Measurement of activity limitations and participation restrictions: examination of ICF-linked content and scale properties of the FIM and PC-PART instruments

Purpose: To explore the operationalization of activity and participation-related measurement constructs through comparison of item phrasing, item response categories and scoring (scale properties) for two separate instruments targeting activities of daily living.

Method: Personal Care Participation Assessment and Resource Tool (PC-PART) item content was linked to ICF categories using established linking rules. Previously reported ICF-linked FIM content categories and ICF-linked PC-PART content categories were compared to identify common ICF categories between the instruments. Scale properties of both instruments were compared using a patient scenario to explore the instruments’ separate measurement constructs.

Results: The PC-PART and FIM shared 15 of the 53 level two ICF-linked categories identified across both instruments. Examination of the instruments’ scale properties for items with overlapping ICF content, and exploration through a patient scenario, provided supportive evidence that the instruments measure different constructs.

Conclusions: While the PC-PART and FIM share common ICF-linked content, they measure separate constructs. Measurement construct was influenced by the instruments’ scale properties. The FIM was observed to measure activity limitations and the PC-PART measured participation restrictions. Scrutiny of instruments’ scale properties in addition to item content is critical in the operationalization of activity and participation-related measurement constructs.

• Implications for Rehabilitation

• When selecting outcome measures for use in rehabilitation it is necessary to examine both the content of the instruments’ items and item phrasing, response categories and scoring, to clarify the construct being measured.

• Measurement of activity limitations as well as participation restrictions in activities of daily living required for community life provides a more comprehensive measurement of rehabilitation outcomes than measurement of either construct alone.

• To measure the effects of interventions used in rehabilitation, it is necessary to select measures with relevant content and scale properties that enable evaluation of change in the constructs that are expected to change, as a result of the rehabilitation intervention.

     

The Pediatric Version of the Eating Assessment Tool: a caregiver administered dyphagia-specific outcome instrument for children

Purpose: To develop and evaluate the psychometric properties of the Pediatric version of the caregiver administered Eating Assessment Tool.

Methods: The study included developmental phase and reported content, criterion validity, internal consistency and test–retest reliability of the Pediatric Eating Assessment Tool. Literature review and the original Eating Assessment Tool were used for line-item generation. Expert consensus assessed the items for content validity over two Delphi rounds. Fifty-one healthy children to obtain normative data and 138 children with cerebral palsy to evaluate test–retest reliability, internal consistency, and criterion validity were included. The Penetration-Aspiration Scale was used to assess criterion validity.

Results: All items were found to be necessary. Content validity index was 0.91. The mean score of Pediatric Eating Assessment Tool for healthy children and children with cerebral palsy was 0.26?±?1.83 and 19.5?±?11, respectively. The internal consistency was high with Cronbach’s alpha =0.87 for test and retest. An excellent correlation between the Pediatric Eating Assessment Tool and Penetration-Aspiration score for liquid and pudding swallowing was found (p?r?=?0.77; p?r?=?0.83, respectively). A score >4 demonstrated a sensitivity of 91.3% and specificity of 98.8% to predict penetration/aspiration.

Conclusions: The Pediatric Eating Assessment Tool was shown to be a valid and reliable tool to determine penetration/aspiration risk in children.

• Implications for rehabilitation

• The pediatric eating assessment tool: a new dyphagia-specific outcome survey for children.

• The Pediatric Version of the Eating Assessment Tool is a dysphagia specific, parent report outcome instrument to determine penetration/aspiration risk in children.

• The Pediatric Version of the Eating Assessment Tool has good internal consistency, test–retest reliability and criterion-based validity.

• The Pediatric Version of the Eating Assessment Tool may be utilized as a clinical instrument to assess the need for further instrumental evaluation of swallowing function in children.

     

Cross-cultural adaptation,reliability, and validation of the Korean version of the identification functional ankle instability (IdFAI)

Abstract

Purpose: To cross-culturally adapt the Identification Functional Ankle Instability for use with Korean-speaking participants.

Methods: The English version of the IdFAI was cross-culturally adapted into Korean based on the guidelines. The psychometric properties in the Korean version of the IdFAI were measured for test-retest reliability, internal consistency, criterion-related validity, discriminative validity, and measurement error 181 native Korean-speakers.

Results: Intra-class correlation coefficients (ICC_2,1) between the English and Korean versions of the IdFAI for test–retest reliability was 0.98 (standard error of measurement?=?1.41). The Cronbach’s alpha coefficient was 0.89 for the Korean versions of IdFAI. The Korean versions of the IdFAI had a strong correlation with the SF-36 (r_s?=??0.69, p?<?.001) and the Korean version of the Cumberland Ankle Instability Tool (r_s?=??0.65, p?<?.001). The cutoff score of >10 was the optimal cutoff score to distinguish between the group memberships. The minimally detectable change of the Korean versions of the IdFAI score was 3.91.

Conclusion: The Korean versions of the IdFAI have shown to be an excellent, reliable, and valid instrument. The Korean versions of the IdFAI can be utilized to assess the presence of Chronic Ankle Instability by researchers and clinicians working among Korean-speaking populations.

• Implications for rehabilitation

• The high recurrence rate of sprains may result into Chronic Ankle Instability (CAI).

• The Identification of Functional Ankle Instability Tool (IdFAI) has been validated and recommended to identify patients with Chronic Ankle Instability (CAI).

• The Korean version of the Identification of Functional Ankle Instability Tool (IdFAI) may be also recommend to researchers and clinicians for assessing the presence of Chronic Ankle Instability (CAI) in Korean-speaking population.

     

Assessment of activity limitations and participation restrictions with persons with chronic fatigue syndrome: a systematic review

Abstract

Purpose: To summarize measurement instruments used to evaluate activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS) and review the psychometric properties of these instruments. Method: General information of all included measurement instruments was extracted. The methodological quality was evaluated using the COSMIN checklist. Results of the measurement properties were rated based on the quality criteria of Terwee et?al. Finally, overall quality was defined per psychometric property and measurement instrument by use of the quality criteria by Schellingerhout et?al. Results: A total of 68 articles were identified of which eight evaluated the psychometric properties of a measurement instrument assessing activity limitations and participation restrictions. One disease-specific and 37 generic measurement instruments were found. Limited evidence was found for the psychometric properties and clinical usability of these instruments. However, the CFS-activities and participation questionnaire (APQ) is a disease-specific instrument with moderate content and construct validity. Conclusion: The psychometric properties of the reviewed measurement instruments to evaluate activity limitations and participation restrictions are not sufficiently evaluated. Future research is needed to evaluate the psychometric properties of the measurement instruments, including the other properties of the CFS-APQ. If it is necessary to use a measurement instrument, the CFS-APQ is recommended.

• Implications for Rehabilitation

• Chronic fatigue syndrome (CFS).

• Chronic fatigue syndrome causes activity limitations and participation restrictions in one or more areas of life.

• Standardized, reliable and valid measurement instruments are necessary to identify these limitations and restrictions.

• Currently, no measurement instrument is sufficiently evaluated with persons with CFS.

• If a measurement instrument is needed to identify activity limitations and participation restrictions with persons with CFS, it is recommended to use the CFS-APQ in clinical practice and scientific research.

     

Assessment of spasticity after stroke using clinical measures: a systematic review

Abstract

Purpose: To identify and appraise the literature on clinical measures of spasticity that has been investigated in people after stroke. Methods: The literature search involved four databases (PubMed, CINAHL, Embase and The Cochrane Library) up to February 2014. The selected studies included those that aimed to measure spasticity using a clinical assessment tool among adult patients post-stroke. Two independent raters reviewed the included articles using a critical appraisal scale and a structured data extraction form. Results: A total of 40 studies examining 15 spasticity assessment tools in patients post-stroke were reviewed. None of the reviewed measurement tools demonstrated satisfactory results for all psychometric properties evaluated, and the majority lacked evidence concerning validity and absolute reliability. Conclusion: This systematic review found limited evidence to support the use of most of clinical measures of spasticity for people post-stroke. Future research examining the application and psychometric properties of these measures is warranted.

• Implications for Rehabilitation

• There is a need for objective clinical tools for measuring spasticity that are clinically feasible and easily interpreted by clinicians.

• This review identified various clinical measures of spasticity that have been investigated in people after stroke.

• Insufficient evidence of psychometric properties precludes recommending one tool over the others.

• Future research should focus on investigating the psychometric properties of clinical measures of spasticity.

     

Translation of the Leicester Cough Questionnaire into Swedish,and validity and reliability in chronic obstructive pulmonary disease

Abstract

Purpose: The purpose of this study was to translate and culturally adapt the Leicester Cough Questionnaire into Swedish and to test the validity and reliability of the Swedish version, in patients with chronic obstructive pulmonary disease.

Methods: The original Leicester Cough Questionnaire was translated into Swedish by a method, which followed an established forward-backward procedure, including cross-cultural adaptation and pretest. To test the validity of the final version of Leicester Cough Questionnaire in Swedish, the St George’s Respiratory Questionnaire and the COPD Assessment Test were used (n?=112) and to test reliability, the questionnaire was repeated (n?=?86).

Results: The Leicester Cough Questionnaire in Swedish showed proof of construct validity and proof of internal consistency (Cronbach’s alpha coefficient 0.97). All domains and total scores had good-excellent test-retest reliability (intra-class correlation coefficient 2,1?>?0.94). The standard error of measurement, (standard error of measurement percent), for the Leicester Cough Questionnaire in Swedish was 0.84 (5.15%). The smallest real difference, (smallest real difference percent), derived from cross sectional standard error of measurement was 2.33 (14.25%). The Bland–Altman plot indicated no systemic change in the mean.

Conclusion: The Leicester Cough Questionnaire in Swedish is a valid and reliable instrument to measure health-related quality of life in patients with chronic obstructive pulmonary disease and can be used in clinical settings.

• Implications for Rehabilitation

• The Leicester Cough Questionnaire, has been translated into Swedish, following an established forward-backward procedure, including cross-cultural adaptation

• The Swedish version of the Leicester Cough Questionnaire, is a valid, reliable instrument for measuring health-related quality of life regarding cough in patients with chronic obstructive pulmonary disease

• The Swedish version of the Leicester Cough Questionnaire is easy to administer and can be used in clinical and rehabilitation settings and for research purposes

• The absolute reliability presented at group and individual levels to indicate a real improvement is an advantage to assist when interpreting a clinically relevant difference

     

Validating a measure to assess factors that affect assistive technology use by students with disabilities in elementary and secondary education

Purpose/Aim: The purpose of this study was to measure the predictive validity, internal consistency and clinical utility of the Matching Assistive Technology to Child & Augmentative Communication Evaluation Simplified (MATCH-ACES) assessment. Methods: Twenty-three assistive technology team evaluators assessed 35 children using the MATCH-ACES assessment. This quasi-experimental study examined the internal consistency, predictive validity and clinical utility of the MATCH-ACES assessment. Results: The MATCH-ACES assessment predisposition scales had good internal consistency across all three scales. A significant relationship was found between (a) high student perseverance and need for assistive technology and (b) high teacher comfort and interest in technology use (p?=?(0).002). Conclusions: Study results indicate that the MATCH-ACES assessment has good internal consistency and validity. Predisposition characteristics of student and teacher combined can influence the level of assistive technology use; therefore, assistive technology teams should assess predisposition factors of the user when recommending assistive technology.

• Implications for Rehabilitation

• Educational and medical professionals should be educated on evidence-based assistive technology assessments.

• Personal experience and psychosocial factors can influence the outcome use of assistive technology.

• Assistive technology assessments must include an intervention plan for assistive technology service delivery to measure effective outcome use.

     

A head-to-head comparison of the de Morton Mobility Index (DEMMI) and Elderly Mobility Scale (EMS) in an older acute medical population

Abstract

Purpose: To compare the clinimetric properties of the de Morton Mobility Index (DEMMI®) and the Elderly Mobility Scale (EMS). Method: A head-to-head comparison of the EMS and DEMMI® with 120 consecutive older acute medical patients. The DEMMI® and EMS were administered within 48?h of hospital admission and discharge. Results: At admission, 6% and 15% of participants scored the lowest scale score for the DEMMI® and EMS, respectively. For the DEMMI®, 17% of participants scored within the minimal detectable change of the lowest scale score compared to 20% for the EMS at admission. At hospital discharge, DEMMI® scores were normally distributed and the EMS had a ceiling effect. Similar evidence of convergent, discriminant and known groups validity were obtained for the DEMMI® and EMS. There was no significant difference in responsiveness to change between the DEMMI® and EMS. The EMS was significantly quicker to administer compared to the DEMMI®. Conclusion: The DEMMI® and EMS are both valid measures of mobility for older acute medical patients. The DEMMI® has a broader scale width than the EMS with interval level measurement and therefore provides a more accurate method for measuring and monitoring changes in mobility for older acute medical patients.

• Implications for Rehabilitation

• Mobility of older acute medical patients.

• Hospitalised older acute medical patients are at “high risk” of mobility decline.

• Accurate measurement of mobility is essential for preventing and treating mobility decline.

• Many existing mobility measures have significant measurement limitations.

• The DEMMI® is a more accurate measure of mobility than the EMS in an older acute medical population.

     

Validity of microscopy for diagnosing urinary tract infection in general practice – a systematic review

Abstract

Objective: To investigate the validity of microscopy as a diagnostic tool for urinary tract infection in general practice.

Methods: (Design/setting) A systematic review was conducted by searching Medline for clinical studies made in general practice, outpatient clinics or similar settings in which the accuracy/validity of microscopy was evaluated with urine culture as the reference standard.

Results: Our search resulted in 108 titles. 28 potentially eligible studies were retrieved for full-text reading. We included eight studies involving 4582 patients in this review. The quality of the studies was moderate to high. Specificity ranged from 27% to 100%, sensitivity from 47% to 97%. The variation between studies did not allow for meta-analysis.

Conclusion: We did not find substantial evidence to determine the clinical validity of microscopy performed in general practice on urine samples from patients with symptoms of UTI.

• Key points

• Urinary tract infection is common in general practice. Methods for precise diagnosis are needed in order to avoid inappropriate treatment.

• Currently no evidence-based consensus exists regarding the use of urinary microscopy in general practice.

• We did not find substantial evidence to determine the overall clinical validity of microscopy performed in general practice on urine samples from patients with symptoms of UTI.

• Light microscopy with oil immersion had high sensitivity and specificity but is time-consuming. Phase-contrast microscopy is quick and had high specificity but lower sensitivity.

     

Participation-based environment accessibility assessment tool (P-BEAAT) in the Zambian context

Purpose: The purpose of this study was to describe the preliminary development and validation of a potential measure for assessing the accessibility of the built environment in Zambia. It was designed to identify environmental features that present barriers to participation for people with mobility limitations (PWML) using mobility devices such as wheelchairs or crutches.Method: The Participation-Based Environment Accessibility Assessment Tool (P-BEAAT) was developed through focus group discussions and personal interviews with 88 PWML from five provinces of Zambia regarding the accessibility of their built environment. The content validity of the P-BEAAT checklist was accomplished through three phases of development with data gathered from 11 focus groups and nine personal interviews. Results: Participants described accessibility barriers which affect their participation in daily life. This information generated the P-BEAAT with 66 items describing eight environmental features with potential for identifying environmental barriers. The P-BEAAT has shown good homogeneity with Cronbach’s α score of 0.91. Conclusion: The P-BEAAT was constructed grounded in the reality of people’s experiences in Zambia for use in assessing environmental features important in the participation of daily life of PWML pertinent to developing countries. Further clinimetric testing of the properties of the P-BEAAT to establish reliability should be conducted next.

Implications for Rehabilitation

• Identification of barriers in the built environment is a critical element in the process of eliminating obstacles to participation by people with mobility limitations.

• Accessible built environment facilitates the enhancement of participation of people with mobility limitations.

• The process of identifying obstacles requires audit/assessment tools to evaluate and measure the presence or absence of barriers to accessibility of the built environment.

• This study shows that the Participation-Based Environment Accessibility Assessment Tool provides a preliminary checklist to be used in identifying environmental barriers in the process of promoting lifelong participation for people with mobility limitations using wheelchairs or crutches in Zambia.

     

Psychometric validation of the Core Self-Evaluations Scale in people with spinal cord injury

Purpose: Core self-evaluations (CSE) are the perceptions that people have about their overall worth and capability. CSE may be a useful global indicator of adaptation to disability and subjective well-being. The Core Self-Evaluations Scale (CSES) is the most common direct measure of CSE, but its use with persons with disabilities has not been validated. This study aims to evaluate the factorial and concurrent validity of the CSES in persons with spinal cord injury. Method: Two hundred forty-seven individuals with spinal cord injury completed an online survey consisting of the CSES, measures of the four CSE traits, and selected psychosocial variables. Results: Confirmatory factor analysis results provide support for the one-factor measurement structure of the CSES. When correlated with selected psychosocial variables, the CSES was found to perform in a similar fashion to an indirect measure of CSE constructed from measures of the individual CSE traits. Conclusions: The CSES demonstrated acceptable psychometric properties, and its use as a brief, cost-effective measure of CSE in rehabilitation research and practice is supported.

• Implications for Rehabilitation

• Core self-evaluations (CSE) are the perceptions that people have about their overall worth and capability, and the construct has promise as a global indicator of adaptation to disability and subjective well-being in rehabilitation research and practice.

• The Core Self-Evaluations Scale (CSES) is a brief, valuable and cost-effective instrument that can be easily used in both rehabilitation research and practice and has the potential to reduce burden associated with client/participant assessment.

• This study provided evidence of the factorial and concurrent validity of the CSES in persons with spinal cord injury, and supports its use in rehabilitation settings.

     

Validation of the Danish version of the McGill Ingestive Skills Assessment using classical test theory and the Rasch model

Purpose: The study aimed to validate the Danish version of the Canadian the “McGill Ingestive Skills Assessment” (MISA-DK) for measuring dysphagia in frail elders. Method: One-hundred and ten consecutive older medical patients were recruited to the study. Reliability was assessed by internal consistency (Chronbach’s alpha). External construct validity (convergent and known-groups validity) was evaluated against theoretical constructs assessing the complex concept of ingestive skills. Internal construct validity was tested using Rasch analysis. Results: High internal consistency reliability with Chronbach’s alpha of 0.77–0.95 was evident. External construct validity was supported by expected high correlations with most of the constructs related to ingestive skills (r_s?=?0.53 to r_s?=?0.66). The MISA-DK discriminated significantly between known-groups. Fit to the Rasch model (x² (df)?=?12 (12), p?=?0.424) and unidimensionality of the MISA-DK was confirmed after resolving disordered thresholds for 11 items and adjustment of local dependency. Conclusion: The psychometric properties of the MISA-DK equal the original Canadian version. Assessment of internal construct validity indicated multidimensionality due to local dependency. Although achieving good fit to the Rasch model after adjustments, additional studies are needed to establish cross-cultural validity. Finally, establishment of the inter- and intra-rater reliability of the MISA-DK is also needed.

Implications for Rehabilitation

• Validity evidence is a prerequisite to verify whether a measurement instrument in fact accomplish what it is supposed to accomplish.

• Using classical test theory in combination with the Rasch Model provides comprehensive insight of validity evidence.

• The Danish version of the McGill Ingestive Skills Assessment provides valid estimates of dysphagia patients’ ingestive skill abilities.

     

Cross-cultural adaptation,reliability, and validity of the Japanese version of the Cumberland ankle instability tool

Purpose To study validity and reliability of a Japanese version of the Cumberland Ankle Instability Tool and to determine the optimal cutoff score. Methods In this study, the questionnaire was cross-culturally adapted into Japanese. The psychometric properties tested in the Japanese version of the CAIT were measured for criteria validity, internal consistency and test–retest reliability in 111 collegiate soccer athletes. We also established the questionnaire cutoff score for discriminating between individuals with and without CAI. Results There was a significant correlation between the Japanese version of the CAIT and the Karlsson score (r?=?0.604, p?α?=?0.833) and reliability [intraclass correlation coefficient (ICC)?=?0.826, 95% confidence interval (CI): 0.732–0.888]. The optimal cutoff score was?≤25, which was consistent with previous reports. Conclusions The Japanese version of the CAIT has been shown to be a valid and reliable questionnaire for determining the presence of CAI. We expect that researchers and clinicians will use the Japanese version of the CAIT in Japan.

• Implications for Rehabilitation

• Chronic Ankle Instability (CAI), which not only increases recurrence rate of ankle sprain but also decreases athletic performance, is a residual symptom after ankle sprain.

• Cumberland Ankle Instability Tool, which has the reliability and validity to assess CAI, will be critically useful in assessment procedure for CAI.

• It is preferable for clinicians and researchers to use the native language version of the CAIT.

     

Evaluation of the clinical utility of the Home Falls and Accidents Screening Tool (HOME FAST)

Purpose: The HOME FAST was developed and trialled in Australia as a screening tool designed to be used by any health professional to identify older people at increased risk of falls and to facilitate referral for more detailed assessment and intervention. This study aimed to evaluate the clinical utility of the HOME FAST from the perspective of users.

Method: A mixed-methods approach using survey data (n?=?32), focus group data (n?=?46) and interview data (n?=?5) from occupational therapists, physiotherapists, community nurses and other health professionals working in hospitals, community services and private practice, located in the UK, Canada and Australia. Data were integrated using a matrix of quantitative and qualitative data that aligned the findings with established theoretical constructs of clinical utility.

Results: Findings across the data sources provide evidence of the clinical utility of the HOME FAST, and these findings align with theoretical constructs about how a tool such as the HOME FAST is adopted in practice.

Conclusion: The HOME FAST can be used in a variety of international setting in developed countries and by different health professionals as a screening tool. A manual would assist in the consistent application of the HOME FAST.

• Implications for Rehabilitation

• Hazards in the home environment are a key contributor to falls risk for older people

• The Home Falls and Accidents Screening Tool (HOME FAST) was designed for any health professional to screen older people at increased risk of falling because of home hazards.

• Even with psychometric evidence of the reliability and validity of a tool, it is critical that the tool can be easily adopted by clinicians (clinical utility), otherwise its applicability to practice and research is limited.

• An international mixed-method study has provided evidence of the clinical utility of the HOME FAST.

     

Revised Measure of Environmental Qualities of Activity Settings (MEQAS) for youth leisure and life skills activity settings

Purpose: The aim was to create an expanded version of a published observer-rated Measure of Environmental Qualities of Activity Settings (MEQAS-32). Method: Testing was conducted using a diverse sample of activity settings. Raters completed the original MEQAS questionnaire (MEQAS-66) for 76 youth leisure and life skills activity settings. Scales for the revised measure (MEQAS-48) were determined using a two-step approach: (a) developing a theoretically-based model based on item-to-item linkages, and (b) confirmatory factor analysis. Results: The analysis revealed a good fitting 9-factor model (CFI=?0.965, RMSEA=?0.049). Five of the six MEQAS-32 scales remained and were validated in an independent dataset. Four additional scales were identified in the MEQAS-48: Comfortable Place-related Qualities, Opportunities for Privacy/Relaxation, Opportunities to Interact with Peers, and Opportunities for Cooperative Group Activity. Opportunities for Choice and Opportunities for Personal Growth were significantly correlated with corresponding youth experiences. Construct validity was demonstrated through predictions for various types of activities. Conclusions: The MEQAS-48 more completely reflects the original conceptualization of the measure’s content than does the MEQAS-32. Findings suggest the increased utility of the measure due to broader coverage of environmental qualities. The MEQAS-48 can be used to assess environmental qualities for research, program design, and clinical practice.

• Implications for Rehabilitation

• The MEQAS is the first observer-completed measure of environmental qualities of activity settings.

• Compared to the MEQAS-32, the MEQAS-48 captures a broader range of important environmental qualities, including comfortable place-related qualities, and opportunities for privacy/relaxation, peer interaction, and cooperative group activity.

• The MEQAS-48 has clinical utility for use in program design and development, and research utility for understanding environmental qualities.

     

The validity,reliability, responsiveness and minimal clinically important difference of the de Morton mobility index in rehabilitation

Purpose: Determine the clinimetric properties of the de Morton Mobility Index (DEMMI) in an adult inpatient rehabilitation population.

Method: Prospective open cohort case series. DEMMI and functional independence measure assessed within three days of admission and discharge and seven-point Likert assessment of global change in mobility during inpatient rehabilitation reported by the patient, physical therapist and rehabilitation physician.

Results: A total of 366 patients had assessments of the DEMMI completed on both admission into and discharge from rehabilitation. There was no floor or ceiling effect observed in the sample, but there was a mild (19%) ceiling effect at discharge in patients with a stroke. Evidence was obtained for the convergent, discriminant and known group validity of the DEMMI. The minimal clinically important difference was obtained using two methods. The DEMMI was highly responsive to change (Cohen’s d?=?1.3).

Conclusions: The findings give support to the use of the DEMMI in rehabilitation patients and on the basis of previous studies, support the use of the DEMMI across the continuum of hospital settings.

• Implications for rehabilitation

• This study provides evidence that the clinimetric properties of the de Morton Mobility Index (DEMMI) are sound.

• The findings give support to the use of the DEMMI in rehabilitation patients.

• Our findings, in conjunction with previous research, support the use of the DEMMI across the continuum of hospital settings.

     

Cross-cultural validation and psychometric evaluation of the Participation and Environment Measure for Children and Youth in Korea

Purpose: To develop the Korean version of the Participation and Environment Measure for Children and Youth (KPEM-CY) and examine its psychometric properties.

Method: The PEM-CY was cross-culturally translated into Korean using a specific guideline: pre-review of participation items, forward/backward translation, expert committee review, pre-test of the KPEM-CY and final review. To establish internal consistency, test–retest reliability and construct validity of the KPEM-CY, 80 parents of children with disabilities aged 5–13 years were recruited in South Korea.

Results: Across the home, school and community settings, 76% of participation items and 29% of environment items were revised to improve their fit with Korean culture. Internal consistency was moderate to excellent (0.67–0.92) for different summary scores. Test–retest reliability was excellent (>0.75) in the summary scores of participation frequency and extent of involvement across the three settings and moderate to excellent (0.53–0.95) in all summary scores at home. Child’s age, type of school and annual income were the factors that significantly influenced specific dimensions of participation and environment across all settings.

Conclusions: Results indicated that the KPEM-CY is equivalent to the original PEM-CY and has initial evidence of reliability and validity for use with Korean children with disabilities.

• Implications for rehabilitation

• Because ‘participation’ is a key outcome of the rehabilitation, measuring comprehensive participation of children with disabilities is necessary.

• The PEM-CY is a parent-report survey measure to assess comprehensive participation of children and youth and environment, which affect their participation, at home, school and in the community.

• A cross-cultural adaptation process is mandatory to adapt the measurement tool to a new culture or country.

• The Korean PEM-CY has both reliability and validity and can therefore generate useful clinical data for Korean children with disabilities.

     

Development of the participation and environment measure for children and youth: conceptual basis

Purpose: The purpose of this paper is to describe the conceptual foundation of a new parent-report measure of the participation and environment of children and youth: the Participation and Environment Measure ? Children and Youth version (PEM-CY). Methods: The ICF-CY provided an initial conceptual framework. Results from a qualitative study to obtain parent perspectives and in-depth review of the literature were used to identify relevant dimensions, items and rating scales for measurement. Results: Life situations, defined as sets of activity categories, were identified for three settings: home, school and community. Participation was operationalized as a multidimensional construct with three measurement dimensions: frequency, extent of involvement and desire for change. Parallel sets of items examining environmental factors that are perceived to help or facilitate participation were defined in relation to the typical activities of each setting. Conclusions: The PEM-CY provides a new measure of participation and environment that reflects the perspectives of parents of children and youth. The instrument will facilitate research and professional practice to understand and support the participation of children and youth with and without disabilities.

Implications for Rehabilitation

• As defined by the International Classification of Functioning, Disability, and Health (ICF), participation and environment are multidimensional constructs that have been challenging to measure.

• A new parent-report survey measure has been developed that is feasible for use in large-scale studies of children and youth with and without disabilities.

• The instrument examines participation and environment of children and youth aged 5 to 17 years across three major settings: home, school and community.

     

Measurement properties of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ): a study based on Classical Test Theory

Purpose: The construct validity, test–retest reliability, and measurement error of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) were examined. Additionally, the influence of administration-method on reliability and measurement error was investigated.

Method: 112 Dutch adult MS-patients from an academic- and a residential care-facility participated. Questionnaires were administered on paper, online or as interview, and patients performed several performance tests. Construct validity was assessed by testing pre-defined hypotheses. Reliability was assessed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurements (SEMs) and Smallest Detectable Changes (SDCs).

Results: For construct validity (N?=?105) 9 of 13 hypotheses were confirmed (69%). As expected, the AMSQ showed moderate to strong relationships with the instruments measuring similar constructs. The test–retest reliability coefficient was 0.96 (95% Confidence Interval 0.94–0.97); SEM was 6.3 (6.3% of scale range); SDC was 17.5 (on a sale from 0 to 100). Different administration-methods showed good reliability (ICC 0.88–0.94) and small standard errors (SEM 5.6–7.2).

Conclusion: The AMSQ shows satisfying results for validity and excellent reliability; allowing for proper use in research. Due to a large SDC value, caution is needed when using the AMSQ in individual patient care. Further research should determine whether the SDC is smaller than the minimal important change.

• Implications for Rehabilitation

• The Arm Function in Multiple Sclerosis Questionnaire (AMSQ) measures activity limitations due to hand and arm functioning in patients with Multiple Sclerosis (MS).

• Results of this study confirm adequate validity and reliability of the AMSQ in patient with MS.

• The equivalence of scores from online, paper or interview administration is supported.

• A change score of ≥18 points on the scale of the AMSQ (on a scale 0–100) needs to occur to be certain a change beyond measurement error has occurred in an individual patient.