Running head: EVIDENCE-BASED PAPER

Evidence Based Paper Assignment

Davis Legaspi-David and Leslie Ramos
Touro University Nevada

EVIDENCE BASED PAPER

Relation of Study to the Research Question
Having spent time in a nontraditional occupational therapy setting for our fieldwork, we
had the opportunity of observing adolescents and young adults in their natural environment
partaking in their occupation. Particularly, being assigned to the fine and performing art
department of our fieldwork facility, allowed exposure to individuals performing leisure

activities such as singing, dancing, and painting. As a result, our research question seeks whether
or not emotional and physical well-being will improve through the participation of leisure
activities. As a reference guide the research article, Relationships between Leisure Participation
and Quality of Life of People with Developmental Disabilities examines essential needs that
represent the core of a persons life dimensions. Therefore, this study relates with our question
because emotional and physical are two of the essential needs that were examined. This study
will provide valuable information towards the correlation with leisure activities.
Purpose
Prior to this study, there were no researches that examined the components of leisure
participation of individuals with developmental disabilities and its relationship with quality of
life (Badia, Orgaz,Verdugo, Ulln, & Martinez, 2013). Therefore, the purpose of this study was
aimed towards those with developmental disabilities and how the relationship between
participation, preference, interest and constraints to leisure activities affects their objective and
subjective quality of life.
Hypotheses
This study had three hypotheses. The first one hypothesized that they would obtain
significant relations between quality of life dimensions and leisure participation dimensions.
Second, an expectation of the dimensions of quality of life that are related to self-determination,

EVIDENCE BASED PAPER

social inclusions and material, emotional and physical well-being will also be related to
subjective leisure participation. Lastly, they expected that subjective leisure participation and
personal and environmental variables would predict subjective dimensions of quality of life.
(Badia et. al., 2013)
Justification for the Study
Within the realm of support services, the idea of quality of life for those with disabilities

is becoming increasingly popular (Badia et. al., 2013). Therefore, this study is necessary because
it examines how diverse components of leisure participation can possibly improve the quality of
life of individuals with developmental disabilities. As a result, the literature reviews that were
used justify this study because they all seem to describe how participating in recreational
activities can help better integrate individuals with disabilities into the community and enhance
their emotional and physical well-being.
Study Design and Level of Evidence
The research used a qualitative study approach in order to examine the relationship
between the participation of leisure activities and quality of life. With that said, this research also
used systematic review, which makes this studys level of evidence a five. (Badia et. al., 2013)
Number of Participants, Assigned Group, Recruitment and Demographic
There were a total of 125 adult male and female participants with intellectual disability
for the study. The study had all the subjects together in one group. These individuals were
recruited from different services in Spain such as, occupational centers, special employment
centers and supported employment service. In order for an individual to be eligible to participate
in the study certain criteria had to be met. Individuals need to be able to communicate, have
comprehensive skills and must fall within the age range of 17 to 65 years. Aside from that, the

EVIDENCE BASED PAPER

only exclusion criterion was having mental health issues. At the end of the recruitment process,
there were marginally more females (52.8%) than males (47.2%) who partook in the study.
(Badia et. al., 2013)
Independent and Dependent Variables
The independent variable to this study is the participation in leisure activities (Badia et.
al., 2013). However, since there are three hypotheses to this study, there will also be three
dependent variables. The first dependent variable is the significant relationship between quality
of life dimensions and leisure participation dimensions. The second dependent variable is the
relation between dimensions of quality of life to subjective leisure participation. The third

independent variable is the increase in predicting subjective dimensions of quality of life. (Badia
et. al., 2013)
Types of Measures Used
The study used three types of measure, the Leisure Assessment Inventory (LAI) and the
Generalitat de Catalunya Scale (GENCAT Scale). Due to the study being conducted in Spain, the
Spanish version of the LAI was used to measure leisure behavior in adults. The LAI consist of
four subcomponents the Leisure Activity Participation Index (LAP), the Leisure Preference
Index (L-PREF), the Leisure Interest Index (L-INT), and the Leisure Constraints Index (L-CON)
(Badia et. al., 2013). The LAP provides a measure of a persons engagement in an activity. The
L-PREF measures how please the individual is with a certain activity. The L-INT is used to
measure how interested a person is to an activity that they do not partake in. The L-CON simply
examines any internal or external barriers that are preventing a person from participating in an
activity. The second measurement tool the GENCAT Scale is typically used by social service to
assess quality of life of their clients (Badia et. al., 2013). The third measurement tool used was

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the subjective subscale of Integral Quality of Life Scale, which examines the satisfaction with
self-determination, social inclusion, job well-being, material well-being and family (Badia et. al.,
2013).
Intervention and Statistical Analyses
Since the entire study was based on taking surveys, there was no intervention that was
mentioned. The study however, used several statistical analyses to test the hypotheses. The first
statistical analysis tool that was used was the Pearson correlation coefficient. This tool was used
in order to gain a bivariate relationship between the indexes of the LAI and the diverse
dimensions of quality of life. The second tool that was used a regression analysis. This tool
helped to determine what variables predict levels of quality of life. The third statistical analysis
was a procedure to test diminishing relationships, which would focus on the moderating effect of
personal variables (Badia et. al., 2013).
How the Findings Supports the Hypothesis
Due to the study having three hypotheses, it produced a mix of results. First, involved the
relationship between the LAI indexes and quality of life dimensions. The study did not find any
correlation between the LAI indexes and the quality of life dimensions of the GENCAT.
However, there was a significant correlation with the L-PREF index and the dimensions of
material, emotional and physical well-being. Second set of results involved the results of the
regression analysis in explaining how good of a predictor the L-PREF and L-CON are in
determining the quality of life dimensions. The regression analysis showed the L-PREF (with a P
< 0.05) and L-CON (with a P < 0.01) to be significant predictors for material, physical and
emotional well-being (Badia et. al., 2013). The last set of results involved moderating effect of
personal and environmental variables on the relationship between LAI indexes and subjective

EVIDENCE BASED PAPER

quality of life dimensions. The L-PREF and the L-CON did not show any significance with
material, physical and emotional well-being. As a result, the study did not support all of the
hypotheses. It only showed that quality of life is closer correlated to the subjective indexes of
leisure participation not he objective.
Relation of Findings to Previous Research

Previous research in the literature review provide evidence of participation in recreational

activities helping people with developmental disabilities to become integrated into the
community as well as enhancing their emotional and physical well-being. Similarly, this study
explores the relationship of leisure participation and quality of life among people with
developmental disabilities. Leisure participation is the individuals time to select activities that
promote feelings of pleasure and happiness. This study found some aspects of leisure
participation that may help enhance the quality of life in adults with developmental
disabilities. The aspects of quality of life include the following domains: emotional well-being,
interpersonal relationships, material well-being, personal development, physical well-being, selfdetermination, social inclusion and rights.
Clinical Implications
The author did not state any clinical implications for the findings.
Limitations
There were several limitations in the study. First, the small sample size is a major
weakness to the study. A larger sample size needs to be conducted to confirm the
findings. Second, most of the aspects of quality of life and leisure participation did not associate
with impairments. This may be a barrier because the population consist of adults with
developmental disabilities. Some barriers that this population may have are physical, social, and

EVIDENCE BASED PAPER

attitudinal barriers. Lastly, the researchers chose to use the Constraints Index of the LAI because
of its use in previous studies with the same population; however, the researchers did not assess
the value of all the dimensions contained in the construct environment.
Implications for Future Research
Badia et. al. (2013) discuss further research to understand the relationship between how
participation in leisure activities and quality of life differ as a function of other personal and
environmental variables.
Sample Size
The study used a convenience sample of 125 people between the ages of 17 to 65 living
in the community. This sample size is a small representation of the community in
Spain. However, because the researchers used a convenience sample, the sample size is
adequate because of the participants similar variables such as socioeconomic status, degree of
disability, IQ level, and living setting.
Significant Difference between Groups
This study did not separate their participants into groups.
Control or Comparison Group
This study did not have a control or comparison group.
Administers and Outcome Measures
There were several individual interviews that were carried out by professionals who
received training from a research assistant before the study began. None of the test applicators
had any knowledge of the goals of the study to eliminate bias. Consequently, those
administering the outcome measures were blind to the study.

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Where the Participants Blind to Group Assignment?
The authors did not specify whether or not the participants were blind to the study.
Dropouts in Study
The authors did not account for dropouts in the study. There was no statement written
about participants dropping out so the assumptions can be made that all participants completed
the study. If there were dropouts, the results could have been influenced depending on the

amount of dropouts. However, the participant dropout may slightly skew results when analyzing
variables for each domain of quality of life.
Reliability, Validity and Outcome Measure
Badia et. al. (2013) discussed the Leisure Assessment Inventory (LAI) indexes including
the Spanish version as a valid measure of the attributes of leisure behaviors. In addition, the LAI
also demonstrated high test-retest reliability. These instruments were highly used to calculate
participation, preference, and interest. The researchers did not report reliability and validity in
many of the other instruments used to determine the outcome measures. In addition, no
questions were made about the outcome measures chosen.
Confounding Factors
The researchers suggest that factors of the physical, social and attitudinal environment
can have an influence on the outcome of quality of life (Badia et. al., 2013). These factors were
a bigger influence on leisure participation more so than disability related factors. Therefore,
these factors would need to be considered when conducting a future study.
Strengths of Study
1. The study used several outcome measures to identify specific dimensions of each
participants quality of life through subjective and objective scales.

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2. The study used a convenience sample which consisted of participants with similar
backgrounds and levels of disability.

3. The study defined and broke down quality of life into specific domains that were assessed
by several instruments.
Weaknesses of Study
1. The study did not specify whether or not the participants were blind to the study.
2. The sample size was not a representational sample of the community.
3. The study used several instruments to determine the outcome measures; however, the
researchers did not state the reliability and validity of all instruments.
Use of Article as a Therapist
As a therapist, this article would be beneficial to help validate therapy sessions when
therapist incorporate a clients leisure activities. Occupational therapist can use a top down
approach by making the treatment more client centered. By having the client do what he or she
enjoys doing will provide a sense of motivation to fulfill goals and progress during each
session. This type of participation can help increase specific areas of a clients well-being to
overall improve their quality of life.
Supports Participation in Occupation and the Field of Occupational Therapy
This article supports participation in occupation and the field of occupational therapy by
promoting quality of life among adults with disabilities. Based on the findings of this research
article, interventions can be aimed at removing limitations and helping clients participate in
leisure activities that will help increase their quality of life. Major factors to consider are
physical and social environments that influences leisure participation other than factors related to
disabilities. Overall, the importance of understanding how to attain quality of life among adults

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with disabilities is a major goal that occupational therapist seek when determining a clients
intervention.

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Reference
Badia, M., Orgaz, M. B., Verdugo, M. ., Ulln, A. M., & Martnez, M. (2013). Relationships
between Leisure Participation and Quality of Life of People with Developmental
Disabilities. Journal Of Applied Research In Intellectual Disabilities, 26(6), 533-545.
doi:10.1111/jar.12052