Quality of Life: Changes in Self-Perception in People with down Syndrome as a Result of Being Part of a Football/Soccer Team. Self-Reports and External Reports

brain sciences Article Quality of Life: Changes in Self-Perception in People with down Syndrome as a Result of Being Part of a Football/Soccer Team. Self-Reports and External Reports Rocío Camacho 1, Cristina Castejón-Riber 2, Francisco Requena 1,* , Julio Camacho 1, Begoña M. Escribano 1, Arturo Gallego 3, Roberto Espejo 3, Amaranta De Miguel-Rubio 4and Estrella I. Agüera 1   Citation: Camacho, R.; Castejón-Riber, C.; Requena, F.; Camacho, J.; Escribano, B.M.; Gallego, A.; Espejo, R.; De Miguel-Rubio, A.; Agüera, E.I. Quality of Life: Changes in Self-Perception in People with down Syndrome as a Result of Being Part of a Football/Soccer Team. Self-Reports and External Reports. Brain Sci. 2021,11, 226. https:// doi.org/10.3390/brainsci11020226 Academic Editor: Anke Sambeth Received: 16 December 2020 Accepted: 8 February 2021 Published: 12 February 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Department of Cellular Biology, Physiology and Immunology, University of Cordoba, 14071 Cordoba, Spain; [email protected] (R.C.); [email protected] (J.C.); [email protected] (B.M.E.); [email protected] (E.I.A.) 2 Department Artistic and Corporal Education, University of Cordoba, 14004 Cordoba, Spain; [email protected] 3Department of Statistics, University of Cordoba, 14071 Cordoba, Spain; [email protected] (A.G.); [email protected] (R.E.) 4Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; [email protected] *Correspondence: v02r[email protected]; Tel.: +34-(66)-9588756 Abstract: The hypothesis posed was whether being part of a football/soccer team influenced the quality of life (QL) of the people who participated in it since their perception of themselves is enhanced by factors, such as self-determination, social inclusion, emotional well-being, physical wellbeing, material well-being, rights, personal development, and internal relationships. The objective was to evaluate the QL of people with Down Syndrome (DS) using their self-perception (n= 39) and the perception of the informants (family members, teachers) (n= 39). The KidsLife-Down Scale, with a few modifications, was used. In general, differences of opinion between the subgroups of participants with DS and informants showed that results were higher in terms of perception for participants in the DS subgroup. Scores for all variables were higher for those participants with DS who said they did engage in practicing competitive football/soccer. Although the perception of informants provides a great deal of information regarding the QL of participants with DS, participants with DS should also be involved in the evaluation process and their self-perceptions taken into account. It is not participating in a football team that causes the conclusions of the study, but training (which includes the friendly matches that are played), the cause correlated with the improvements detected in the athlete’s DS. Keywords: Down Syndrome; perception; quality of life; sport; age; gender; scale 1. Introduction The Cordoba Down Centre (CDC) is an NGO concerned with increasing the quality of life (QL) of people with Down Syndrome (DS) by promoting a healthy, autonomous, and independent lifestyle. QL occupies an important place in society because it is considered a way of measuring personal well-being. The need to assess quality of life has become a matter of great importance and practical utility for the development of good practices that, in accordance with the provisions of Spain’s Law 39/2006 dated 14 December 2006 on the Promotion of Personal Autonomy and Attention to Dependent Persons, has been included as an essential criterion in the accreditation process to guarantee the quality of centers, services, and the System for Autonomy and Attention to Dependent Persons (Resolution dated 2 December 2008 in Spain’s Official State Bulletin (BOE) published 17 December 2008). In the aforementioned resolution, these centers, services, and entities are required to present, among other things, documentation related to the user, including objectives, interdisciplinary work plan, interventions, and evaluation of results in terms of improvement in their quality of Brain Sci. 2021,11, 226. https://doi.org/10.3390/brainsci11020226 https://www.mdpi.com/journal/brainsci Brain Sci. 2021,11, 226 2 of 16 life. Currently, in Spain, according to the abovementioned law, instruments that allow the assessment of QL with sufficient guarantee of validity and reliability are indispensable. QL has been defined as a series of objective biological, psychological, and social indicators that express a subjective evaluation of the degree to which life satisfaction has been achieved or the perceived level of personal well-being [ 1 – 4 ]. Schalock and Verdugo [ 5 ] proposed a model of QL defined as “the desired state of personal well-being from a multidimensional viewpoint, given that it includes both objective and subjective components and is also influenced by environmental factors and personal characteristics”. This model distinguishes eight essential aspects of quality of life and their corresponding indicators which are important for all people: social inclusion (participation, inclusion, and support), self-determination (goals, preferences, choice, and autonomy), emotional well-eing (satisfaction, absence of stress, motivation), physical well-being (nutrition, health, sport), material well-being (economic independence, technology, material support) rights (dignity, respect), personal development (adaptive behaviour, communication strategies, social skills), and interpersonal relations (friendship networks, autonomy). According to Claes et al. [ 6 ], the areas of emotional, physical, and material well-being, reflect the general well-being of the person; interpersonal relationships, social inclusion, and rights refer to social participation; personal development and self-determination express personal independence. Instruments to evaluate quality of life with a sufficient guarantee of validity and reliability are indispensable for dependent persons [ 7 ]. Given that interventions aimed at improving quality of life must be based on evidence, in Spain, the KidsLife Scale [ 8 ] was developed and validated for the evaluation of children and young adults with DS, using the model proposed by Schalok and Verdugo in 2003 [5]. The KidsLife Scale is intended to identify the person’s QL profile and provide evidence of validity and reliability for the implementation of evidence-based practices and the design of individual support plans. It provides standardized scores and percentiles for the eight core aspects of QL (emotional well-being, physical well-being, material well-being, personal development, interpersonal relationships, social inclusion, self-determination, and rights). It also allows the information obtained to be illustrated in a QL profile. This scale is aimed at childhood, adolescence, and youth. The CDC includes a group of federated athletes who belong to the Cordoba Football Club of LaLiga Genuine Santander, Spain. Currently, in Spain, parallel to the Professional Football League, LaLiga Genuine Santander consists of a competitive national football league made up of people with intellectual disabilities. This league plays eight-a-side football in a single mixed category. The objective of the present study was to evaluate the QL of people with DS at CDC using their self-perceptions and the perceptions of informants. To this end, we focused on: (1) Analysing the correlation of age in participants with DS and the informants with respect to aspects of QL; (2) Analysing differences in terms of gender in participants with DS and informants with respect to aspects of QL; (3) Verifying if there are differences in aspects of QL between those who practice competitive sport and those who do not, according to the self-perceptions of participants with DS and the opinions of the informants, and finally (4) Evaluating differences of opinion with regard to the aspects of QL between groups (people with DS and informants). With this study, we wanted to emphasize that, in spite of the fact that the perception of informants provides a great deal of information regarding the QL of participants with DS, participants with DS should also be involved in the evaluation process and their self-perceptions taken into account. Scale hypotheses for people with Down syndrome was: Gender, age and being part of a football/soccer team improve the quality of life for people with DS. The perception of your QL should coincide with the perception thereof on the part of informants. Scale hypothesis for informants was: Brain Sci. 2021,11, 226 3 of 16 Gender, age and being part of a football/soccer team contribute to improve the quality of life for people with DS. The perception of QL should coincide with the perception on the part of people with DS. 2. Materials and Methods 2.1. Participants A total of 78 people participated in the study, 39 with DS who were users of CDC, with an age between 21–40 years (29 ± 3) (men n= 24; women n= 15; athletes n= 9, non-athletes n= 30) and 39 informants. Here, “athletes” refers to the federated footballers belonging to a football/soccer team (the Cordoba Football Club of LaLiga Genuine Santander, Spain); “non-athletes” were non-federated and did not participate in that team. The informants (family members, teachers) needed to know the participant well for at least six months and have the opportunity to observe them in different environments for prolonged periods. The relationship of the informants with the person evaluated was 34 parents and 5 teachers (87.17% parents and 12.82% teachers). The informants for athletes were 8 parents and 1 teacher (88.89% parents and 11.11% teachers); informants for the group of non-athletes were 26 parents and 4 teachers. The sociodemographic data used in forming the work groups were collected by each informant before proceeding with evaluation: age, gender, place of birth, percentage of recognized disability, intellectual disability in terms of adaptive behavior (conceptual, social and practical skills), recognized level of dependence (moderate, severe, high dependence), other assessed conditions (physical, auditory or visual disability, obesity, etc.). All participants with DS were Spanish, Caucasian, with a medium-high socioeconomic level. The percentage of recognized disability ranged from 73–75%. Both athletes and non-athletes with DS participated in two regular sessions of Physical Education at CDC in which basic movement patterns were practiced to resolve motor difficulties in daily life using various circuits and posts (jumping, throwing, coordination, and balance) as well as improving basic physical qualities: strength, speed, stamina, and range of movement. Finally, various sports were practiced (basketball, football, etc.), which included the use of balls in games modified and adapted to the participants’ different levels of ability. Outside CDC, athletes also took part in two 90 min training sessions a week under the supervision of a coach. Each session consisted of a warm-up period, the main session, and a cool-down period: (a) Warm-ups were divided into general warm-ups, in which the participants activated the neuromuscular system with group games, followed by specific warm-ups for which the goalkeepers were separated from the field players and specific motor activities were practiced. (b) During the main session, balls were used, and the specific technical and tactical moves of football were practiced (control, passing, shooting, etc.) Strategic roles were distributed for each side (offense player with ball, offense player without ball, defensive player, goalkeeper). Later, real play situations were practiced in short games, changing the rules to meet the objective established for each session. (c) During cool-down, the participants did stretches. This type of training is more demanding of motor skills than the routine sessions at CDC. All participants with DS lived with their families. 2.2. Method Previous to the study, the objective was presented to the directors of CDC to obtain their ethical approval and the consent of those involved or their family members. The authors of this study declare that, based on the Helsinki Declaration, they have taken into account the basic principle of respect for the individual, his/her right to self-determination, and to make decisions once clearly informed of the pros and cons, risks and benefits of Brain Sci. 2021,11, 226 4 of 16 participating in this research study [ 9 ]. The study was carried out respecting the ethical standards of the CDC committee. Once written consent was obtained, a meeting was held with the participants with DS and informants to discuss rules of application and proper use, as well as to warn informants not to influence the responses of participants with DS, though they could clarify points as needed. Participants with DS were told they could request clarification of anything they did not understand. The first author of this study then sent the QL scale to CDC, who distributed it to parents, teachers, and coordinators (a printed version and via email). The scales were gathered by a CDC liaison. Once filled out, the researchers compiled the answers in a database and carried out the pertinent statistical analyses. During the process of administering the scale, no personal data were compiled that might identify the person under evaluation. Instead, identification codes were used (such as pseudonyms) that were unknown to the researchers to protect confidentiality, in accordance with Spain’s Organic Law 3/2018 on the protection of personal data and guarantee of digital rights. These identification codes allowed the results of the evaluations to be returned to CDC to be used in later interventions with the participants [10]. Once ethical approval and acceptance for participation in the study were obtained, the researchers did not select the participants; rather, they voluntarily agreed to participate. They were not given any incentives. 2.3. Instrument A modified version of The KidsLife-Down scale [ 8 ] was used to evaluate QL. Participants with DS responded with one of two options (dichotomy) and informants with a Likert scale. All 78 participants (DS and informants) answered the scale. The scale consisted of items divided into eight aspects of QL (self-determination, rights, emotional well-being, material well-being, physical well-being, social inclusion, interpersonal relationships, and personal development) [ 11 ]. This scale provides standardized scores and percentiles for the eight aspects, as well as a QL profile report. There were two versions of the scale used: (a) a self-report filled out by participants with DS, with two options (yes/no) and (b) an external report filled out by informants using a Likert scale with four frequency options (never, sometimes, often, always) [ 12 ]. The questions asked of informants were the same as those answered by participants with DS, but in the third person. Direct scores for each aspect of QL were the sum of the scores for the items in each section. The direct scores were then converted to standard scores (M = 10; SD = 3) following the 15-to-21-year age range provided by the scale. The total standard score was obtained by adding up the standard scores for the eight aspects, which was then converted to the standard composite score or Quality of Life Index (QLI) (M = 100; SD = 15) [ 8 ], taking into account the aforementioned range. High scores for the various aspects of QL and QLI indicate a high level of functioning for the person in a given area, greater QL, and personal well-being. All scores can be shown in a graph of the QL profile [5]. At the time of writing the survey questions, we attempted to avoid any cognitive bias in the two groups of respondents so as to obtain honest information. For people with DS, the questions were written using personal, direct language (Table 1). To facilitate their responses, the dichotomous (Y/N) type of response was chosen. Questions that were considered more complex were stated in a simpler way or using colloquial language. It was found that the formulation of the questions did not influence the answers, nor did it induce inaccuracies in relation to the information collected [ 13 ]. In addition, the sample bias was taken into account to ultimately obtain reliable information of good quality (The requirements of the respondents to fulfill the objectives of the work were clearly defined [ 13 ]. There were two different responses (dichotomy and Likert scale), and these were scored so as to obtain (M = 10) for all of them. Brain Sci. 2021,11, 226 5 of 16 Table 1. Examples of questions for the informants and people with Down Syndrome (DS) view. Informants People with DS Take the recommended amount of food and fluids to maintain good health. Do you eat everything your parents or the Association give to you? Has he/she adequate hygiene (e.g., teeth, hair, nails, body) and personal image (e.g., clothing and accessories appropriate for their age and for the occasion). Do you wash your teeth, hair, nails, and body? Do you wear the clothes you like? Performs activities and physical exercises appropriate to their characteristics and needs. Do you practice physical activity in any sport outside of the Association: football/soccer, swimming, basketball . . . ? Does he/she have a preventive health plan (e.g., regular tests, specialist reviews) Do you go to the doctor even if you are not sick for a check-up (e.g., blood test)? 2.4. Method of Scale Validation The scale used was validated by Gómez et al. [ 8 ]. To validate the modifications introduced, the validation process was carried out by a team of professional experts belonging to the CDC’s board of directors. This committee did not participate as informants. The earliest version of the questionnaire was sent to CDC, who reviewed the possible errors in formulating the questions. They provided feedback that served to reformulate the questions in an appropriate way to avoid confusion among the people surveyed. Feedback focused mainly on the following issues: wording of questions, vocabulary related to the context of CDC, elimination of ambiguous questions in favor of more specific ones, removal of terminology that could be interpreted as being patronizing or offensive, and benefits of some questions regarding the logic of the questionnaire. The revision of the questionnaire was carried out with an in-depth analysis of all contributions so that it included those that could be considered adequate to allow for the drafting of a definitive model. The improved version was again forwarded to CDC. The questionnaire was considered non-offensive, comprehensible, and suitable for participants. To validate the reliability of the questionnaire, verify and confirm the matter under investigation, Cronbach’s alpha consistency coefficient was used [14–16]. 2.5. Statistical Analysis Normality compliance was tested for each group using the variables of gender, age, and football (to practice competitive football/soccer or not) via the Kolmogorov–Smirnov test. The aforesaid hypothesis was not met for all variables studied (p< 0.001 in all cases); therefore, non-parametric or free distribution tests were applied, specifically Spearman’s Rho (rank-order correlations) and Mann–Whitney’s U-tests. The SPSS program (v25; IBM, Armonk, NY, USA) was used for all statistical analyses of data. 3. Results The psychometric properties of the scale were satisfactory. The questionnaire answered by participants with DS obtained a Chronbach alpha coefficient of 0.6, and that answered by the informants obtained a coefficient of 0.87. The randomness of the sample was verified with the Runs test (Wald–Wolfowitz), obtaining Z< 0.001, p> 0.05, which showed that it was random. 3.1. Intellectual Disability and Other Conditions Participants with DS presented a predominant moderately high level of intellectual disability (in terms of adaptive behavior) of 50%: in detail, 56% in conceptual skills, 51.3% in social skills, and 54% in practical skills. The percentage of recognized disability ranged from 73–75%. Other conditions evaluated showed that 25.5% had physical disabilities, 44% obesity, 18.3% sensorial disability, 6.3% had serious health problems, and 4.9% had Brain Sci. 2021,11, 226 6 of 16 sleep disorders. Table 2clarifies the descriptive statistics (%) for the level of intellectual disability (in terms of adaptive behavior) and the level of recognized dependence. An analysis of variance (ANOVA) was used to test the hypothesis that the means of athletes and non-athletes were equal. The p-value obtained for all variables was greater than the level of significance; therefore, there were no significant differences in the results obtained, and the groups did not show a priori differences in intellectual disability and level of dependence. Table 2. Descriptive statistics (%) of the level of intellectual disability and level of dependency recognized of participants with DS (n= 39). Category Total Athletes No Athletes Variables Level % % % F p Conceptual skills Mi 28.2 55.6 20 Mo 56.4 44.4 60 5.55 >0.01 Se 15.4 0 20 Social skills Mi 38.5 66,7 30 Mo 51.3 33,3 56.7 4.52 >0.01 Se 10.3 0 13.3 Practical skills Mi 35.9 55.6 30 Mo 56.4 33.3 63.3 0.84 >0.01 Se 7.7 11.1 6.7 Recognized level of dependency Mo 20.5 22.2 20 Se 12.8 22.2 10 0.87 >0.01 Hd 10.3 22.2 6.7 Note: Mi: Mild; Mo: Moderate; Se: Severe; Hd: High dependency. 3.2. Age In the analysis of age correlation for both participants with DS and informants with respect to quality of life, the Kolmogorov–Smirnov test showed that normality compliance was not achieved. Therefore, Spearman’s Rho (rank–order correlations) was used for the subsample of participants with DS (n= 39) as well as the subsample of informants (n= 39), using the age scale and all aspects of QL implied in the study (Table 3). Table 3. Spearman’s Rho correlations between age of participants with DS (n= 39) and self-perception with respect to the aspects of the study, and the correlation of these ages with informant perceptions (n= 39). Age DS Informants Dependent variables rprp Social inclusion −0.44 −0.792 −0.057 −0.728 Auto-determination −0.212 −0.196 −0.081 −0.622 Emotional well-being −0.246 −0.131 −0.093 −0.572 Physical well-being −0.353 −0.027 −0.012 −0.942 Material well-being −0.062 −0.708 −0.120 −0.474 Rights −0.083 −0.614 −0.114 −0.490 Interpersonal relationship −0.135 −0.411 −0.011 −0.946 Pesonal development −0.219 −0.181 −0.074 −0.656 Quality life index −0.194 −0.237 −0.204 −0.212 Results for the subsample of participants with DS indicated a single statistically significant correlation (r= − 0.353; p= 0.027) with moderate magnitude and negative meaning with respect to the physical well-being variable. No other significant relationship was detected for the remaining variables, including QLI. However, no statistically significant Brain Sci. 2021,11, 226 7 of 16 relationship was detected between the age of participants with DS and the opinions of informants in terms of any aspect of the study. 3.3. Differences in Terms of Gender In the analysis of differences in terms of gender, with respect to the aspects studied and QLI of participants with DS and informants, the Kolmogorov–Smirnov test showed that normality compliance was not achieved. Therefore, to contrast the differences between both groups (participants with DS and informants), non-parametric testing was applied, equivalent to Student t-test for independent groups, Mann–Whitney U-tests (Table 4). Results for self-perception of participants with DS indicated significant differences for the emotional well-being variables (Z = − 2.29; p= 0.022 ), material well-being (Z = − 2.29; p= 0.022 ), and personal development (Z = − 2.20; p= 0.028). For these three variables, results were higher for men. No statistically significant difference was detected for the remaining variables nor for QLI (Table 4). In the second place, with regard to informants, statistically significant differences were detected between genders for participants with DS for the variables social inclusion ( Z = −2.49 ;p= 0.013), emotional well-being (Z = − 2.29; p= 0.022), physical well-being ( Z = −2.45 ;p= 0.014), material well-being (Z = − 3.88; p< 0.001), and QLI (Z = − 2.84; p= 0.004 ). For all five variables, results were higher for men. No statistically significant difference was detected for the remaining variables (Table 4). Therefore, the opinions of participants with DS and informants coincided with respect to emotional well-being and material well-being. 3.4. Differences between Variables in the Study and QLI between Athletes and No Athletes To verify if there were differences between variables in the study and QLI between athletes and no athletes, according to the self-perceptions of participants with DS and in the opinion of informants, the non-parametric Mann–Whitney U-test was again applied. Results are shown in Table 5. The opinion of participants with DS showed statistically significant differences between the group with DS who practiced competitive football/soccer and those who did not. These results for all variables, including QLI, were higher for those participants who said they practiced competitive football/soccer (in all cases, p< 0.001; Table 5). In the second place, with reference to informant opinion, no statistically significant difference was detected for any of the variables as regards the practice or not of competitive football/soccer on the part of participants with DS. Brain Sci. 2021,11, 226 8 of 16 Table 4. Mann–Whitney U tests for independent variables of the study with respect to gender for the subgroup of participants with DS (men n= 24; women n= 15) concerning self-perception and perception of informants (n= 39). DS Participants Informants Dependent Variable Gender (DS) Mean SD Min Max Average Range UMW ZpMean SD Min Max Average Range UMW Zp SI M 5.58 1.586 4 8 21.85 135.50 −1.350 0.177 4.83 1.239 3 7 23.23 102.50 −2.488 0.013 F 4.73 0.704 4 6 17.03 3.93 0.961 3 6 14.83 AU M 5.71 1.517 3 8 22.69 115.50 −1.899 0.058 4.13 0.900 3 5 22.50 120.00 −1.841 0.066 F 4.73 1.387 3 8 15.70 3.60 0.632 3 5 16.00 EW M 5.00 1.142 4 7 23.06 106.50 −2.294 0.022 5.08 1.412 3 7 23.21 103.00 −2.289 0.022 F 4.13 0.834 3 6 15.10 4.07 0.884 3 6 14.87 PW M 9.08 0.717 8 10 21.98 132.50 −1.463 0.143 8.88 0.947 8 10 23.25 102.00 −2.446 0.014 F 8.53 1.125 7 10 16.83 8.00 0.845 6 9 14.80 MW M 6.96 1.197 5 9 23.15 104.50 −2.294 0.022 6.43 1.273 4 8 24.98 46.50 −3.875 <0.001 F 6.07 1.033 5 8 14.97 4.73 0.704 4 6 11.10 RM 4.79 1.817 3 8 20.50 168.00 −0.357 0.721 4.88 1.676 3 8 20.42 170.00 −.304 0.761 F 4.27 0.961 3 6 19.20 4.40 0.986 3 7 19.33 IR M 5.46 1.285 4 7 20.77 161.50 −0.567 0.571 5.21 1.141 4 7 21.60 141.50 −1.184 0.236 F 5.20 1.207 4 7 18.77 4.73 0.799 4 7 17.43 PD M 5.42 1.248 4 7 23.06 106.50 −2.203 0.028 4.46 0.658 3 5 21.60 141.50 −1.229 0.219 F 4.47 0.915 3 6 15.10 4.20 0.676 3 5 17.43 QLI M 72.71 8.800 63 86 21.75 138.00 −1.238 0.216 68.96 7.369 62 80 23.44 97.50 −2.841 0.004 F 67.53 3.701 63 73 17.20 63.00 0.000 63 63 14.50 NOTE: M: Male; F: Female; DS: People with Down syndrome; SI: Social inclusion; AU: Auto-determination; EW Emotional well-being; PW: Physical well-being; MW: Material well-being; R: Rights; IR: Interpersonal relationship; PD: Personal development; QLI: Quality life index. Brain Sci. 2021,11, 226 9 of 16 Table 5. Mann–Whitney U-tests for dependent variables with respect to practicing competitive football on the part of participants with DS (Yes, n= 9; No, n= 30) according to the opinions of the subgroup with DS and informant perceptions (n= 39). DS Participants Informants Dependent Variable Football (SD) Mean SD Min Max Average Range UMW ZpMean SD Min Max Average Range UMW Zp SI Y 7.44 0.726 6 8 34.89 1.00 −4.695 <0.001 4.56 1.130 3 6 20.94 126.50 −0.315 0.781 N 4.60 0.621 4 6 15.53 4.47 1.252 3 7 19.72 AU Y 7.33 0.707 6 8 33.89 10.00 −4.249 <0.001 4.22 0.833 3 5 23.83 100.50 −1.222 0.255 N 4.73 1.143 3 8 15.83 3.83 0.834 3 5 18.85 EW Y 6.33 0.500 6 7 34.67 3.00 −4.757 <0.001 4.78 1.481 3 7 20.56 130.00 −0.172 0.883 N 4.17 0.648 3 6 15.60 4.67 1.295 3 7 19.83 PW Y 9.78 0.441 9 10 31.39 32.50 −3.645 <0.001 8.67 1.000 8 10 20.67 129.00 −0.217 0.857 N 8.60 0.855 7 10 16.58 8.50 1.009 6 10 19.80 MW Y 8.33 0.500 8 9 34.33 6.00 −4.525 <0.001 6.25 1.389 4 8 23.69 86.50 −1.235 0.235 N 6.10 0.803 5 8 15.70 5.63 1.351 4 8 18.38 RY 6.89 1.054 5 8 34.44 5.00 −4.465 <0.001 4.67 1.581 3 7 19.17 127.50 −0.263 0.806 N 3.90 0.845 3 6 15.67 4.70 1.442 3 8 20.25 IR Y 7.00 0.000 7 7 33.00 18.00 −4.138 <0.001 5.33 1.323 4 7 22.17 115.50 −0.692 0.522 N 4.87 0.973 4 7 16.10 4.93 0.944 4 7 19.35 PD Y 6.67 0.500 6 7 33.83 10.50 −4.308 <0.001 4.33 0.866 3 5 20.39 131.50 −0.129 0.909 N 4.57 0.898 3 7 15.85 4.37 0.615 3 5 19.88 QLI Y 83.33 1.500 81 86 35.00 0.00 −4.594 <0.001 67.78 7.225 62 79 20.83 127.50 −0.298 0.806 N 66.93 3.423 63 73 15.50 66.33 6.283 63 80 19.75 NOTE: Y: Practicing competitive football/soccer (Yes); N: Not Practicing competitive football/soccer (No); DS: People with Down syndrome; SI: social inclusion; AU: auto-determination; EW Emotional well-being; PW: Physical well-being; MW: Material well-being; R: Rights; IR: Interpersonal relationship; PD: Personal development; QLI: Quality life index. Brain Sci. 2021,11, 226 16 of 16 43. Garvía, B. Avances y retos en el Síndrome de Down. Perspectivas desde la calidad de vida. Rev. Psicol. Gen. Apl. 2019,32, 1–2. 44. Abella, B. La Discapacidad Tiene Rostro de Mujer. Revista CeRmi.es. 2013. Available online: http://semanal.cermi.es/noticia/ Igualdad-genero-entidades-discapacidad-reportaje.aspx (accessed on 13 November 2020). 45. Sabo, D. Comprender la Salud de los Hombres. Un Enfoque Relacional y Sensible al Género. Organización Iberoamericana de la Salud; Harvard Center for Population and Development Studies: Cambridge, MA, USA, 2000. 46. Courtenay, W.H. Constructions of masculinity and their influence on men well-being: A theory of gender and health. Soc. Sci. Med. 2000,50, 1385–1401. [CrossRef] 47. Avia, M.D.; Vázquez, C. Optimismo Inteligente; Alianza: Madrid, Spain, 1998. 48. Reindl, M.S.; Waltz, M.; Schippers, A. Personalization, self-advocacy and inclusion: An evaluation of parent-initiated supported living schemes for people with intellectual and developmental disabilities in the Netherlands. J. Intellect. Disabil. 2016 ,20, 121–136. [CrossRef] [PubMed] 49. García-Moltó, A.; Ovejero-Bruna, M. Satisfacción vital, autodeterminación, y práctica deportiva en las personas con discapacidad intelectual. RPD 2017,26, 13–19. 50. Quero, A. Deporte y Síndrome de Down. Master’s Thesis, Universidad de Almería, Almería, Spain, 2016. 51. Carl, J. Social capital and sport participation. HSS 2003,63, 4097-A. 52. Jarvie, G. Communitarianism, sport and social capital: Neighbourly insights into Scottish sport. Int. Rev. Sport 2003 ,38, 139–153. [CrossRef] 53. Spaaij, R. The glue that holds the community together. Sport and sustainability in rural Australia. Sport Soc. 2009 ,12, 1132–1146. [CrossRef] 54. Stempel, C. Gender, social class, and the sporting capital-economic capital nexus. Sociol. Sport J. 2006,23, 273–292. [CrossRef] 55. Walseth, K. Bridging and bonding social capital in sport -experiences of young women with an immigrant backgroun. Sport Educ. Soc. 2008,13, 1–17. [CrossRef] 56. Pino, J. Análisis Funcional del Fútbol como Deporte de Equipo; Wanceulen Editorial Deportiva, S.L.: Sevilla, Spain, 2002. 57. Haigh, A.; Lee, D.; Shaw, C.; Hawthorne, M.; Chamberlain, S.; Newman, D.W.; Clarke, Z.; Beail, N. What Things Make People with a Learning Disability Happy and Satisfied with Their Lives: An Inclusive Research Project. J. Appl. Res. Intellect. Disabil. 2013,26, 26–33. [CrossRef] [PubMed] 58. Smith, R.E.; Smoll, F.L. Behavioral research and intervention in youth sports. Behav. Ther. 1991,22, 329–344. [CrossRef] 59. Ramírez, W.; Vinaccia, S.; Suárez, G.R. El impacto de la actividad física y el deporte sobre la salud, la cognición, la socialización y el rendimiento académico: Una revisión teórica. Rev. Estud. Soc. 2004,18, 2–8. [CrossRef] 60. Stancliffe, R.J. Proxy respondents and the reliability of the Quality-of-Life Questionnaire Empowerment Factor. JIDR 1999 ,43, 185–193. [CrossRef] [PubMed] 61. Flórez, J. Síndrome de Down. Comunicar la Noticia: Primer Acto Terapéutico; Fundación Iberoamericana Down21: Madrid, Spain, 2017. 62. Wehmeyer, M.; Agran, M.; Hughes, C.; Martin, J.; Mithaug, D.; Palmer, S. Promoting self-determination in students with intellectual and developmental disabilities. In Discapacidad e Inclusión Manual para la Docencia; Amaru: Salamanca, Spain, 2007. 63. Santamaría, M.; Verdugo, M.; Orgaz, B.; Gómez, L.; de Urríes, F.J. Calidad de vida percibida por trabajadores con discapacidad intelectual en empleo ordinario. Siglo Cero 2012,43, 46–61. 64. Hatton, C.; Ager, A. Quality of life measurement and people with intellectual disabilities: A reply to Cummins. J. Appl. Res. Intellect. Disabil. 2002,15, 254–260. [CrossRef] 65. Corral, S. La Ventaja del Síndrome de Down en la Calidad de Vida Individual y Familiar. Master’s Thesis, Universidad Pontificia ICAI ICADE Comillas, Madrid, Spain, 2016. 66. Cummins, R.A. Assessing quality of life for people with disabilities. In Quality of Life for People with Disabilities: Models, Researchs and Practice, 2nd ed.; Brown, R.I., Ed.; Stanley Thornes: Cheltenham, UK, 1997; pp. 116–150. 67. Cummins, R.A. The validity and utility of subjective quality of life: A reply to Hatton & Ager. J. Appl. Res. Intellect. Disabil. 2002 , 15, 261–268. 68. Claes, C.; Vandevelde, S.; van Hove, G.; van Loon, J.; Verschelden, G.; Schalock, R.L. Relationship between self-report and proxy ratings on assessed personal quality of life-related outcomes. J. Policy Pract. Intellect. Disabil. 2012,9, 159–165. [CrossRef] 69. Nota, L.; Ferrari, L.; Soresi, S.; Wehmeyer, M. Self-determination, social abilities, and the quality of life of people with intellectual disability. J. Intellect. Disabil. Res. 2007,51, 850–865. [CrossRef] [PubMed] 70. Wehmeyer, M.L.; Gamer, W. The impact of personal characteristics of people with intellectual and developmental disability on self-determination and autonomous functioning. J. Appl. Res. Intellect. Disabil. 2003,16, 255–265. [CrossRef]