Abstract
Children with Developmental Disabilities (DD) often face significant challenges in performing dressing task, fundamental activities of daily living. Inability to accomplish this task independently significantly impacts participation in social and recreational activities, affecting Quality of Life (QoL). Additionally, burden on caregivers increases which in turn leads to stress and burnout. Addressing dressing-related challenges through innovative clothing designs enhances self-independence, alleviate caregiver burden, and improve QoL. However, studies published in this focused area are quite heterogeneous resulting in lack of comprehensive understanding of different clothing solutions that exist for children with DD. Therefore, this scoping review is undertaken to map clothing design solutions available for children with DD between 0 and 18 years. Arksey and O'Malley's framework will be followed, database-specific search strategy and grey literature searches will be conducted to retrieve articles published in English from January 2000 to May 2024. All selected articles will be screened independently by two reviewers, and data will be extracted. The purpose of this scoping review is to map clothing design solutions available for children with DD from scientific literature. Adaptive clothing being an emerging area, evidence from this study may encourage designers to bring innovation in clothing industry for a wider range of disabilities.
Keywords: Clothing, Design, Children, Disability
Method name: Scoping review protocol
Graphical abstract
Specifications Table
| Subject area: | Neuroscience |
| More specific subject area: | Clothing design, Children with developmental disability |
| Name of your protocol: | Clothing design solutions for children with developmental disabilities: A scoping review protocol |
| Reagents/tools: | Not applicable |
| Experimental design: | Not applicable. This scoping review protocol follows Arksey and O'Malley framework. |
| Trial registration: | Not applicable, this is not a trial. This scoping review protocol is registered in the Open Science framework (https://doi.org/10.17605/OSF.IO/PZXBT) |
| Ethics: | This study protocol does not involve human subjects, animal experiments, or data collection from social media platforms; thus, informed consent is not required. |
| Value of the Protocol: |
|
Background
UNICEF estimated that one in ten children worldwide lives with disability, with more severe cases prevalent among those under seventeen. Around 240 million children face functional and psychosocial challenges [1], and approximately 1.3 billion people experience significant disability (WHO) [2]. Disability is defined as either physical or mental condition, leading to activity limitation and participation restrictions (CDC) [3] Children with DD experience challenges in leisure activities, self-care, and activities of daily living (ADLs) [4,5] due to limited mobility, weak muscles, and stiffness. Inability to dress independently impacts participation in social and recreational activities resulting in poor QoL [6,7]. Additionally, burden on caregivers increases [8,9] as they must provide support to their child with disability, leading to further stress and burnout [10]. Therefore, there is a strong need to address dressing-related challenges by developing innovative clothing designs, to enhance independence, alleviate caregiver burden and improve QoL.
Clothing is a fundamental human necessity that reflects personal preferences, fulfills social or cultural needs, and indicates social status. Clothing also synonymously called clothes, attire, garments, dresses, outfits, or apparel, referred to as items worn for social and functional purposes to protect, decorate, and cover body [[11], [12]–13]. Hence, definition of clothing is operationalized as “fabric-based items worn on body to cover trunk and limbs that serve protection, modesty, functionality, and aesthetics.”
Wearing inappropriate clothing that does not meet specific needs and challenges linked to one's disability significantly impacts a person's QoL and can hinder their ability to engage in ADLs [14]. Appropriate clothing is essential for leading fulfilling social life, but its effectiveness is influenced by personal characteristics, environmental conditions, body structures and functions [11]. Children with disabilities have unique requirements, necessitating special clothing adaptations in clothing that are comfortable, accessible, and aesthetically pleasant, while minimizing dressing challenges [15]. Specially designed clothing boosts self-confidence and promotes independence in dressing task [16,17]. Hence, clothing should be tailored to user's needs. Studies by Hall [16] and Tuteja [18] have proposed clothing design solutions like consideration of materials including fabric and fasteners such as velcro, and modification of basic patterns to meet unique needs of individuals with disabilities.
Thorough literature search revealed a review by Hyun-Shin [19] that provided information on existing clothing design solutions. However, it lacked scientific rigor as it was based on review of websites [19]; and did not include scientific/peer-reviewed articles. Another systematic review by Yang et al., focused on clothing development for individuals with disability, that included studies conducted only in Korea leading to lack of generalizability [20]. Furthermore, Esmail et al.’s scoping review [11] identifies impact of clothing on participation among individuals with disabilities, including clothing types, associated challenges, and design suggestions. Since it is essential to understand clothing needs of all individuals with disabilities, there is unmet need for considering clothing requirements and innovating design solutions for children with DD.
To gauge availability of clothing design solutions, it is essential to review existing research in this field. With this background, proposed scoping review aims to identify and map clothing design solutions for children with DD, addressing a significant gap in existing literature.
Description of the protocol
Children with DD face challenges in finding clothing that meets their unique needs, such as ease of dressing and undressing, comfort, improved mobility, and enhanced self-esteem. Addressing these clothing needs not only reduces caregiver burden and improves convenience, but also promotes inclusivity, and improves QoL for both children and their caregivers.
Despite the critical need, there is a lack of available information on clothing design solutions specially tailored to children with DD. Therefore, this scoping review aims to address this gap by identifying the existing clothing design solutions that cater to the unique clothing requirements of children with DD. By gathering and synthesizing scientific data in this field, this review will provide insight into innovative design solutions for the clothing industry. The results of this scoping review may encourage designers to develop suitable clothing options that support the overall well-being of children with DD and their caregivers.
Hence, a scoping review approach will be employed to meet the objective, as it is a frequently used method for mapping the status of the subject of interest within a specific field and for defining terms and conceptual boundaries [21,22]. The proposed scoping review will be conducted as per the six-stage framework proposed by Arksey and O'Malley (2005) [21,23], and carried out in sequence: 1) Identifying the research question, 2) Identifying relevant studies, 3) Study selection, 4) Charting the data, 5) Collating, summarizing, and reporting results, and 6) Consultation.
Identifying the research question
Arksey and O'Malley recommend an iterative approach for formulating research questions. During the literature search, a scoping review by Esmail et.al. examined the impact of clothing on the participation of individuals with physical disabilities aged 14 years and above [11], that summarizes the clothing-related problems, solutions suggested by the participants, and the need for unique designs. However, the purpose of this proposed scoping review is to gather information on clothing design solutions developed by stakeholders such as researchers, designers, caregivers, or individuals with disability themselves. Furthermore, it focuses specifically on the research conducted on children with DD under 18 years of age. Hence, the objective of the proposed review is to identify and map the clothing design solutions tailored to the needs of children with DD.
Research question
Limited research exists on comprehensive resource that encompasses the full spectrum of information on clothing design solutions for children with DD, highlighting the huge unmet needs. Addressing this gap would help in exploring various materials such as fabrics, fasteners (zip, button, magnetic closures), as well as innovative pattern-making and garment construction techniques. This scoping review will identify the clothing design solutions available exclusively for children with DD.
Hence, the research question of this scoping review is;
What are the existing clothing design solutions for children with developmental disabilities?
Specially designed clothing has a significant impact on enhancing the QoL for the wearers and their caregivers. By researching available information on solutions for clothing-related problems, researchers may identify existing solutions and recommend areas for improvement that may lead to improved comfort, independence, and functionality for the wearers. By exploring clothing design solutions, this review may help identify design concepts, provide insightful ideas to the fashion industry's stakeholders, and encourage the creation of more inclusive and adaptive clothing.
For this review, a clothing design solution is defined as “any clothing design that addresses challenges individuals face when dressing themselves or assisting others with dressing activities using commonly available clothing. Solutions may be achieved through the application of design elements such as fabric, fasteners, construction techniques, innovative features like adjustable components or closures considering functional, expressive, and aesthetic factors of the clothing”.
Identifying the relevant studies
The PCC framework (Population, Concept, and Context) [24] will be used to identify the studies. The PCC framework is intended to support determining the who, what, and where of the subject matter of interest. It serves as a guide while creating specific, meaningful objectives and qualifying criteria for a scoping review [[23], [24]–25]. This scoping review will include articles on clothing design solutions for children with DD below 18 years, regardless of gender, and do not have any geographical restrictions.
Population
Studies conducted on children with developmental disabilities corresponding to ICD-10 [26] health conditions, such as cognitive, motor, vision, hearing, speech, and behavioral conditions will be included. This includes conditions like cerebral palsy, spinal muscular atrophy, muscular dystrophy, post-polio paralysis, spina bifida, mental retardation, and other conditions like down syndrome, intellectual disability, spinal dysraphism, and other genetic diseases.
Concept
Studies that document clothing solutions for children with DD will be included. It considers the studies that discussed clothing-related problems experienced by an individual while dressing and undressing, or assisting others in these activities, using commonly available clothing, and developed clothing design solutions in the form of using different types of fabric, fasteners, their placement in the clothing, construction techniques, and overall functionality. There are no restrictions on whether the specially designed clothing was used, the duration of clothing usage by the children, or the type of clothing documented. Studies focused on clothing components that are not part of the garment, such as accessories (gloves, footwear, socks, stockings, caps, belts, bags, and bed linens, to name a few), and studies conducted on therapeutic garments, websites, and clothing brands that focus on adaptive clothing for children with DD will be excluded.
Context
This review will include studies conducted in various settings without any restrictions and studies from any region or country will be included without geographical limitations.
Study design
This scoping review will include all the study designs, irrespective of their publication status, peer-reviewed or not, such as journal articles, reports, thesis, and dissertations. commentaries, editorials, and opinion papers. Non-English articles, in case full-text is unavailable, clinical trial registries, and conference abstracts will be excluded.
Search strategy and searches
A comprehensive search strategy has been designed by NN and SS in consultation with all authors by referring to previous publications [11,20,27] and the Medical Subject Heading Library [28]. The search is conducted from the year 2000 to May 2024, as there has been a sudden surge in considering the unique needs of individuals with DD in the last two decades. Search will be carried out on scientific databases such as Medline (PubMed), Embase (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and CINAHL (EBSCO). Additionally, grey literature constitutes a significant component, offering contextual insights on a specific topic [29] and perspectives not typically published by commercial agencies. By encompassing a diverse array of sources, it contributes a balanced understanding of the subject matter, and hence, the researchers intend to utilize grey literature searches [30]. Grey literature sources to be searched include ProQuest, Google Scholar, MedNAR, OpenGrey, PEDRo, and in websites such as AusAACPDM, AACPDM, and CanChild. The key terms identified from the literature were used and search strategy has been developed. Boolean operators were used to combine the search terms, and modified based on the requirements of the specific database using a polyglot search translator. A detailed list of databases and websites that is used for carrying out the searches is presented in Table 1. A comprehensive list of the search strategies used in the corresponding databases, and number of articles retrieved is presented in the online supplemental Appendix 1. Articles retrieved through grey literature and websites will be reported in the final scoping review.
Table 1.
List of databases and organizational websites for carrying out the searches.
| Database | Website |
|---|---|
| Medline (PubMed), Embase (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and CINAHL (EBSCO) Grey Literature: ProQuest, Google Scholar, MedNAR, OpenGrey, PEDro |
AusAACPDM, AACPDM, and CanChild |
Study selection
Records from various databases will be imported into the Rayyan (https://www.rayyan.ai/) QCRI (Qatar Computing Research Institute, Doha, Qatar), a platform facilitating de-duplication, screening, and the administration of the essential screening statistics among reviewers. Upon removing duplicate records, two independent reviewers (NN and SS) will conduct screening independently at two stages for assessment against the selection criteria for the review: initially focusing on titles and abstracts, and later full-text screening of the selected articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) will be followed in reporting the scoping review [31].
The selection criteria have been developed and the list of articles excluded at the full-text screening stage along with their reason for exclusion will be presented as an appendix in the final scoping review.
Selection criteria
The criteria for selecting the articles are outlined in the following table, specifying both inclusion and exclusion requirements (Table 2).
Table 2.
Selection criteria.
| Inclusion Criteria | Exclusion Criteria |
|---|---|
Population
|
|
Concept
|
|
Context
|
|
Study Design
|
|
Charting the data
Data will be extracted using a pretested, standardized Microsoft Excel 2007 data extraction sheet (DES) in consultation with all the authors. The developed DES will be pilot-tested on 5 % of the articles included following the full-text screening. The online supplemental Appendix 2 will have a preliminary DES, subject to modification as required. Any modifications made to the DES will be made as needed and will be mentioned in the completed review. Data will be extracted initially for the study design, type of clothing, target population (age group, gender, type of disability), clothing practices, design features (design solutions), the outcome of design solutions.
Further information will be captured based on the need as the topic is emergent in nature. A quality appraisal of the included studies will not be performed as this review aims only to map the clothing design solutions and record the challenges. The quality of included studies will not influence the study objective as the aim is not to estimate the efficacy of these interventions [32].
Collating, summarizing, and reporting results
The analysis will map the clothing design solutions implemented, especially for children with DD. A tabular format will present the data for clothing type, design solutions, and the population in which they were implemented, and tables and figures will be presented. A narrative synthesis will be used to summarize the findings and represented in a tabular format. The search results and the study inclusion process will be reported in the final scoping review and presented in a PRISMA-ScR flow diagram.
Operational definition
-
•
For the purpose of this review, clothing practice is defined as a range of behaviors through which an individual interacts with clothing in their daily life. It includes varied patterns of clothing-related choices, habits, acquisition methods, preferences, and thoughtful decisions individuals make about the garments they wear, as well as their style preferences (how they prefer to dress), the habits they develop around clothing, and methods of buying new clothing items.
-
•
Clothing problems may include concerns related to fit, comfort, style, don/doff, ease, and/or size as per body type requirements. The clothing design process helps in understanding the problem, addressing the challenges, and improving the attributes of clothing in the form of clothing design solutions.
Consultation
The researchers propose to engage stakeholders such as caregivers, designers, patients, and health professionals, through consultation once the scoping review is completed. Subsequently, the study findings will be disseminated in a separate publication.
Conclusion
By applying good design principles and ergonomic criteria, caregiver burden can be reduced while enhancing the wearer's independence, and promoting equality [33]. Therefore, the purpose of the proposed scoping review is to gain a greater insight into the available clothing design solutions for children with DD. Additionally, it helps to understand the clothing practices, clothing problems, and needs of children with DD. We hope to identify knowledge gaps and present the status of the research in the field of clothing for children with DD. The scoping review could be useful in generating information regarding the requirements that need to be considered while choosing materials of clothing for children with DD. It might offer distinctive pattern and garment development methods, as well as clothing design solutions to meet the user's clothing needs. The findings of the study might stimulate industry innovation and lead to the development of clothes that are more adaptive to a broader range of disabilities.
Protocol validation
This scoping review protocol has been registered in the Open Science framework. (https://doi.org/10.17605/OSF.IO/PZXBT).
Strengths
The strength of our review is first the choice of methodology i.e. scoping review methodology to review the literature and report our findings. This methodology is particularly valuable when the researchers want to explore and seek an understanding of a broad topic area. To our knowledge, this will be the first of its kind of scoping review that aims to provide an in-depth overview of existing literature in the clothing industry by focusing exclusively on clothing design solutions for children with developmental disabilities. This scoping review will provide meaningful insights into various design solutions, including modifications to existing designs and innovative developments in fabric, patterns, fasteners, and garment construction techniques. The another notable strength of this work lies in the thematic analysis and mapping of the available clothing design solutions, which will not only offer valuable insights for designers, manufacturers, and parents but will also identify the critical gaps in current knowledge. We anticipate that the findings of this review will entail to future research and innovation, ultimately contributing to the development of clothing exclusively designed to meet the unique needs of children with DD. This work aims to address a significant gap in the literature.
Limitations
This scoping review will have several limitations that should be considered when interpreting its results. Despite the comprehensive search, it is possible that not all relevant studies will be captured due to the absence of standardized vocabulary and the presence of various keywords related to clothing design solutions, such as therapeutic garments and accessories. These terms are sometimes used interchangeably, which may have affected the search results. To mitigate this, an extensive search was conducted across multiple databases, supplemented by manual searches and exploration of grey literature and multiple relevant websites.
To ensure scientific rigor and reliability of the findings, this scoping review will exclude apparel brands, as they may offer potential clothing design solutions for children with developmental disabilities but are not peer-reviewed sources. This scoping review will include only the studies published in English from 2000 to 2024. This might lead to a selection bias as studies reported in another language and published before 2000 will automatically be excluded. However, considering the significant advancements over the past three decades, this timeframe is chosen to capture the most recent developments and relevant information on clothing for children with disabilities, making the results more generalizable.
CRediT authorship contribution statement
Nagaveni N. Nayak: Conceptualization, Methodology, Investigation, Validation, Writing – original draft, Writing – review & editing. Shristi Shakya: Conceptualization, Methodology, Investigation, Writing – review & editing. Nachiket Gudi: Conceptualization, Methodology, Validation, Writing – review & editing. Sonia Khurana: Conceptualization, Methodology, Writing – review & editing. Sivakumar Gopalakrishnan: Conceptualization, Project administration, Writing – review & editing. Veena Rao: Conceptualization, Validation, Writing – review & editing. Bhamini Krishna Rao: Conceptualization, Methodology, Project administration, Supervision, Writing – review & editing.
Declaration of Competing Interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The authors would like to acknowledge Manipal Academy of Higher Education, Manipal, Karnataka, for technical support.
Footnotes
Related research article: None.
Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.mex.2024.102974.
Appendix. Supplementary materials
Table 1: List of databases and organizational websites for carrying out the searches
Table 2: Selection Criteria
Appendix 1: Preliminary searches on scientific databases
Appendix 2: Preliminary data extraction sheet template
Data availability
No data was used for the research described in the article.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Table 1: List of databases and organizational websites for carrying out the searches
Table 2: Selection Criteria
Appendix 1: Preliminary searches on scientific databases
Appendix 2: Preliminary data extraction sheet template
Data Availability Statement
No data was used for the research described in the article.