Sage Journals: Discover world-class research

Abstract

Postsecondary students with disabilities (SWDs) face significant challenges to their academic and personal well-being. There is a demand for more supportive strategies to facilitate fulfilling and equitable academic experiences for SWDs. This review aimed to (1) determine the effectiveness of various interventions, programs, and accommodations for enhancing the overall well-being of postsecondary SWDs and (2) evaluate the implications of these support strategies for disability service providers at postsecondary institutions. A narrative review was conducted, examining 13 studies aimed at enhancing the well-being of postsecondary SWDs. Studies were classified using the International Classification of Functioning, Disability and Health (ICF) Model. Ergonomics, assistive technology, and counselling programs had positive improvements on the academic success of SWDs. In SWDs, health status was associated with higher community participation, and physical interventions were beneficial to reducing pain over time. Coaching and mentoring opportunities were beneficial for successful goal fulfilment. However, there remains a risk of digital eye strain when using technology to support postsecondary SWDs. The findings indicate that a range of support strategies can benefit several different components of SWDs experiences. This review identifies research gaps and opportunities to examine support strategies to improve the physical and mental well-being of SWDs.

Keywords

occupational therapy functioning office ergonomics assistive technology post-secondary students narrative review

Introduction

Across Canada and the United States, a growing portion of students in postsecondary institutions identifies as individuals with disabilities or severe health conditions (Gotlib et al., 2019; Oakes et al., 2020). According to Statistics Canada’s Canadian Survey on Disability (CSD) from 2017, a fifth of Canadians aged over 15 years had one or more disabilities—namely, of the 540,000 youths surveyed, 13% fell under this category (Morris et al., 2018; National Educational Association of Disabled Students [NEADS], 2018; Statistics Canada, 2017). Youths with disabilities are at risk of less access to education or employment. According to the same report, around 31% of severely disabled youths in Canada are neither in school nor employed. On the other hand, for youths in school, there is a demand and need for more environmental features that would allow them to live and function optimally in educational settings. For example, over half of those students with disabilities (SWDs) interviewed in the CSD reported unmet needs for technology-related aids, such as audio aids for reading text. Furthermore, barriers remain to equitable student experiences based on disability type and severity. Namely, in postsecondary academic services that focus on supporting those with learning and attention disorders, students that struggle with social skills and self-determination are often left unaddressed (Berg et al., 2017).

An occupational therapy (OT) approach is useful for promoting accessibility and disability accommodations in higher learning institutions. In SWDs, occupational identity is closely related to academic and personal well-being. This is because occupations can give students a sense of belonging and allow them opportunities to build self-efficacy for personal goal fulfilment (Ekelman et al., 2013). OT provides evidence-based methods for achieving these outcomes by building strategies for and encouraging SWDs to actively participate in regular, everyday activities in their postsecondary lives.

This narrative review will examine existing literature on support and interventions for SWDs in postsecondary environments. This review will encompass a broad range of disabilities including, but not limited to, physical, learning, sensory, developmental, cognitive, and mental health. Through examining literature across different types of disabilities, the study provides a comprehensive overview of the support and interventions in postsecondary environments. This approach entails gaining insights into the different experiences and support of students with varying types of disabilities. Moreover, we will review the effectiveness of a range of support strategies. By applying our results to the World Health Organization’s International Classification of Functioning (ICF), we aim to (1) provide a holistic overview of existing psychosocial, as well as physical, supports provided to post-secondary SWDs; and (2) evaluate these supports in terms of their implications for practitioners hoping to enhance the quality of their institution’s disability services.

Materials and Methods

In this narrative review, we conducted a search in all major databases (PubMed, OVID (Medline), and Web of Science) focusing on “disability,”“ergonomics,”“mental health,”“physical health,” among postsecondary students. We completed a title screen of articles using these keywords. We then screened these articles based on their title and abstract relevancy and reviewed their full texts at a later stage. Inclusion criteria included articles that directly addressed or were relevant to the health of post-secondary students or youth and their experiences related to attending a postsecondary institution. This review included quantitative and qualitative research, including pilot studies and a practice brief. Letters, conference proceedings, abstracts, and unpublished works were excluded. All papers were in English.

ICF Model

The international Classification of Functioning, Disability and Health (ICF) was created by the World Health Organization (WHO) to universally classify health and health-related conditions. This framework looks at health from a biopsychosocial lens, generating a cohesive view of health from a biological, individual, and social perspective (Stewart & Rosenbaum, 2003). The ICF is a hierarchical framework composed of two parts with two components each. The first part is functioning and disability, broken into body functions and structures, activities and participation (Skalko, 2020). Activities refer to tasks and actions an individual can execute, and participation is the individual’s engagement in society and life situations (National Center for Health Statistics [NCHS], 2022). The ICF splits activities and body functioning, and structures into two different categories. These two categories were combined in this review as both categories look at disability from an individual level as opposed to at an environmental or societal level. The second part examines contextual factors, including environmental and personal factors. ICF is a useful tool that guides clinical thinking, practice, policy development and research in various fields, especially in the context of disability (Stewart & Rosenbaum, 2003). Similarly, the ICF can measure the effectiveness of rehabilitation services for functional profiling and creating unique interventions for different individual needs (Üstün et al., 2003).

Results

This literature review used the International Classification of Functioning Disability and Health (ICF) framework to categorize the studies included in this review (World Health Organization [WHO], 2022). A more coherent biopsychosocial view can be obtained using the ICF model.

Environmental Factors Associated with Supporting SWDs in Postsecondary

Six studies of this review were classified and included in the “Environmental Factor” category of the ICF model (Chu et al., 2020; Goodman et al., 2002; Harrington et al., 2021; Lindsay et al., 2019; Mohamed Thariq et al., 2010; Vázquez et al., 2012). Environmental factors are crucial for supporting students with diverse accommodations in higher education, ranging from physical disabilities to mental health conditions. Environmental factors such as incorporating environmental on-campus accommodations and recommendations (Chu et al., 2020), occupational therapy-led coaching opportunities (Harrington et al., 2021), and assistive technology (Goodman et al., 2002) were effective in students with physical disabilities, learning disabilities, cognitive disabilities, and with mental health conditions. Students with mental health disabilities also benefited from the use of cognitive behavioral therapy and relaxation programs (Vázquez et al., 2012). Moreover, it was found that constructing ergonomic office furniture helped to prevent the onset of physical disabilities and improve the well-being of students (Mohamed Thariq et al., 2010). Table 1 in the appendix illustrates a more detailed capture of study characteristics and outcomes.

Table 1.

Environmental Factors Associated with Supporting SWDs in Postsecondary.

Author/year/country	Aim/objective	Population/sample (N)	Intervention	Outcome
Chu et al. (2020), USA	The objective of this study was to Inform occupational therapists (OTs) about Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and to determine their role in helping university students affected by ME/CFS.	A narrative/literature review was conducted on College/University students with uncommon, “invisible diseases” such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)	Some examples of the recommended accommodations included increasing/maintaining awareness about ME/CFS and its “unpredictability,” requesting accommodations for students as early as possible from the disability office, and advising students to communicate with an academic advisor and their professors.	Implementing the recommended accommodations and removing environmental barriers that exist for these students is important for their academic experience. The role of OTs is crucial in understanding the perspectives of these students.
Mohamed Thariq et al. (2010), Sri Lanka	The objective of this study is to propose and develop “design dimensions” to construct “fixed-type side-mounted desktop chairs” for university students in Sri Lanka. This objective is important to develop ergonomic support to ensure ideal/proper posture and comfort for university students	This observational study collected anthropometric measurements of 385 undergrad students including 221 males and 164 females, ranging from students in their first year to their final year and aged 20 to 28 years were retrieved.	To propose and develop the dimensions of an ergonomic chair, anthropometric measurements were taken using two different anthropometers, “an adjustable stool” and a bathroom scale.	The recommended height for the fixed-type side-mounted desktop chairs is 229 mm from the surface of the chair seat.
Harrington et al. (2021), USA	To determine the effectiveness of Therapy-Led Coaching in post-secondary students with disabilities	This phenomenological study interviewed 18 students who were previously enrolled in the GOALS program and had at least one mental health diagnoses	Coaching sessions were conducted by OTs to assist postsecondary students with educational, vocational and social concerns within their university.	Four major themes emerged, including academic and personal growth, open and supportive environment, perception of success, and the importance of accountability and engagement. The students felt positively about the overall OT-led coaching experience.
Goodman et al. (2002), USA	The purpose of this study was to evaluate and assess the factors that influenced college students with various disabilities to either incorporate/decline incorporating Assistive Technology (AT) to their personal computers. In turn to “evaluate the effectiveness of a computer course on adapted computer use” at a Midwest university.	This longitudinal study included 20 participants. 14 of these students completed all three of the interviews conducted for this study. The ages of the population ranged from 18 to 59 years. Participants included those with partial visual impairment, completely blind, fine motor control, confined to WC, Quadriplegia w/RUE non-function, muscle weakness in all limbs, endurance, reading, spelling, writing, comprehension, cognitive deficits, decreased concentration, short term memory limitations, speech impairment, stuttering disorder	The investigators provided students with a Q-sort questionnaire comprised of 48 statements. Using the Scherer’s model, the statements were separated into four major categories. Students were asked to state whether they agree, disagree or are neutral about these statements. A total of three interviews were conducted with the participants to monitor the progress of the course and how well AT was being “adopted” by the students.	75% of the students incorporated and adopted some sort of AT. In addition, all the participants in the study claimed that they had a “positive experience” in terms of all aspects of the class leading to a “successful experience.”
Vázquez et al. (2012), Spain	Compares the efficacy of a CBT vs a RT program in preventing depressive symptoms in university students with heightened depressive symptoms. Depression and anxiety symptoms were both measured.	This study was a randomized control trial. N = 133 university students with elevated depressive symptoms were included. Mean age 23.3 years. Most (82.8%) were women.	Participants were randomly assigned to either a cognitive-behavioral intervention (CBT), or a relaxation training (RT) intervention. Participants then took part in 90 min CBT or RT sessions with 5/6 other participants. There was one session per week, for 8 weeks. Independent raters rated depression and anxiety scores in participants before, immediately after, and 3 and 6 months after intervention.	The intervention type had no significant effect on depression or anxiety scores. CBT participants showed a large (d = 1.32) reduction in depression scores immediately after intervention, though this effect decreased by a half in follow up. RT participants showed only a medium reduction in Depression scores immediately after (d = 0.66), but gradually tended to improve in follow-up. Intervention groups did not differ significantly in reduction of anxiety scores on the Beck Anxiety Inventory (BAI)
Lindsay et al. (2019), Canada	Literature review on the barriers and facilitators of disability disclosure and accommodations available for postsecondary students. Studies were analyzed based on study results, quality of evidence, methodology and participant characteristics.	Of the 36 studies used for this systematic literature review, 5,174 participants with various disabilities (learning, physical, mental health) from six different countries were represented.	Interventions or facilitators that helped post-secondary students disclose their disability and seek accommodations include supports and resources, mentorship, realizing the benefits of disclosure, and coping and self-advocacy skills	Barriers SWDs face when asking for accommodations include stigma, discrimination, lack of knowledge of supports and how to access them, type of course and instructor, coping styles, and type of disability. Those with non-visible disabilities have a more difficult time identifying the support they need.

Personal Factors Associated with Supporting SWDs in Postsecondary

One study was classified and included in the “Personal Factors” category of the ICF model (Eismann et al., 2017). In order to facilitate the transition into postsecondary learning, programs should aim to provide support and accommodations for those with disability-related functional impacts. It is integral for coordinators to note that students’ health statuses, verbal comprehension skills, and functional abilities strongly correlate with their community participation success. Thus, Eismann et al. (2017) suggest that it may be especially useful to target these factors when creating accessible forms of participation within the postsecondary community for SWDs, specifically those with intellectual and development disabilities. This allows disabled students a source of social fulfilment and belonging within their learning environments. For example, program coordinators can consider diversifying employment opportunities for disabled individuals with a larger variation in health statuses (Eismann et al., 2017). Table 2 in the appendix illustrates a more detailed capture of study characteristics and outcomes.

Table 2.

Personal Factors Associated with Supporting SWDs in Postsecondary.

Author/year/country	Aim/objective	Population/sample (N)	Intervention	Outcome
Eismann et al. (2017), USA	Aims to identify characteristics in people with disabilities who had also received OT between late adolescence and adulthood. To investigate if these characteristics were associated with a successful transition into Higher-level education.	This was a correlational study. The population was youth and young adults with intellectual and developmental disabilities, who were receiving OT services from public schools between transitioning from secondary to postsecondary. From this population, Eismann et al. analyzed data from a sample of N = 5,580 youth and young adults. 420 of these individuals had received OT services from their educational district within the past year. The mean age of individuals was 20.3 years.	This is a secondary analysis of the fourth wave of data from the NLTS2 (National longitudinal transition study). Descriptive statistics of students were generated (i.e., disability classifications, functional ability of motor skills). Regression (Binary logistic or Simple linear) used to develop models describing relationships between student characteristics and postsecondary transition outcomes (i.e., involvement in education, employment, and community contributions)	There was a significant inverse relationship reported between functional ability at motor skills and enrollment in a 2-year college; possibly due to youths with more mobility choosing to enroll in 4-year colleges over 2-year ones. Verbal comprehension was significantly related (positively) to individuals with disabilities’ number of paid jobs in the past 2 years, or since leaving high school. Lastly, there was a significant relationship between health status and the degree of community participation. A significant relationship was also seen for the latter and functional motor skills.

Activities, Body Function, and Structure Related Factors Associated with Supporting SWDs in Postsecondary

Three studies were categorized and included in the “Activities/Body Function and Structure” category of the ICF model (Jain et al., 2022; Lima et al., 2018; Nesbitt et al., 2021). These studies demonstrated that engaging in activities is beneficial for those with physical disabilities and mental health conditions. Participating in some form of physical activity throughout the day, either once or multiple times a day, can be a protective measure against musculoskeletal disorders, improving body structure and function, and pain and low back disability (Jain et al., 2022; Lima et al., 2018). It may also serve as a de-stressor to those who face serious mental health concerns. Refer to Table 3 in the appendix for a more nuanced capture of study characteristics and outcomes.

Table 3.

Activities, Body Function and Structure Related Factors s Associated with Supporting SWDs in Postsecondary.

Author/year/country	Aim/objective	Population/sample (N)	Intervention	Outcome
Nesbitt et al. (2021), Canada	To identify occupational performance issues (OPI’s) of university students who seek out mental health support. To investigate the relationship between a therapeutic physical activity (PA) intervention and the quality of occupational performance in post-secondary students. Occupational performance is loosely defined as the ability to “choose, organize, and perform satisfactorily” in personally meaningful roles.	This was a pilot study. N = 20, Canadian undergraduate/graduate students who were seeking mental health support were include/ These students all indicated >1 mental health concern, and were not sufficiently active according to Canadian PA guidelines (<23 Metabolic equivalents of moderate-to-vigorous PA per week)	Participants completed 1-hour PA interventions each week for 6 weeks: this included 30 min of light-to-moderate intensity aerobics, and then 30 min of behavior change coaching (use of a workbook to educate participants on strategies to promote positive PA behavior)	77 OPI’s were identified in total: 37% were self-care related, 31% related to productivity, and 32% were related to leisure. Post 6 weeks of PA intervention, occupational performance ratings significantly improved by a mean of 2.7 points. Performance satisfaction also improved significantly by a mean of 3.7 points. The intervention had a clinically significant positive effect overall.
Jain et al. (2022), India	To determine the effectiveness of a physical activity intervention (PAI) on computer users’ musculoskeletal health during the COVID-19 pandemic in university students.	This cohort study included 40 university students with musculoskeletal disorders.	PAI required daily physical activity for 1 hr a day. Participants were instructed to do stretches and static running for 2-minutes every 2 hr. Bodily discomfort measured using the scale of Corlett and Bishop.	Computer users’ discomfort before PAI were mostly seen in the wrist/forearm, lower back, elbow and neck. PAI significantly decreased the discomfort among users in various body regions suggesting the importance of using OT for students that work remotely or for those that heavily rely on computers.
Lima et al. (2018), Brazil	To assess the effectiveness of a 10-week core and mobility training program on the perception of pain and low back disability in students, professors and university employees.	This randomized control trial included 24 participants consisting of students, professors and university employees. These participants were those having pain and low back disability.	All participants received guidelines to adopt ergonomic postures during work and activities of daily living. Only the experimental group received the training program. The visual analog pain scale and the Roland-Morris questionnaire were applied pre- and post-intervention.	The experimental group scored significantly better on the visual analog pain scale and the Roland-Morris questionnaire pre- and post-intervention for both variables. No significant differences in pain perception or low back functional disability were found in the control group. The training program was successful at reducing pain and low back disability.

Participation Factors Associated with Supporting Students in Postsecondary

Two studies were categorized and included in the “Participation” category of the ICF model (Boney et al., 2019; Schindler, 2019). Coaching and mentoring opportunities using trained individuals have also shown great potential for enhancing postsecondary living and academic success in students who have a learning disability, physical disability, sensory disability, mental health condition, developmental disability, and cognitive disability. This suggests that regularly and directly engaging these students in dialogue can be an efficient way of gaining insight into the kinds of support these students require. Also, doing so could empower students to build feasible strategies for goal fulfilment in future life opportunities. Refer to Table 4 in the appendix for a more nuanced capture of study characteristics and outcomes.

Table 4.

Participation Related Factors Associated with Supporting SWDs in Postsecondary.

Author/year/country	Aim/objective	Population/sample (N)	Intervention	Outcome
Schindler (2019), USA	The purpose of this study is to investigate the quantitative academic outcomes of the Occupational Therapy (OT) based Supported Education (SEd) Program for students who have been diagnosed with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)	Three study designs were incorporated; retrospective, 1-group comparison and the 1-group pre-posttest design. The population for this study was 80 undergraduate students who are enrolled at a northeast suburban university for at least one semester. Two thirds of the participants were male. The age range was 18 to 50 years. 95% of the participants were full-time students. 80% identified as white.	This OT based SEd program specifically consists of a one-to-one mentoring program with an OT master’s student being the mentor and an undergraduate level student with a DSM-5 disability being the mentee. The mentoring occurs biweekly for 2 hr. The Canadian Occupational Performance Measure (COPM) is used to identify the various potential “occupational performance problems” within post-secondary education.	96% of the students who started the program completed at least one semester of university. There was a retention rate of 77.5%. A statistically significant change in GPA was found amongst 62 of the 80 participants. The positive quantitative results/outcomes of the study indicating student success supports the need for an OT-based Support Education program for university students with DSM-5.
Boney et al. (2019), USA	Aimed to assess effectiveness and value of the “Greater Opportunity for Academic Learning and Living Sucesses” (GOALS2) program in helping students with disabilities reach self-identified goals that traditional accessibility services do not tend to cover (i.e., interpersonal, self-management goals). Participants were studying at a medium-sized university in eastern Pennsylvania.	This was a pilot study. 13 students with disabilities were identified. 10 became ongoing participants, (attended >3 GOALS2 sessions). Participants reported having attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), a learning disability, deaf/hearing impairment, mental health, physical/mobility related disability, and Autism.	In each session, Masters level Occupational therapy students met with participants to brainstorm strategies to help them reach goals. Each participant attended an average of 9.5 sessions. Sessions took a “Coaching-in-Context” approach. Students gave Goal Attainment Scaling (GAS) ratings during each session. These were used to assess if goals were reached. Seven of the 10 ongoing participants were also interviewed on their impressions of the program.	All goals related to health and Wellness + Interpersonal Relationships were reached, Six out of nine Academic goals were reached. Five out of seven Time-Management/Organization goals were reached. Two out of seven interviewed participants reported they did not use goal-reaching strategies. Also, two out of seven participants reported unexpected obstacles (i.e., class assignments) as a challenge in reaching goals. However, researchers state that there was “overwhelmingly” positive feedback from students about GOALS2.

Health Condition Related Factors Associated with Supporting SWDs in Postsecondary

One study was classified and included in the “Health Condition (Disorder or Disease)” category of the ICF model (Kaur et al., 2022, pp. 1655–1680). Where applicable, careful and ergonomic integration of digital technology should be incorporated into supporting student health. This may be particularly important for students with visual disabilities or those who spend considerable time using electronic devices. Eye strain can be prevented through the mindful use of devices. Ergonomics practices such as the reduction of screentime to less than 4 hr per day, taking regular/frequent breaks away from the screen, using blue light blocking glasses, correct posture/positioning to maintain a 20-inch distance from the screen and adjusting the brightness of your screen to match the brightness of your environment are a few examples of the ergonomic practices recommended to reduce eye strain. The study also recommends individuals partake in outdoor activities and decrease screentime when possible (Kaur et al., 2022, pp. 1655–1680). Refer to Table 5 in the appendix for a more nuanced capture of study characteristics and outcomes.

Table 5.

Health Condition Related Factors Associated with Supporting SWDs in Postsecondary.

Author/year/country	Aim/objective	Population/sample (N)	Intervention	Outcome
Kaur et al. (2022), India	The purpose of this review was to characterize digital eye strain (DES) and its symptoms and recommend ways that DES can be managed and prevented.	This systematic review included all English language papers found on Google Scholar, PubMed, and Cochrane database on DES that mentioned prevalence, risk factors, and clinical features. All the articles with available abstracts along with the referenced articles until the date of search were evaluated. Students were mainly diagnosed with autism, ADHD, a learning disability, depressive disorder, and anxiety disorder	No intervention. DES symptoms include dry eyes, itching, watering, blurring vision, headaches. Non-ocular symptoms included neck stiffness, fatigue, and backaches.	The COVID-19 pandemic has led to a 50% increase in myopia. Recommendation includes correct ergonomic use of digital devices, reducing daily screen time to 4 hr, taking frequent breaks from the screen, using blue-light glasses and taking part in outdoor activities.

Discussion

Environmental barriers, including participation in learning and academic environments, can prevent individuals from reaching their maximum potential. Hence, this narrative review aims to provide potential solutions for SWDs to promote and enhance their engagement and participation in higher education studies. These support strategies are at physical, environmental, and social levels.

A total of six studies are included in the ICF environmental category. According to WHO, ICF environmental factors are defined as the social, physical, and attitudinal environment inhabited by people, which can be a barrier or facilitator for the person’s functioning. This review found that environmental factors played a significant role in improving the experience of students with varying disabilities. This category has the greatest number of studies in this review. There is currently more literature focusing on making the physical environment around students better via office ergonomics (Castellucci et al., 2017; Moslander & Jacobs, 2022; Mowatt et al., 2018; Upadhyay et al., 2021) than there is a focus on social and attitudinal environmental factors. Thus, in this narrative review, more studies focused on attitudinal factors (Goodman et al., 2002; Vázquez et al., 2012) and social factors (Chu et al., 2020; Harrington et al., 2021; Lindsay et al., 2019). The lack of literature focused on the attitudinal and social-environmental factors affecting students is alarming. While physical barriers such as office ergonomics are integral to creating an equitable environment for SWDs, it is also important to investigate and understand biopsychosocial factors behind SWDs experiences in higher education.

Three studies were included in the Activities and body functioning and structures category. All the studies in these categories focused on individual actions students could take to eliminate bodily pain and improve bodily function. Another reason why the categories, activity and body functioning, were combined is that they are co-dependent. The execution of a task by a person (activity) depends on their physiological and anatomical ability to perform that task (body functioning and structures) and vice versa. The studies in this category show a positive correlation between taking short physical activity breaks throughout the day and a reduction in bodily pain over time. This category had the second-highest number of studies in it. It is universally known that physical activity benefits both physical and mental health (Dwyer et al., 2020). Sedentary lifestyles are becoming the norm, especially for students in higher education. A cross-sectional study conducted in a south African university found that musculoskeletal pain was highly prevalent among health science undergraduate students, associated with sedentary time and lack of structured physical activity participation (Ogunlana et al., 2021). As a result, more studies in this review focused on physical activity interventions to showcase the significance of taking part in daily physical activities, even if for short periods of time.

There are two studies in the category of participation. The WHO defines participation as involvement in life situations and the participation restrictions faced by those with a disability. Both studies in this category look at the impact of mentoring programs led by masters-level occupational therapy students on achieving academic and wellness outcomes in SWDs. While both these studies show OT-led programs to positively affect students’ social and academic outcomes, this category has only two articles, much fewer than some of the other categories. Research on educational-based OT-led programs for SWDs in higher education is scarce in the current literature. Participatory programs have been helping to change students’ behaviors towards ergonomics (Korkmaz & Sommerich, 2009, Miguez et al., 2012; Robertson et al., 2002). Implementing OT programs that directly engage SWDs in planning and setting strategies to enhance their participation in their lives and academics could improve physical, social and educational outcomes for SWDs.

The categories of personal factors and health conditions have only one article each. Personal factors determine how disability is experienced by an individual, as influenced by their demographics (WHO, 2022). The study included in the personal factors category aimed to identify characteristics in people with disabilities who received OT services between late adolescence and adulthood. The reason why more studies focusing on personal factors are not included is due to personal factors varying for each student. This review aimed to focus on macro-level approaches as they can be of greater significance by helping a wide range of students regardless of their disability. For instance, at the macro-level, educational policies and programs should target mental health outcomes as opposed to firmly focusing on the academic outcomes of students with mental health disabilities (McAllister et al., 2018). Another reason this category has the least number of articles is the lack of OT-led programs for SWDs in higher education. While there are multiple such programs for school children, not many are observed for university and higher education students (Fairbairn & Davidson, 1993; Novak & Honan, 2019; Pierce et al., 2020).

Similarly, health conditions also vary for students; hence, only one study was included in this narrative. The study by Kaur et al. focuses on digital eye strain. This specific study was included in the narrative as digital eye strain is becoming more common, with higher education programs relying heavily on digital devices (Leccese et al., 2016). The COVID-19 pandemic has exacerbated this use of electronics resulting in more individuals complaining of eye strain (Khanwalkar & Dabir, 2022). Exposure to electronic devices will likely continue to increase over the years, especially for students. Future studies must focus on long-term visual ergonomic interventions to promote students’ visual health.

The findings from this review can be implemented to create programs, policies, and interventions to enhance the well-being and experiences of SWDs. With understanding the role of environmental factors, institutions can partake in initiatives that create universally accessible physical spaces such as those with ergonomic considerations. Additionally, social and attitudinal environments, such as workshops and training programs, can foster a more inclusive and support environment for SWDs. Likewise, implementing programs such as Occupational Therapy (OT)-led participatory programs can engage SWDs in preparing strategies for enhanced academic and social participation. Institutions can also encourage physical activity programs to improve physical and mental well-being and address the impact of sedentary lifestyles on the health of SWDs.

This narrative review is also subjected to limitations. Bias can often occur in narrative reviews, especially selection bias. Researchers may specifically choose articles that support their claim. This occurs due to a lack of explicit criteria for article selection; thus, studies included often support the argument. The articles in this narrative review were not evaluated for validity. Further, the articles in narrative reviews are not selected systematically across databases. Regarding article selection, tertiary study designs such as literature reviews and are acceptable for the narrative review methodology, which is otherwise not acceptable to use in arguably stronger designs such as systematic reviews and meta analyses. In our narrative review, a literature review by Chu et al. (2020) was used to support our arguments. Overall, selection bias may have manifested in our narrative reviews through non-systematic article selection, lack of article validity measuring, and tertiary study selection to support our claim.

Furthermore, when looking at the chosen studies, some studies had a very small sample size. Studies conducted by Lima et al. (2018), Nesbitt et al. (2021), and Harrington et al. (2021) had sample sizes of less than 20. Large sample sizes ensure that study results can be generalizable. However, since this narrative review focuses on SWDs, although small, the sample sizes were reflective of this study population. Finally, some studies, such as Mohamed Thariq et al. (2010), were conducted outside Canada and North America. This is seen as a limitation to this narrative review as education systems and their environments vary across the world. There is a possibility that the results from such studies may not be applicable to Canadian students due to geography based differences in institutional structures (e.g., services provided to individuals with disabilities varies from one region to another

Conclusions

Our findings suggest that various accommodations, programs, and interventions at physical, environmental, and social levels can significantly improve the educational experience of SWDs. It is important to further study and implement these support strategies to ensure SWDs have equitable opportunities and experiences as their peers.

Footnotes

Acknowledgements

The authors would like to thank Michelle Morgani, Sezgi Ozel, and Sarah Goodfield Weinstein from Accessibility Services at the University of Toronto for their rich discussion regarding the topic of our paper.

Author Contributions

Conceptualization, B.N.K.; methodology, C.T., R.K., and B.A.; validation, B.N.K. and V.K.C.; formal analysis, C.T., R.K., and B.A.; investigation, C.T., R.K., and B.A.; resources, C.T., R.K., and B.A.; data curation, C.T. R.K., and B.A.; writing—original draft preparation, C.T., R.K., and B.A.; writing—review and editing, B.N.K., S.A and V.K.C.; visualization, C.T., R.K., and B.A.; supervision, B.N.K..; project administration, B.N.K..; funding acquisition, V.K.C and B.N.K.. All authors have read and agreed to the published version of the manuscript.

Declaration of Conflicting Interests

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

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Behdin Nowrouzi-Kia

Sujatha Alla

Vijay Kumar Chattu

Data Availability Statement

All the data presented in this study has been included and is publicly available.

References

Berg

L. A.

Jirikowic

Haerling

MacDonald

(2017). Navigating the hidden curriculum of higher education for postsecondary students with intellectual disabilities. The American Journal of Occupational Therapy, 71(3), 1–9. https://doi.org/10.5014/ajot.2017.024703

Boney

J. D.

Potvin

M. C.

Chabot

(2019). The GOALS2 program: Expanded supports for students with disabilities in postsecondary education (practice brief). Journal of Postsecondary Education and Disability, 32(3), 321–329.

Castellucci

H. I.

Arezes

P. M.

Molenbroek

J. F. M.

de Bruin

Viviani

(2017). The influence of school furniture on students’ performance and physical responses: Results of a systematic review. Ergonomics, 60(1), 93–110. https://doi.org/10.1080/00140139.2016.1170889

Chu

Fuentes

L. R.

Marshall

O. M.

Mirin

A. A.

(2020). Environmental accommodations for university students affected by Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Work, 66(2), 315–326. https://doi.org/10.3233/WOR-203176

Dwyer

M. J.

Pasini

de Dominicis

Righi

(2020). Physical activity: Benefits and challenges during the COVID-19 pandemic. Scandinavian Journal of Medicine & Science in Sports, 30(7), 1291–1294. https://doi.org/10.1111/sms.13710

Eismann

M. M.

Weisshaar

Capretta

Cleary

D. S.

Kirby

A. V.

Persch

A. C.

(2017). Characteristics of students receiving occupational therapy services in transition and factors related to postsecondary success. The American Journal of Occupational Therapy, 71(3), 1–8. https://doi.org/10.5014/ajot.2017.024927

Ekelman

Bazyk

(2013). The relationship between occupational engagement and well-being from the perspective of university students with disabilities. Journal of Occupational Science, 20(3), 236–252. https://doi.org/10.1080/14427591.2012.716360

Fairbairn

Davidson

(1993). Teachers’ perceptions of the role and effectiveness of occupational therapists in schools. Canadian Journal of Occupational Therapy, 60(4), 185–191. https://doi.org/10.1177/000841749306000404

Goodman

Tiene

Luft

(2002). Adoption of assistive technology for computer access among college students with disabilities. Disability and Rehabilitation, 24(1–3), 80–92. https://doi.org/10.1080/09638280110066307

10.

Gotlib

Saragoza

Segal

Goodman

Schwartz

(2019) Evaluation and management of mental health disability in post-secondary students. Current Psychiatry Reports, 21(6), 43. https://doi.org/10.1007/s11920-019-1024-1

11.

Harrington

E. E.

Santos

G. O.

Potvin

M. C.

(2021). Postsecondary education students with disabilities’ perceptions of occupational therapy-led coaching. The Open Journal of Occupational Therapy, 9(2), 1–13.

12.

Jain

Verma

Rana

K. B.

Meena

M. L.

(2022). Effect of physical activity intervention on the musculoskeletal health of university student computer users during homestay. International Journal of Occupational Safety and Ergonomics, 29(1), 25–30. https://doi.org/10.1080/10803548.2021.2014090

13.

Kaur

Gurnani

Nayak

Deori

Kaur

Jethani

Singh

Agarkar

Hussaindeen

J. R.

Sukhija

Mishra

(2022). Digital eye strain—A comprehensive review. Ophthalmology and Therapy, 11(5), 1655–1680. https://doi.org/10.1007/s40123-022-00540-9

14.

Khanwalkar

Dabir

(2022). Visual ergonomics for changing work environments in the COVID-19 pandemic. Work, 73(s1), S169–S176. https://doi.org/10.3233/WOR-211130

15.

Korkmaz

S. V.

Sommerich

C. M.

(2009). Facilitating student learning about ergonomics and healthy computing skills via participatory ergonomics. Work, 34(4), 439–448. https://doi.org/10.3233/WOR-2009-0944

16.

Leccese

Salvadori

Rocca

(2016). Visual discomfort among university students who use CAD workstations. Work, 55(1), 171–180. https://doi.org/10.3233/WOR-162370

17.

Lima

V. P.

de Alkmim Moreira Nunes

da Silva

J. B.

Paz

G. A.

Jesus

de Castro

J. B. P.

Dantas

E. H. M.

de Souza Vale

R. G.

(2018). Pain perception and low back pain functional disability after a 10-week core and mobility training program: A pilot study. Journal of Back and Musculoskeletal Rehabilitation, 31(4), 637–643. https://doi.org/10.3233/BMR-169739

18.

Lindsay

Lamptey

D. L.

Cagliostro

Srikanthan

Mortaji

Karon

(2019). A systematic review of post-secondary transition interventions for youth with disabilities. Disability and Rehabilitation, 41(21), 2492–2505. https://doi.org/10.1080/09638288.2018.1470260

19.

McAllister

Fritzell

Almroth

Harber-Aschan

Larsson

Burström

(2018). How do macro-level structural determinants affect inequalities in mental health?—A systematic review of the literature. International Journal for Equity in Health, 17(1), 180. https://doi.org/10.1186/s12939-018-0879-9

20.

Miguez

S. A.

Hallbeck

M. S.

Vink

(2012). Participatory ergonomics and new work: Reducing neck complaints in assembling. Work, 41, 5108–5113. https://doi.org/10.3233/WOR-2012-0802-5108

21.

Mohamed Thariq

M. G.

Munasinghe

H. P.

Abeysekara

J. D

. (2010). Designing chairs with mounted desktop for university students: Ergonomics and comfort. International Journal of Industrial Ergonomics, 40(1), 8–18. https://doi.org/10.1016/j.ergon.2009.10.003

22.

Morris

Fawcett

Brisebois

Hughes

(2018). A demographic, employment and income profile of Canadians with disabilities aged 15 years and over, 2017. Canadian Survey on Disability Reports. https://www150.statcan.gc.ca/n1/pub/89-654-x/89-654-x2018002-eng.htm

23.

Moslander

Jacobs

(2022). Efficacy of an ergonomics intervention for remote college students. Work, 71(2), 423–431. https://doi.org/10.3233/WOR-210689

24.

Mowatt

Gordon

Santosh

A. B. R.

Jones

(2018). Computer vision syndrome and ergonomic practices among undergraduate university students. International Journal of Clinical Practice, 72(1), e13035. https://doi.org/10.1111/ijcp.13035

25.

National Center for Health Statistics (NCHS). (2022). International classification of functioning, disability and health (ICF). Centers for Disease Control and Prevention.

26.

National Educational Association of Disabled Students (NEADS). (2018). Landscape of accessibility and accommodation in post-secondary education for students with disabilities. National Education Association of Disabled Students.

27.

Nesbitt

A. E.

Collins

K. J.

Nalder

Sabiston

C. M.

(2021). Occupational outcomes of a physical activity intervention for post-secondary student mental health. Canadian Journal of Occupational Therapy, 88(3), 254–65. https://doi.org/10.1177/00084174211021708

28.

Novak

Honan

(2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian Occupational Therapy Journal, 66(3), 258–273. https://doi.org/10.1111/1440-1630

29.

Oakes

L. R.

Milory

J. J.

Hickerson

B. D.

(2020). Health disparities and health promotion needs of college students with intellectual and/or developmental disabilities: A systematic literature review. Journal of American College Health, 68(7), 742–753. https://doi.org/10.1080/07448481.2019.1615495

30.

Ogunlana

M. O.

Govender

Oyewole

O. O.

(2021). Prevalence and patterns of musculoskeletal pain among undergraduate students of occupational therapy and physiotherapy in a South African university. Hong Kong Physiotherapy Journal, 41(1), 35–43. https://doi.org/10.1142/S1013702521500037

31.

Pierce

Sakemiller

Spence

LoBianco

(2020). Effectiveness of transition readiness interventions by school-based occupational therapy personnel. OTJR: Occupation, Participation and Health, 40(1), 27–35. https://doi.org/10.1177/1539449219850129

32.

Robertson

M. M.

Amick

B. C.

III Hupert

Pellerin-Dionne

Cha

Katz

J. N.

(2002). Effects of a participatory ergonomics intervention computer workshop for university students: A pilot intervention to prevent disability in tomorrow’s workers. Journal of Prevention, Assessment & Rehabilitation, 18(3), 305–314.

33.

Schindler

(2019). An occupational therapy-based supported education program for university students with various DSM-5 diagnoses: Program description and academic outcomes. The Open Journal of Occupational Therapy, 7(2), 1549. https://doi.org/10.15453/2168-6408.1549

34.

Skalko

T. K.

(2020). Understanding the international classification for functioning, disability, and health (ICF) model. Recreational Therapy Assessment.

35.

Statistics Canada. (2017). Canadian survey on disability, 2017. Statistics Canada. www150.statcan.gc.ca/

36.

Stewart

Rosenbaum

(2003). The international classification of functioning, disability, and health (ICF): A global model to guide clinical thinking and practice in childhood disability. CanChild Centre for Childhood Disability Research.

37.

Upadhyay

Juneja

Dhiman

Kautish

(2021). Evaluation of ergonomics-related disorders in online education using fuzzy AHP. Computational Intelligence and Neuroscience, 20(21), 1–11. https://doi.org/10.1155/2021/2214971

38.

Üstün

T. B.

Chatterji

Bickenbach

Kostanjsek

Schneider

(2003). The international classification of functioning, disability and health: A new tool for understanding disability and health. Disability and Rehabilitation, 25(11–12), 565–571. https://doi.org/10.1080/0963828031000137063

39.

Vázquez

F. L.

Torres

Blanco

Díaz

Otero

Hermida

(2012). Comparison of relaxation training with a cognitive-behavioural intervention for indicated prevention of depression in university students: A randomized controlled trial. Journal of Psychiatric Research, 46(11), 1456–1463. https://doi.org/10.1016/j.jpsychires.2012.08.007

40.

World Health Organization (WHO). (2022). International classification of functioning, disability and health (ICF). World Health Organization.