Interprofessional Collaboration: Supporting Activity Competence and Opportunities for Participation of Children with Physical Disabilities

Theoretical framework

When interpreting the data, both the results and the discussion are informed by Anne Edwards’ scholarship on relational work (Edwards 2010, 2011, 2017). In the Norwegian context, policy strongly emphasizes interprofessional collaboration. Edwards’ work provides an analytic vocabulary for understanding the relational processes that unfold in these collaborations, particularly those that characterize successful interprofessional work.

The concept of working refers to what practitioners actually do—how they enact their professional practice. As practitioners engage in practice, they bring knowledge, cultural backgrounds, and personal motivations that shape how practice is enacted and understood (Edwards 2017). Edwards (2010) argues that practice is not a neutral space but an intersection where different professional perspectives meet. In these collaborative spaces, mutual respect is essential, and listening is valued as highly as speaking.

Three relational concepts underpin Edwards’ account of interprofessional collaboration: relational expertise, common knowledge, and relational agency. Together, they describe the skills demonstrated in successful interprofessional work that strengthens support for children and families (Edwards 2017). Relational expertise refers to the ability to interpret and address challenges collaboratively by engaging with diverse professional perspectives. Common knowledge is the shared understanding and mutually supportive relationships developed at the boundaries between professional practices, providing a foundation for understanding what matters to those involved. Relational agency involves drawing on this common knowledge to take collective action (Edwards 2010, 2017). Central to this process is ensuring that the voices of children and their families shape collaboration—from identifying concerns and clarifying what matters to them, to working together to address these issues and foster agency (Hedegaard & Edwards 2023).

Study context

As indicated, our study is situated in a Norwegian context. More precisely, our context comprised interprofessional collaborative meeting points across municipal settings (schools and preschools) and specialist services (the health sports center offering rehabilitation services). Interprofessional collaboration took place in conference-room meetings and joint walk-throughs of the premises. Those present from the interprofessional collaboration conducted joint on-site walk-throughs and discussions to identify participation opportunities and barriers. They considered the layout and design of indoor facilities (e.g., staircases and classrooms), outdoor areas (e.g., schoolyards and nature paths), parking and charging stations for electric wheelchairs, writing practices, and spaces for rest and rehabilitation. At the health sports center, the intensive, targeted rehabilitation program emphasized physical and social activity, functional independence, individualized follow-up, family involvement, and sustained change through collaboration with local services. Local services attended a two- to three-day program to observe and engage with the child, learn about facilitating physical activities and activity aids, and join individual follow-up discussions with the child, parents, and sports educator. Having a study context comprising such interprofessional meeting points across services and settings allowed us to explore how interprofessional collaboration was enacted within and across these contexts.

Recruitment and participants

Our study targeted everyone involved in the interprofessional collaboration around each child with physical disabilities aged five to seven. We employed purposive sampling (Patton 2015). We contacted relevant patient organizations and municipal services for children in eastern Norway to share study information. We communicated by email, phone, and oral presentations to patient organizations, management, and clinicians familiar with the first author (LMS). Recruitment continued through snowballing (Patton 2015), with participants and research colleagues sharing the information within their networks. This yielded two interprofessional collaborations. These involved two boys—Hans Hansen (aged five) and Martin Martinsen (aged six at the start of the study)—their parents, and professionals. In total, nineteen professionals participated. They represented municipal leadership (four from schools, after-school programs, and preschools); municipal services (three teachers, three physiotherapists, one occupational therapist, one school health nurse, one special education teacher, and two assistants); and specialized services (one physiotherapist, two sports educators, and one representative of the educational psychological service). Our analytic focus was on the adults (professionals and parents) within these interprofessional collaborations.

Characteristics of these collaborations are presented in Tables 1 and 2.

As participation was limited to just two families, descriptive detail is restricted to preserve anonymity: the families were from two different municipalities and had different family compositions. The Hansen family comprised a mother, a father, Hans, and his sister, and they lived in a small municipality with fewer than twenty thousand residents. The Martinsen family comprised Martin’s mother, his father, and his two siblings, with whom he lived in one of Norway’s five largest municipalities. There are pronounced differences in resources and capacity across Norwegian municipalities, and it has been reported that the smallest municipalities face the greatest challenges in maintaining broad, high-quality service provision. Consequently, larger municipalities are often better positioned to follow up on children with disabilities, even though the national income equalization system is intended to mitigate such disparities (Riksrevisjonen 2021). These contextual differences allowed us to consider how interprofessional collaboration may take shape across different municipal contexts.

Participant observation

The participant observations that were conducted were all carried out by the first author (LMS). They took place as described in the study context section, and comprised interprofessional collaborative meeting points across municipal settings (schools and preschools) and specialized services (a rehabilitation institution). By observing in-situ interactions, such as conference-room meetings and joint walk-throughs, LMS observed how interprofessional collaboration was enacted in practice—what participants did, said, and negotiated—while having the opportunity to engage in conversations with the participants directly (Fangen 2010; Justesen & Mik-Meyer 2012).

The data comprise 17 hours of participant observation and 75 pages of descriptive field notes. These notes were the textual data analyzed in this study. For each interprofessional collaboration, we conducted four observations in the municipal context and four in a specialized service setting. Local observations included, for example, a preschool meeting with the physiotherapist, preschool and school management, a preschool assistant, and the child’s mother. All specialized-service observations took place at a health sports center. Two local observations—one in each collaboration—were conducted digitally. The diversity and number of professionals/actors varied across and within the two collaborations for Martin and Hans. Each observation lasted 30–120 minutes.

Observations were guided by specific pointers. We noted who was present, room layout, seating, and who spoke. We also noted interaction patterns, role distributions, and collaboration indicators such as joint problem-solving and active listening.

LMS both observed quietly at a distance and engaged with those present (Fangen 2010; Justesen & Mik-Meyer 2012). As a quiet observer, she tracked interactional dynamics without entering the dialogue. She positioned herself behind the group. Engagement occurred through small talk during set-up and, at times, brief conversations with professionals, parents, and, where appropriate, children. Interaction varied by setting. Joint walk-throughs prompted more small talk and occasional follow-up questions. Conference-room meetings had strict agendas and limited room for dialogue.

The writing of field notes focused on what happened, when, who was involved, context, and collaborative processes supporting participation or activity competence (Emerson, Fretz, & Shaw 2011). Notes were taken in a notebook or on a laptop, depending on context. LMS wrote contemporaneous notes with text and drawings. She captured actions and discussions. Notes included near-verbatim quotes, room sketches, and concise words or sentences. She expanded and refined them immediately after each session. All notes were processed and de-identified and constitute the data. Appendix 1 offers a detailed overview of the characteristics of the settings of the interprofessional collaboration in which participant observations were conducted.

Given LMS’s role and background as an occupational therapist (OT), she is trained to observe activity and person–environment interaction. In this study, she maintained a researcher role guided by the research question and the theoretical lens. She kept reflective notes and discussed influences with co-researchers. This reflexive work addressed how a professional background might shape noticing, interpretations, and actions. Her background also provided skills for observing involvement in activities with young children and their families.

Ethical considerations

Our study received approval from the Norwegian Agency for Shared Services in Education and Research (SIKT), ref. number 635319. All participants, professionals, and non-professionals received both written (email or hand-outs) and oral information (face-to-face or by phone) about the study and their rights as participants prior to their involvement. For children and families, initial information came via service providers, who shared information letters and LMS’s contact details. After first contact, LMS provided additional details and answered questions. Those who agreed signed informed consent electronically or by hand before participant observations.

Efforts were made to ensure that all participants, regardless of their role, were equally able to provide informed consent. For instance, all participants were explicitly and individually informed that their participation was voluntary and that declining would not affect professional relationships, their standing within their group, or access to services.

Additionally, we acknowledge that the children may have been in a position of dependency. To address this, observations were conducted in what we considered a safe and supportive environment, ensured by the presence of a familiar person—either a parent or a professional with an established relationship with the child. The children’s assent in the situation was obtained through age-appropriate language, explaining the purpose of LMS’s presence, and informing them that they could ask, either directly or through the familiar person, for her to leave at any time. Furthermore, LMS monitored body language and stepped back if a child withdrew.

During participant observations, LMS reiterated study details and rights to confidentiality and withdrawal. All participants were assured of confidentiality, use of pseudonyms in any publications, and that no diagnoses or sensitive personal information would be included in the analysis or reporting.

Analysis

Our analysis is anchored in reflexive thematic analysis, as developed by Braun and Clarke (2022). Reflexive thematic analysis focuses on identifying patterns and meanings within a qualitative dataset and involves a six-step process: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing up, which may include iterative back-and-forth adjustments (Braun & Clarke 2022).

In the first step after completing the fieldwork, LMS began by familiarizing herself with the data during the refinement of the field notes and re-reading them. In the second step, she continued re-reading the field notes, organizing potential meanings related to our research question by labeling directly in the documents using the commentary function in Microsoft Word. Some preliminary codes included ‘co-observation’, ‘collective reflection’, ‘collective ground’, and ‘collective actions to support participation.’

In the third step, all authors came together twice to openly discuss and reflect on the preliminary codes, engaging in the further identification of patterns across the data. Collaboratively, starting from our research question, we advanced the analysis by formulating analytical questions such as, ‘How are perspectives aligned?’, ‘How are actions proposed and agreed upon?’, and ‘What characterizes shared reflection in interprofessional collaboration?’.

We drew on each author’s professional and clinical backgrounds, and on our interprofessional and research experience, to interrogate the data and co-construct interpretations; we treat this reflexive use of collective expertise as a resource for knowledge production (Braun and Clarke 2022).

These questions helped us to reflect on patterns across our data and identify preliminary themes such as, ‘my, your, and our expertise’, ‘joint sense-making in practice’, ‘iterative fine-tuning and co-creation’, ‘engaging in learning-in-action’, and ‘shared language.’

In the final stages of our analysis, we adopted an iterative approach informed by Anne Edwards’ (2010, 2017) concepts of relational expertise, common knowledge, and relational agency. These concepts assisted in describing and explaining what characterizes successful enactments in interprofessional collaboration, with a focus on how practice is enacted to support activity competence or participation opportunities for children with physical disabilities. Ultimately, we identified three themes from this process that are presented in the results section of this article.

Appendix 2 provides an overview of the journey from raw data to results.

How common ground matters for successfully supporting participation opportunities

This theme was observed in children’s natural settings within the municipality context of preschool and school, and is therefore discussed in relation to children’s opportunities for participation. In this study, establishing common ground among the actors of the interprofessional collaboration means fostering an environment that supports an active, open dialogue to share and integrate each actor’s expertise and experience. By thinking aloud together and considering situations from multiple perspectives, the collaborators created a basis for new ways of understanding the child’s situation, which in turn enabled the development of tailored approaches and joint solutions that could support opportunities for participation.

One example of this was an interprofessional meeting in the natural setting at Hans’s school, where Hans and his parents met with professionals from within and beyond the school organization. Here, the interprofessional collaboration for Hans engaged in several discussions about finding a balance between assistance and independence. Actors stressed mindful assistance: Hans has the capability to perform these tasks, but in a time-pressured school context (e.g., getting dressed for recess), his physical capability may be constrained, resulting in him being the last one ready to participate in recess and thereby reducing his opportunities for socialization.

The municipal physiotherapist inquires if Hans has a specific aide and knows who will be assisting him on particular days. The school manager replies that there isn’t a dedicated aide, but many adults are around, and they notice Hans does not want help. … Hans’s father mentions that Hans manages well outdoors now, but winter will be more challenging due to the need to change shoes and outerwear. He points out that changing shoes and outerwear in winter will be difficult, and it’s not an option for Hans to do it on his own, possibly not for many years. His mother adds that without help, Hans will always be the last to go out, thereby missing out on social interactions with his fellow pupils. … The municipal physiotherapist emphasizes that an aide should help Hans with dressing and undressing, and this needs to be planned to avoid future issues. An adult should be specifically available for Hans to prevent delays, as someone needs to be his arms and legs. … Hans’s assistant from preschool stresses the importance of recognizing when the child needs support while staying close but not being overly controlling. … Hans’s mother explains that dressing is exhausting for him and suggests conserving his energy for play. … The teacher agrees. … Hans’s assistant from preschool provides practical examples, like helping with his jacket zipper, to manage his energy use. … The specialized physiotherapist adds that adult intervention should be context-dependent, explaining that providing support is sometimes necessary for the child to continue the activity. … The teacher responds that there isn’t a dedicated aide, but some are available at his grade level. … She explains that aides place Hans’s bag next to his chair and open it, supporting his independence without doing the task for him.

As this extract illustrates, assessing a child’s needs on theoretical grounds can be challenging when they do not fully align with practical realities. Several actors emphasized the importance of staying open to this misalignment, as it is important in supporting Hans’s opportunities for participation with peers now and over time. Although the example shows how establishing common ground requires a setting that acknowledges concerns and fosters active dialogue, there remains some imbalance between the actions taken and those needed to support Hans’s opportunities for participation in the school setting. One interpretation is that views on accommodations diverged: the teacher described practices aimed at scaffolding independence within the available aide resources (e.g., positioning his bag and opening it rather than doing the task for him), whereas the parents and others highlighted the extra time and energy that these tasks demand—especially in winter—and the risk that this will reduce opportunities for social interaction. Through their discussions, a fine-tuned process of identifying necessary accommodations unfolded, illustrating how common ground can provide a cohesive basis for collaborative efforts to support opportunities for participation.

Learning together to successfully support activity competence

This theme was mainly observed in the setting of the health sports center and is therefore discussed in relation to children’s activity competence. Learning together as a way to successfully support the child’s activity competence across settings where the child was not specifically observed in their natural context was emphasized in the interprofessional collaborations. The actors unpacked the child’s activities, clarified capabilities and support needs, and identified workable accommodation, with collective discussions helping to translate insights across settings. This learning together happened in professional-only interactions when the child and family were being observed. For example, during Martin’s rehabilitation at the health sports center, Martin, his father, and a sports educator were all in the swimming pool, whereas the municipal physiotherapist and the teacher observed from the side. The example below illustrates this dynamic.

Through their collaboration during a pool session, the municipal physiotherapist and teacher explored Martin’s activity competence, staying close to the pool, supporting easy communication and shared efforts with those in the water. The sports educator focused the session on Martin practicing diving and swimming underwater, providing step-by-step guidance and demonstrating movements. As the activity continued, Martin was passed underwater between his father and the sports educator, which the physiotherapist noted was an innovative approach that he hadn’t considered. … The sports educator stressed the importance of breaks for Martin to catch his breath due to his difficulty switching between breathing and holding his breath underwater. He highlighted several times the pool’s gentle yet effective nature for rehabilitation, aiding muscle strength and balance. Meanwhile, the municipal teacher and physiotherapist discussed ways to make Martin’s school day more active, noting that he spends much time in his wheelchair. They considered floor-based activities for Martin or for the entire class, which could offer diverse learning experiences and support opportunities for participation together with his peer classmates. The teacher emphasized discovering new ways of doing activities that were suitable for all, not just Martin.

This example illustrates how the municipal physiotherapist and the teacher collaborated during the pool session, engaging in on-site learning together, collective observation, and dialogue to identify and understand Martin’s potential ability when in a pool supported by a sports educator and his father. The discussion that followed between the municipal teacher and physiotherapist related to what Martin could potentially do in his natural environment (classroom) and the natural-environment situations in which tasks could be adapted for him. These adaptations could, in turn, become a new way for the whole class to do the activity. Indeed, the engagement of more than one professional from the municipality seemed to enhance the possibilities for learning together in interprofessional collaboration. Such engagement helped align capacity and capability through a fine-grained process of adjustments and shared reflections.

In contrast, although Hans took part in activity bingo at the health sports center as well, only the municipal physiotherapist was present, and she rarely engaged in the activity or in discussions with Hans, his mother, or the sports educator.

During the activity bingo in the gymnastics hall, the municipal physiotherapist sits on a bench, occasionally observing Hans as he does the activities in the activity bingo. … The sports educator sometimes assists Hans by demonstrating and adjusting activities, whilst at other times, Hans’s mother supports him in activities like balloon badminton and bowling.

As shown above, the municipal physiotherapist kept a physical distance from Hans, who was doing the activities in the activity bingo, whilst the sports educator and Hans’s mother stayed close, adjusting, demonstrating, and supporting him through the activities. Notably, although the sports educator, Hans, his mother, and the municipal physiotherapist were all present in the same room during that session, the opportunity for collective discussion was not fully utilized and dialogue amongst all four was not observed. Overall, the situation did not appear oriented toward joint discussion. Accordingly, learning together appeared hindered, and situational dialogue and broader conversations about helping align capacity and capability appeared less likely, perhaps challenging collaborative efforts to support Hans’s activity competence.

Orchestrating to support activity competence and opportunities for participation

Our results show how interprofessional collaboration orchestrates support for activity competence and participation. In doing so, it shapes person–task–environment conditions that open opportunities for participation in the child’s daily environments.

Orchestrating support means that the actors utilize what they have learnt together and the common ground that they have built as a basis for action. Our results show that orchestration brings multiple actors together and underscores how they coordinate people and tasks to translate shared understanding into aligned action across settings. The emphasis here is on synchronization, so that rather than parallel, siloed work by different professionals, the collaboration becomes a unified effort with everyone pulling in the same direction. One example of how this turned out in practice was a school-based municipal meeting that brought together the actors in Martin’s interprofessional collaboration. These were the municipal physiotherapist, the municipal occupational therapist, his mother, the principal, the school health nurse, the educational psychological service, the special education teacher, and his teacher. The municipal physiotherapist and the teacher drew on what they had learned together about Martin’s capacity during the pool session at the health sports center to orchestrate support. The following field note shows how learning was brought back into the broader interprofessional collaboration. This also reflects a deepening of shared understanding and planning for how they could collectively accommodate Martin in the pool sessions that he would have with his classmates as part of his second-grade physical education class.

At the collaborative meeting, observations and learnings from the health sports center pool session informed a collective effort to identify opportunities and plan how to accommodate Martin in second-grade swimming with his peers. … The teacher notes that second-grade pupils have swimming lessons in their physical education curriculum. She and the municipal physiotherapist have planned to join Martin and the physical education teacher in the pool for the initial sessions. Observing Martin at the health sports center, they (the teacher and municipal physiotherapist) were not in the pool, so having the physiotherapist in the water will offer reassurance and support. The physiotherapist emphasizes the importance of knowing how to respond if Martin becomes insecure, such as getting water in his nose. They learned to step back and practice floating before diving again, which will be essential for working with the school and physical education teacher next year. … Collectively working towards opportunities for participation is the focus of the head teacher’s announcement, where she pointed out that a new physical education teacher, experienced in this area and with a background at a health sports center, would be joining the school after the summer.

Based on the pool session at the health sports center, the municipal physiotherapist and the teacher focused their collaborative efforts on applying what they had learned about Martin’s capability and the types of environmental support that they could apply in the pool sessions for him during second-grade swimming lessons, thereby supporting Martin’s activity competence. Additionally, the field note illustrated how the discussion centered on ‘how we’ rather than ‘how you or I’, thereby highlighting the enactment of orchestration in practice. An interpretation of the head teacher’s announcement and the actions taken is that it reflects the school’s collaborative commitment to supporting the activity competence of Martin and the opportunities for participation for all children within their school community.

In another interprofessional meeting at Martin’s school, the actors engaged in orchestration, considering both access to specific areas and opportunities for peer activities. Present were the municipal physiotherapists, a physiotherapist from the habilitation service, the municipal occupational therapist, Martin’s mother, the head teacher, the school health nurse, the educational psychology service, the special education teacher, and Martin’s teacher.

Martin’s mother noted that he might be restricted from certain areas (e.g., the football field) because, with his electric wheelchair, he may struggle to navigate back up the slope from the field. The physiotherapist from the habilitation service acknowledged this concern and emphasized the need for children to move on from the sandbox to other activities with their peers, highlighting mental health and a life-course perspective.

This exchange illustrates the mother’s worry of constraints in the current everyday schoolyard context that appear to hinder Martin in moving around freely. The physiotherapist from the habilitation service primarily emphasized developmental opportunities, mental health, and participation across the life course, with an additional emphasis on moving the focus from limitations to opportunities for participation. Through joint discussion, the interprofessional collaboration worked to align these perspectives in order to find ways to orchestrate their support for Martin’s activity competence.

The municipal occupational therapist suggested helping Martin practice driving his wheelchair across different schoolyard areas. The special education teacher noted that Martin often sits in the sandbox, although other children do as well, even older ones when toys are left outside. His classroom teacher added that Martin chooses when to be in the sandbox and also participates in games like hide-and-seek with his peers; when watching other children play football, he becomes so engaged that he almost joins them on the field.

One interpretation of this extract is that the interprofessional collaboration connected the mother’s access concerns with concrete steps by proposing practice across specific schoolyard areas. It took up the physiotherapist’s emphasis on moving beyond the sandbox by directing efforts toward activities that Martin already approaches and chooses (e.g., hide-and-seek, interest in football), and it used the teachers’ observations to situate these steps in everyday school activities.

Viewed together, the three themes demonstrate that enacting interprofessional collaboration in these ways elevates the collaboration toward a more fully collective effort. Throughout this process, delicate adjustments and joint creation refine the work, revealing the relational processes at play in these collaborations.

Enacting successful interprofessional collaboration for children with physical disabilities

Previous research has identified active family involvement as central to successful interprofessional collaboration for children with physical disabilities (Styczen et al. 2024). However, even when parents’ expertise is acknowledged, fragmented services and poor coordination may limit both parental influence and children’s participation opportunities (Anaby et al. 2022; Eide et al. 2022). Our results indicate a more collaborative pattern.

Hans’s parents highlighted that dressing independently for outdoor recess exceeded his current capabilities and reduced his opportunities to participate with peers. Their perspective shifted the focus away from independence as an end in itself, and towards supporting participation while gradually strengthening activity competence. The professionals responded by contributing complementary perspectives: the municipal physiotherapist emphasized planning for support, the specialist physiotherapist highlighted context-dependent interventions, the preschool assistant suggested practical energy-conservation strategies, and the teacher described how aides could promote independence without taking over. Together, these contributions illustrate how learning with parents, establishing common ground, and the orchestration of support enabled dressing to become a scaffolded step towards participation rather than an isolated functional task. This broader understanding reflects contemporary conceptualizations of participation that emphasize engagement, belonging, and inclusion (Granlund et al. 2012; Whiteneck & Dijkers 2009).

Our results therefore suggest that interprofessional collaboration can broaden understanding of participation by integrating multiple professional and parental perspectives. Through shared learning and common ground, coordinated support may expand opportunities for participation for children with physical disabilities. At the same time, collaboration is always enacted within particular organizational and environmental contexts.

Context shaped both what could be observed and how participation could be understood. The interprofessional meeting concerning Martin took place at the health and sports center rather than in his everyday environment. Consequently, observations primarily illuminated activity competence, while opportunities for participation had to be interpreted through collaborative discussion. Nevertheless, these discussions proved valuable because they generated shared understanding that could later be transferred to Martin’s everyday settings. This result resonates with Castro-Kemp and Samuels (2022), who argue that naturalistic activities create opportunities for teams to develop shared understanding beyond isolated professional observations. Similarly, our results support research highlighting the importance of reflective, relational spaces for collective learning (Duhn, Fleer, & Harrison 2016; Rantavuori, Kupila, & Karila 2017).

The observations of Martin also illustrate how interprofessional collaboration can move beyond shared reflection towards coordinated action. With several professionals participating simultaneously, opportunities for learning together and establishing common ground appeared stronger, supporting what we describe as orchestration. This result aligns with Bricker et al. (2022), who emphasize that coordinated professional contributions are necessary to achieve shared goals. However, previous studies also show that assembling professionals across services is resource intensive (Castro-Kemp & Samuels 2022; Garcia-Melgar et al. 2022). Our results similarly suggest that the potential of orchestration depends not only on professional commitment but also on municipal resources and organizational priorities. Resource differences between municipalities (Riksrevisjonen 2021) may therefore influence opportunities for sustained collaboration. Although co-presence facilitates learning together, common ground, and orchestration, these collaborative achievements remain contingent upon organizational support and adequate resourcing.

Relational expertise, common knowledge, and relational agency

Our results suggest that establishing common ground creates favorable conditions for successful interprofessional collaboration and strengthens efforts to support children’s activity competence and opportunities for participation. However, shared settings alone do not produce common ground. Observations from Hans’s interprofessional meeting and the subsequent activity session illustrate that opportunities for learning together were not always fully utilized when only one municipal professional participated. Common ground depended on active engagement, dialogue, and contributions from all participants rather than simply sharing the same physical space.

Drawing on Edwards’ (2010) concept of common knowledge, we argue that successful collaboration develops through sustained dialogue in which different professional and family perspectives are negotiated and integrated. Without such engagement, shared settings may still result in fragmented understanding and limited collective action. Equally important is professional sensitivity to when support should promote children’s own agency and when more direct assistance is needed.

Edwards (2010, 2017) argues that the intersections between professional practices create opportunities to respond more effectively to complex situations. Our results illustrate how professionals drew on one another’s expertise and gradually incorporated these perspectives into a shared understanding of the child’s participation. During Martin’s pool session, for example, the municipal physiotherapist and teacher observed interactions involving Martin, his father, and the sports educator before transferring these insights into subsequent collaboration within the municipality. Rather than simply exchanging information, professionals interpreted and extended one another’s expertise. This reflects relational expertise—the capacity to contribute specialist knowledge while recognizing and working with the expertise of others (Edwards 2010, 2017).

These collaborative processes also illustrate relational agency. Following the observations at the health and sports center, the teacher and municipal physiotherapist translated their shared learning into coordinated action within Martin’s everyday school context. Collaboration therefore became dynamic, adaptive, and responsive to changing situations, illustrating what Edwards (2005, 2010) describes as relational agency. We describe this coordinated and continually adjusted form of collaboration as orchestration. However, our results also indicate that orchestration is contingent. It depends on mutual engagement, protected time, organizational support, and alignment of professional roles. Where engagement is limited or contributions remain disconnected, opportunities for learning together, establishing common ground, and collective action are reduced.

Taken together, Edwards’ concepts provide a coherent theoretical framework for understanding how successful interprofessional collaboration develops. Rather than viewing collaboration as the coordination of separate professional contributions, our results suggest that successful collaboration is enacted through relational processes in which professionals and families build common ground, develop relational expertise, and translate shared understanding into collective action that supports children’s activity competence and opportunities for participation.

Reflections on future research and practice

Future research should further explore families’ perspectives and how their experiences can strengthen interprofessional collaboration. Greater involvement of families may provide knowledge that supports more tailored approaches to promoting children’s participation. Research involving professionals across service levels would also deepen understanding of the relational dynamics of interprofessional collaboration. In addition, studies conducted in vivo, observing children participating with peers in everyday contexts, are needed to better understand how collaboration supports participation.

Our results are relevant to interprofessional collaboration by illustrating how collaboration can support activity competence and opportunities for participation for children with physical disabilities. We argue that practice should continue to emphasize relational working by creating space for dialogue, active listening, and shared reflection on what matters for the child and family. Such practices can strengthen collaboration, promote continuous learning, and support the implementation of successful practice. Our results also have implications for education by demonstrating how Edwards’ concepts can be used to teach the relational and processual dimensions of collaboration, thereby preparing future professionals while supporting continuing professional development.

Limitations and strengths

Our purposive sample was small and may not represent other contexts or perspectives. Participant observation is inherently interpretive, and both researcher presence and interpretation may have influenced the observations and analysis. However, prolonged fieldwork across multiple settings provided opportunities to identify patterns and developments in interprofessional collaboration over time. Although LMS’s background as an occupational therapist may have heightened sensitivity to activity performance and subtle interactional processes, the study maintained its focus on collaboration through reflexive memo-taking, field-note reviews, debriefings with co-authors, and repeated analysis of the data through a collaboration lens. A further strength was the multidisciplinary composition of the research team, reflecting the collaborative approach advocated in both research and practice.

A limitation is that parents provided written consent on behalf of the children. To respect children’s autonomy, ongoing assent was monitored through observation of body language and brief conversations throughout data collection.