Rehabilitation services are increasingly targeting involvement in daily life. Within the ICF this is referred to as participation. Questions regarding its conceptualization have been raised and a consensus is lacking. In a first phase a critical review of the literature was performed to detect recurring conceptual problems in applying participation and to detect how researchers deal with these. This leaded in the second phase to a systematic review to identify how participation measures are operationalized. Phase 1 resulted in possible solutions to overcome 4 recurring key-limitations: (1) how to deal with ambiguity and vagueness about the term itself, (2) how to differentiate between activity and participation (3) what is the current empirical knowledge about the subjective aspects of participation (4) what are the different ways to measure participation. Phase 2 resulted in 18 instruments operationalising participation in different ways: (a) unidimensional; the frequency of performing activities (b) unidimensional; the limitations in experiencing participation when performing activities (c) multidimensional; multiple subjective dimensions when performing activities and (d) multidimensional: objective and subjective dimensions. Notwithstanding an increasing body-of-knowledge some issues still remain blurred and specifically how participation is measured is subject to debate. This leads to difficulties to use participation in clinical practice. However: insight in current body-of-knowledge and awareness of shortcomings might inspire professionals aiming it's application.