-docx-1-cre-10.1177_02692155231191383 - Supplemental material for Efficacy of rehabilitation interventions evaluated in common neurological conditions in improving participation outcomes: A systematic review

Supplemental material, sj-docx-1-cre-10.1177_02692155231191383 for Efficacy of rehabilitation interventions evaluated in common neurological conditions in improving participation outcomes: A systematic review by Oyéné Kossi, Joke Raats, Jonas Wellens, Mathias Duckaert, Stijn De Baets, Dominique Van de Velde and Peter Feys in Clinical Rehabilitation

Footnotes

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

ORCID iDs

Oyéné Kossi

Stijn De Baets

Dominique Van de Velde

Supplemental material

Supplemental material for this article is available online.

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