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  • This systematic literature review was carried out according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (see Table S1). No protocol exists for this review. The study selection process is summarized in Figure 1. The literature was searched in “PsychInfo”, “Eric” and “PubMed” including all of the available literature up until December 1, 2013. The search was conducted in three stages because it was difficult to obtain relevant results for adults with LD as a primary health condition. There were no limitations on publication years or types of article. However, only titles and abstracts were searched for keywords, and only peer-reviewed journal articles were included. The results were limited to English and to the population aged eighteen and over. Figure data removed from full text. Figure identifier and caption: 10.1371/journal.pone.0106657.g001 PRISMA 2009 Flow Diagram describing the three stages search process conducted for this literature review. The following selection criteria were used for the inclusion of studies: (a) the article was written in English; (b) the article related to adults; (c) LD were referred to as the primary health condition of the study population; (d) The main theme covered by the article was related, according to the authors' view, to one of the domains of activity and participation as described in the ICF model. In the first stage, the keywords ‘learning disabilities’ were combined with the keyword “activity” and then with the keyword “participation” based on the ICF core concepts. Most articles were not relevant for adults with LD, but to a variety of other diagnoses such as physical, intellectual and mental disabilities including mental retardation, autism, cerebral palsy, schizophrenia and other disorders. This stage revealed that the keywords ‘learning disabilities’ refer to mental retardation in the UK and some other European countries. In addition some of the results related to children and adolescents in spite of the age limitation. The keywords for the second stage of the search were chosen according to the common keywords found in use at the first stage of the search. In the second stage the keywords ‘learning disabilities’ were combined with the keyword ‘adults’ and with each of the following keywords: ‘employment’; ‘social skills’; ‘daily performance’; ‘leisure’. In addition, a NOT UK limitation was added to the searches. However, the second stage of the search also yielded few relevant results. Therefore, in the third stage of the search, ICF terminology was used in order to achieve better coverage of other domains of “activity and participation”. In this stage the keywords ‘learning disabilities’ were combined with the keyword ‘adults’ and with each of the following keywords: ‘knowledge’; ‘tasks’; ‘communication’; ‘mobility’; ‘self-care’; ‘domestic’; ‘interactions’; ‘economic’; ‘community’. In addition, the NOT UK limitation was added to the searches again. In total, 853 records were identified through the entire search process and only 132 articles (15.47%) were relevant for adults with LD as a primary health condition. These articles included the 10 additional relevant records which were identified through other sources. It is important to note that in spite of the addition of the keyword ‘adults’ and the limitation of NOT UK all stages of this review resulted in irrelevant articles. Throughout the search process, articles from the UK and other countries in which the term LD refers to mental retardation or other major cognitive impairments as well as articles from other places where LD was presented as a secondary diagnosis and titles which dealt with children or adolescents were duly removed. Classification according to the ICF components and domains: A procedure of classification according to the ICF components/domains was conducted after each phase of the search. It appeared that not all articles included in this review could indeed be classified into the ICF component of “activity and participation” or according to the keywords which led to finding them. Therefore, each article was classified firstly according to the main topic being covered into one of the ICF components (“health condition”, “body functions and structures”, “contextual factors” or “activity and participation”). After this classification only 62 articles out of the 132 articles which related to adults with LD remained classified as related to one of the activity and participation domains (see Table 1 for an overview of these articles). These articles were published between 1981 and 2012. It is important to note that in cases when an article was considered by the authors as relevant to more than one of the ICF components or domains, it was classified according to the main theme it covered as viewed by the authors. Findings of the 62 articles which were found in this review as related to adults with LD and classified into the domains of activity and participation are described below. Table data removed from full text. Table identifier and caption: 10.1371/journal.pone.0106657.t001 Classification of 62 articles to domains of activity and participation according to the ICF model.
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