Introduction Engaging in sports and physical activities is crucial for overall health and quality of life, a fact that holds even greater importance for individuals with physi- cal disabilities (1,2). Physical disabilities arising from various organs may affect physical function, mobil- ity, dexterity, or coordination. These factors can re- strict the individual’s ability to perform certain tasks, making assistive devices or adaptive techniques essential for maintaining independence and active participation in life (3,4). Individuals with physical disabilities often face inequality and barriers to being active outdoors, due to challenges like limited rehabilitative services and professional expertise, personal factors (e.g., motivation, age, and prior ex- periences) and environmental obstacles (e.g. insuf- ficient facilities, equipment, funding, transportation, and accessibility) (2,5-9) Consequently, individuals with disabilities tend to be more inactive compared to their non-disabled peers, which increases their risk for various comorbid conditions (10,11) The Unit- ed Nations (UN) and the World Health Organization (WHO) strongly advocate for health equality, includ- ing equitable access to rehabilitation services and outdoor activities for all individuals with disabilities. They assert that inclusive access to outdoor sports transcends health equity as a fundamental human right, ensuring that everyone, regardless of physical ability, can enjoy the benefits of physical activity in natural settings (1,8,12,13). The benefits of connecting with nature, now recognized as «therapeutic landscapes» (14), have been shown to improve quality of life, encompass- ing physical, psychological, social health, and even employment opportunities for individuals with different physical disabilities (15-20). Water-based activities, especially canoeing and kayaking, have gained attention for their role in rehabilitation of people with physical disabilities in promoting health, quality of life and participation (21,22). Research shows that these activities offer physical benefits such as improved fitness and mobility, psy- chological advantages like stress reduction, cop- ing, and increased self-esteem, and social benefits including better communication and friendships (22-24,25-27). Purposely, rehabilitation professionals’, including occupational therapists, focus have been on adapt- ing everyday tasks and employment (27b), with water activities like canoeing or kayaking receiving less emphasis (28). Still, research highlights the Figure 1: The WHO’s ICF Model (retrieved from World Health Organization, 2001 [12, page 9]). crucial role of rehabilitation professionals in guiding outdoor activities for individuals with physical dis- abilities to overcome barriers (13,29-31). Yet, there’s a scarcity of studies focusing on important factors for facilitation of water activity for this group (2,4,5). Current literature mainly focuses on the necessity of medical screenings, safety protocols, and support that enhance the functional abilities of participants in water sports (25,32). While the health benefits of water activities are well-documented, there is still a significant gap in understanding important factors for the facilitation of canoeing and kayaking for these individuals. THEORETICAL FRAMEWORK The WHO’s International Classification of Function- ing, Disability and Health (ICF) provides a com- prehensive framework for understanding function and participation (33). It adopts a biopsychosocial approach to health, recognizing that participation is the result of a complex interplay between bio- logical, individual, and social factors. Participation is thus seen as a multifaceted concept that reflects an individual’s involvement in diverse activities and roles, influenced by both personal attributes and the surrounding environment, as illustrated in Figure 1. The ICF posits that health conditions or inju- ries, such as physical disabilities, can disrupt body functions and structures and thereby hinder an individual’s activities and societal engagement. It acknowledges that personal characteristics – like gender, age, coping strategies, and past experi- ences – alongside external factors like the physical Ergoterapeuten 2–2025 33
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