The Ladder of Participation (IMAGE) IOS Press Caption The ladder of participation. By Dr. Anna Ambrosini, adapted from: de Wit MP, Kvien TK, Gossec L. Patient participation as an integral part of patient-reported outcomes development ensures the representation of the patient voice: a case study from the field of rheumatology. RMD Open. 2015;1(1):e000129. Credit CHEO Research Institute in Ontario (Canada) Usage Restrictions None License Licensed content Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.