Participation Importance and Satisfaction Across the Lifespan: A Traumatic Brain Injury Model Systems Study

Impact and Implications Among adults with traumatic brain injury (TBI) across the lifespan, a higher frequency of participation does not necessarily translate to higher satisfaction with participation, reinforcing the importance of considering multiple dimensions of participation in research and practice. Across the lifespan, relationships are consistently valued more highly than other life areas by individuals with TBI, indicating that quality of relationships should be considered as an important target for and outcome of rehabilitation interventions. Although participation frequency and satisfaction are not equivalent, providing resources and programs to improve access to more frequent participation could improve participation satisfaction. Providing cognitive interventions early in the rehabilitation process, with periodic follow-up assessment and intervention as needed, could promote and improve participation satisfaction. Objective: In rehabilitation research and practice, participation is defined as involvement in life situations and most often measured as frequency of engaging in these life situations. This narrow measurement approach overlooks that individuals perceive importance of and satisfaction with participation in activities in various life areas differently. The purpose of this study was to determine differences in meaningful participation (perceived importance and satisfaction) after moderate to severe traumatic brain injury (TBI) across age groups and to identify predictors of participation satisfaction. Method: Secondary data analysis of a TBI Model Systems substudy, including the Participation Assessment with Recombined Tools-Subjective (PART-S) that rates participation importance and satisfaction in 11 life areas that we grouped into three domains (i.e., productivity, social relations, out-and-about). We identified differences across age groups (i.e., 16 to 24 years, 25 to 44 years, 45 to 64 years, and 65+ years) and predictors of participation satisfaction. Results: Participation satisfaction in and importance of the 11 life areas varied across age groups. In all age groups, participants rated relationships as being of medium or high importance more often than other life areas. Older adults reported the highest participation satisfaction across life areas, despite having the lowest participation frequency. Consistent predictors of participation satisfaction were cognitive functioning and frequency of participation in the domain examined. Conclusion: Participation importance, satisfaction, and frequency are related, yet distinct, dimensions of participation that should all be measured to adequately evaluate meaningful participation. Future research should explore interventions across the lifespan that target modifiable predictors, like functional cognition and access to frequent participation in important life activities.