Validity of the Utrecht Scale for Evaluation of Rehabilitation-Participation

Purpose: There is still a need for a generic participation instrument that measures both objective and subjective participation in adults living in the community and that is feasible for use in rehabilitation practice. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was developed to satisfy this need, comprising 31 items in three scales: Frequency, Restrictions and Satisfaction. The aim of this study was to examine the validity of this measure. Methods: Cross-sectional study involving former rehabilitation outpatients from five rehabilitation facilities in the Netherlands (n?=?395). The Frenchay Activities Index (FAI), the participation subtotal score of the ICF Measure of Participation and Activities Screener (IMPACT-SP) and the Participation Scale were included as reference measures. Results: Internal consistency of the USER-Participation scales was satisfactory (α 0.70–0.91). Spearman correlations between these scales were between 0.36 and 0.52. Concurrent validity was shown by strong correlations between the Frequency scale and the FAI (0.59), the Restrictions scale and the IMPACT-SP (0.75) and the Satisfaction scale and the Participation Scale (?0.73). Discriminant validity was shown by significant differences in USER-Participation scores between participants with different levels of independence and between participants with different health conditions. Conclusion: The USER-Participation appears to be a valid measure to rate objective and subjective participation in persons with physical disabilities.

Implications for Rehabilitation

• The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) is a new brief generic instrument to rate objective and subjective participation.

• The USER-Participation comprises 31 items in three scales: Frequency, Restrictions and Satisfaction.

• The USER-Participation appears to be a valid measure to rate objective and subjective participation in persons with physical 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.

     

Utility of the Community Integration Questionnaire in a sample of adults with neurological and neuropsychiatric disorders receiving prevocational training

Purpose: To investigate utility of the Community Integration Questionnaire (CIQ) in a mixed sample of adults with neurological and neuropsychiatric disorders. Method: Cross-sectional, interview-based study. Participants were community-dwelling adults with disabilities resulting from neurological and neuropsychiatric disorders (N?=?54), who participated in a pre-vocational readiness and social skills training program. Psychometric properties of the Community Integration Questionnaire (CIQ) were assessed and validated against Mayo-Portland Adaptability Inventory (MPAI) and The Problem Checklist from the New York University Head Injury Family Interview (PCL). Results: Based on the revised scoring procedures, psychometric properties of the CIQ Home Competency scale were excellent, followed by the Total score and Social Integration scale. Productive Activity scale had low content validity and a weak association with the total score. Convergent and discriminant validity of the CIQ were demonstrated by correlation patterns with MPAI scales in the expected direction. Significant relationship was found with PCL Physical/Dependency scale. Significant associations were found with sex, living status, and record of subsequent employment. Conclusions: The results provide support for the use of the CIQ as a measure of participation in individuals with neurological and neuropsychiatric diagnoses and resulting disabilities.

• Implications for Rehabilitation

• An important goal of rehabilitation and training programs for individuals with dysfunction of the central nervous system is to promote their participation in social, vocational, and domestic activities.

• The Community Integration Questionnaire (CIQ) is a brief and efficient instrument for measuring these participation domains.

• This study demonstrated good psychometric properties and high utility of the CIQ in a sample of 54 individuals participating in a prevocational training program.

     

An exploration of the relationship between two measures of children’s participation

Purpose: To investigate the relationship between the Children Participation Questionnaire and the Children’s Assessment of Participation with Hands.

Materials and methods: Two researchers classified the item contents independently using the International Classification of Functioning, Disability and Health-Child and Youth version as a guide. Parents of 51 children with intellectual and developmental disabilities completed both measures within one month.

Results: The linking results indicated that the two participation measures covered a broad range of life domains, which corresponded well to the conceptually matched Activities and Participation categories/chapters of the International Classification of Functioning, Disability and Health-Child and Youth version. A significant moderate link (Spearman’s ρ coefficient?=?0.68, p?ρ?=?0.47–0.71, p?Conclusion: This study provides evidence for the content and construct validity of the two children’s participation measures. The findings also offer important insights about the similarities and differences between the two measures. This knowledge will assist clinicians in selecting outcome measures.

• Implications for rehabilitation

• The Children Participation Questionnaire and Children’s Assessment of Participation with Hands demonstrate good content and convergent validity.

• The two measures capture distinctive aspects and/or degrees of children’s participation.

• Clinicians and researchers need to be aware of the similarities and differences between the two measures before selecting outcome measure.

     

Associations between neighbourhood characteristics and community mobility in older adults with chronic health conditions

Purpose: To explore associations between perceptions of neighbourhood built and social characteristics and satisfaction with community mobility in older adults with chronic health conditions. Method: Two hundred and thirty-seven community-dwelling adults aged 60 years or more with one or more of arthritis (osteoarthritis or rheumatoid arthritis), chronic obstructive pulmonary disease, diabetes or heart disease completed a cross-sectional, mailed survey. The survey addressed community mobility and 11 neighbourhood characteristics: amenities (three types), problems (six), social cohesion and safety. Analysis involved logistic regression modeling for each neighbourhood characteristic. Results: Satisfaction with community mobility was associated with perception of no traffic problems (OR?=?3.0, 95% CI?=?1.4–6.2, p?≤?0.05) and neighbourhood safety (OR?=?3.4, 95% CI?=?1.2–9.8, p?≤?0.05), adjusted for age, ability to walk several blocks and depressive symptoms.

Conclusion: Satisfaction with community mobility is associated with neighbourhood safety and no traffic problems among older adults with chronic conditions. While further research is needed to explore these neighbourhood characteristics in more detail and to examine causation, addressing these neighbourhood characteristics in health services or community initiatives may help promote community mobility in this population.

• Implications for Rehabilitation

• Community mobility, or the ability to move about one’s community, is a key aspect of participation that enables other aspects of community participation.

• Good community mobility is associated with perception of no traffic problems and neighbourhood safety among older adults.

• Considering and addressing a broad range of environmental influences has the potential to improve community mobility in older adults, beyond traditional approaches.

• Health professionals can work with clients to develop strategies to avoid traffic and safety problems and can work with communities to develop safe spaces within neighbourhoods, to improve community mobility in older adults.

     

Participation in life situations by persons with systemic sclerosis

Abstract

Purpose: To measure the frequency of participation in life situations. Methods: A sample of 83 persons with systemic sclerosis (SSc) completed questionnaires regarding the presence and severity of disease symptoms, disability [the Health Assessment Questionnaire (HAQ)], depression [the Center for Epidemiologic Studies Depression Scale (CES-D)], and participation [the Adelaide Activities Profile (AAP)]. On the AAP, individuals rate the frequency of participation in four domains: domestic chores, household maintenance, service to others and social activities. Results: Participants were predominantly female, married, educated, white, and had diffuse SSc. Mean age was 53.7 years and mean disease duration was 9.9 years. On the AAP, participation was significantly more frequent for domestic chores than for household maintenance, service to others, and social activities. More fatigue (p?<?0.05), disability (p?<?0.001), and fatigue (p?<?0.05) resulted in lower total AAP scores. More fatigue, pain, severe gastrointestinal symptoms, and depression related to lower household maintenance scores, while the presence of ulcers and more disability and depression were associated with lower domestic chores scores. Conclusions: Participation in life situations in persons with SSc is related to higher disability, depression, and severity of disease symptoms. Interventions to address the disability, depression and symptoms may increase participation.

• Implications for Rehabilitation

• People with systemic sclerosis (SSc) have restrictions in participation including domestic chores, household maintenance, service to others compared to a normative sample.

• For practitioners, these findings show the need to assess participation in addition to impairments and activity limitations in persons with SSc.

• The Adelaide Activities Profile could be used to measure participation.

• Our findings also suggest that interventions addressing fatigue, disability and depression, may improve participation.

     

Development and structural validation of a shortened version of the Participation Scale

Purpose: To validate a shortened version of the Participation Scale (P-scale) that will be quicker to use and to describe the factor structure found in the P-scale data in various study samples. Methods: A large multi-country and multi-cultural database was compiled consisting of 5125 respondents. Item analysis, explanatory factor analysis and confirmatory factor analysis were applied to identify items for deletion and investigate the factor structure of the P-scale. Results: The multi-country database included 11 databases from six different countries. Respondents were affected by a range of health conditions, including leprosy, HIV/AIDS, dermatological conditions and various disabilities. Of the respondents included 57% were male. The P-scale Short (PSS) contains 13 items. A two-factor structure, with factors named “work-related participation” (three items) and “general participation” (10 items), showed the best model fit (Comparative Fit Index = 0.983, Tucker Lewis Index = 0.979, Rooted Mean Square Error of Approximation = 0.061). The Cronbach’s alphas were very good for both the whole scale and the subscales, 0.91, 0.83 and 0.90, respectively. Correlation between the two factors was high (r = 0.75) indicating that interpreting the P-scale as measuring an overall factor “participation” is still valid. A very high correlation (r = 0.99) was found between the full P-scale and the PSS. Conclusions:The findings suggest good validity of the P-scale across a range of languages and cultures. However, field testing needs to confirm the validity of the PSS to measure the level of social participation restrictions across cultures and health conditions.

Implications for Rehabilitation

• The Participation Scale can be used to measure restrictions in social participation.

• The Participation Scale showed consistent structural validity across many different cultural settings and target groups.

• A shorter version of the scale was developed, namely the Participation Scale Short.

• The Participation Scale Short needs field testing before application to test its reliability, validity, reduction in administration time and usefulness.

     

The cross-cultural equivalence of participation instruments: a systematic review

Purpose: Concepts such as health-related quality of life, disability and participation may differ across cultures. Consequently, when assessing such a concept using a measure developed elsewhere, it is important to test its cultural equivalence. Previous research suggested a lack of cultural equivalence testing in several areas of measurement. This paper reviews the process of cross-cultural equivalence testing of instruments to measure participation in society. Methods: An existing cultural equivalence framework was adapted and used to assess participation instruments on five categories of equivalence: conceptual, item, semantic, measurement and operational equivalence. For each category, several aspects were rated, resulting in an overall category rating of ‘minimal/none’, ‘partial’ or ‘extensive’. The best possible overall study rating was five ‘extensive’ ratings. Articles were included if the instruments focussed explicitly on measuring ‘participation’ and were theoretically grounded in the ICIDH(-2) or ICF. Cross-validation articles were only included if it concerned an adaptation of an instrument developed in a high or middle-income country to a low-income country or vice versa. Results: Eight cross-cultural validation studies were included in which five participation instruments were tested (Impact on Participation and Autonomy, London Handicap Scale, Perceived Impact and Problem Profile, Craig Handicap Assessment Reporting Technique, Participation Scale). Of these eight studies, only three received at least two ‘extensive’ ratings for the different categories of equivalence. The majority of the cultural equivalence ratings given were ‘partial’ and ‘minimal/none’. The majority of the ‘none/minimal’ ratings were given for item and measurement equivalence. Conclusion: The cross-cultural equivalence testing of the participation instruments included leaves much to be desired. A detailed checklist is proposed for designing a cross-validation study. Once a study has been conducted, the checklist can be used to ensure comprehensive reporting of the validation (equivalence) testing process and its results.

Implications for Rehabilitation

• Participation instruments are often used in a different cultural setting than initial developed for.

• The conceptualization of participation may vary across cultures. Therefore, cultural equivalence – the extent to which an instrument is equally suitable for use in two or more cultures – is an important concept to address.

• This review showed that the process of cultural equivalence testing of the included participation instruments was often addressed insufficiently.

• Clinicians should be aware that application of participations instruments in a different culture than initially developed for needs prior testing of cultural validity in the next context.

     

Introducing the therapy outcome measure for AAC services in the context of a review of other measures

Abstract

Purpose: This article discusses the importance of outcome measures in improving Augmentative and Alternative Communication (AAC) services, reviews existing methods and introduces a new approach. Method: Three methods were used in this study. 1. A literature review identifying outcome measures used in AAC research. 2. A questionnaire to AAC services in the UK which aimed to identify the objectives of their services and the outcome measures commonly used. 3. A working group of AAC experts provided additional information and interpretation. Central properties and conceptual framework were considered. Results: The literature review and questionnaire identified 23 outcome measures none of which cover the conceptual frameworks associated with all of the overall objectives of AAC provision. The review has informed the further development of a particular outcome measure the AAC Therapy Outcome Measure (AAC TOM) ensuring that basic principles of the International Classification of Functioning (ICF-WHO) are retained and the measure can be used in benchmarking. Conclusion: An outcome measure needs to reflect change associated with service delivery. AAC services endeavour to impact on all of the domains of the ICF. A new measure is required in order to reflect the nature of these services. This article introduces an outcome measure which is in the process of being trialled by some services in the UK.

• Implications for Rehabilitation

• AAC services aimed to have an impact on impairment, communication, social participation and well-being of the client.

• Many assessments and outcome measures do not systematically gather information of the overall impact of the service.

• Measuring outcomes of all clients is important in improving the quality of service provision.

• Comparing services will assist in identifying areas of concern as well as best practice.

     

An examination of social support influences on participation for older adults with chronic health conditions

Abstract

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs.

• Implications for Rehabilitation

• Varying types of social support can improve participation in older adults with chronic health conditions.

• Tangible support and positive social interaction support are the strongest predictors of participation.

• Creating networks for companionship may be equally as important as providing support for daily living needs.

     

Enhanced life-role participation in response to comprehensive gait training in chronic stroke survivors*

Purpose: Intensive gait training can produce improvements in gait and function (> 6 months after stroke); findings are mixed for enhanced life role participation. Therefore, it is unclear if improved gait and function translate into life role participation gain. Our objective was to evaluate whether intensive gait therapy can produce significant improvements in life role participation for chronic stroke survivors. Methods: In conjunction with a clinical gait training trial, we conducted a secondary analysis for a 44-member cohort with stroke (>6 months). Gait training interventions included exercise, body weight supported treadmill training (BWSTT), over-ground gait training, and functional electrical stimulation (FES) for 1.5 h/day, 4 days/wk for 12 weeks. Study measures included Tinetti Gait (TG) (gait impairment), Functional Independence Measure (FIM, function), Stroke Impact Scale Subscale of Life Role Participation (SISpart), and Craig Handicap Assessment & Reporting Technique (CHART, life-role participation). Analyses included Wilcoxon Signed Rank Test and PLUM Regression Model. Results: Gait interventions produced significant improvement in CHART (p = 0.020), SISpart (p = 0.011), FIM (p < 0.0001), and Tinetti Gait (p < 0.0001). Age, gender and time since stroke did not predict response to treatment. Conclusions: Intensive, multi-modal, long-duration gait therapy resulted in significant gain in life-role participation, according to a relatively comprehensive, homogeneous measure.

Implications for Rehabilitation

• It is important to measure life role participation in rehabilitation intervention studies, and using a homogenous measure of life role participation provides clear results.

• Intensive gait training produced a significant improvement in life role participation in the chronic phase after stroke.

• Functional electrical stimulation (FES) had no significant additive effect on life role participation during the treatment phase, but FES did have an additive effect during the follow-up period, in enhancing life role participation beyond that obtained using an identical comprehensive gait training intervention without FES.

     

Child engagement in daily life: a measure of participation for young children with cerebral palsy

Abstract

Purpose: The objectives of this study were to determine the: (1) internal consistency and test–retest reliability of the Child Engagement in Daily Life measure; (2) construct validity of the measure (known groups methods), that is, the ability of the measure to discriminate participation in family and recreational activities and self-care among young children of varying age and motor ability and between children with and without cerebral palsy, and (3) stability and hierarchical ordering of the items for young children with CP to devise an interval-level scoring system. Methods: 429 children with CP and their parents and 110 parents of children without CP participated in this methodological study. Parents completed the Child Engagement in Daily Life measure and therapists assessed the children's gross motor function. Rasch analysis was used to create an interval-level measure. Results: Children's frequency in and enjoyment of participation in family and recreational activities and self-care varied by age and gross motor ability. Internal consistency of the domains of the measure was high, Cronbach alpha values ranging from 0.86 to 0.91; test–retest for participation in family and recreational activities was acceptable, ICC?=?0.70, and in self-care was high, ICC?=?0.96. The items in the measure had a good fit and a logical hierarchical ordering. Conclusion: Study results support the validity and reliability of the Child Engagement in Daily Life measure as an assessment of participation in family and recreational activities and self-care for young children with CP.

• Implications for Rehabilitation

• Participation in family and recreational activities and self-care for young children with cerebral palsy can be reliably and validly assessed using the Child Engagement in Daily Life measure.

• Service providers are encouraged to support young children's participation in family and recreational activities and self-care.

     

The effect of a running intervention on running ability and participation in children with cerebral palsy: a randomized controlled trial

Abstract

Purpose: The purpose of this study is to evaluate effects of a running intervention on running ability and participation in children with cerebral palsy.

Materials and method: Children with cerebral palsy (9–18 years) with Gross Motor Function Classification System levels I-III were randomly assigned to a 12-week running intervention or usual care. Primary outcomes included improvement in running ability (assessed by Goal Attainment Scaling, high level mobility (assessed by the High-Level Mobility Assessment Tool) and participation (assessed by the Participation and Environment Measure for Children and Youth). Secondary outcomes were aerobic and anaerobic fitness and agility. Blinded assessments took place at baseline and 12?weeks. Regression analysis adjusting for baseline differences was used to determine between group differences.

Results: Forty-two participants (mean age 12.5?years, SD 2.8?years; 15 female) completed the study. Statistically significant group differences at 12-weeks were found for improvements in running ability (86% treatment group versus 0% control group achieved or exceeded their running goals, p?<?0.001), and participation in the school environment (Participation and Environment Measure mean difference 1.18: 95%CI 1.00–1.39, p?=?0.045).

Conclusion: A 12-week individualized running training skills intervention results in achievement of running ability goals and participation in the school environment in children with cerebral palsy.

• Implications for Rehabilitation

• Children with cerebral palsy who can walk unaided demonstrate impairments in higher level mobility such as running.

• Running is a motor skill that can be trained in children with cerebral palsy.

• Individually tailored running skills intervention, delivered in a group context can improve goal-identified running ability and translate into a higher frequency of participation in school activities.

     

Long-term functional outcome of patients with longitudinal radial deficiency: cross-sectional evaluation of function,activity and participation

Purpose: To evaluate all functional aspects of patients with longitudinal radial dysplasia and to clarify the relationship between body functions on the one hand and limitations in activity and participation on the other hand. Methods: Thirty-one arms of seventeen adult patients with longitudinal radial dysplasia were analysed. Body function was assessed by measuring grip and pinch strength and active range of motion (ROM) of the hand. Activities were measured using the “Sequential Occupational Dexterity Assessment “, to measure perceived restrictions in participation the “Impact on Participation and Autonomy questionnaire” was used. Relationships between severity of dysplasia, body function, participation and activity were determined. Results: Patients with a severe type scored significantly lower in body function scores than patients with a mild form. Patients with limited active finger joint motion performed worse on activities. We found no significant differences in activity and participation between mild or severe types and found no correlation in participation scores. Conclusion: Although considerable restrictions in joint mobility and strength were revealed, little or no limitations on the activity and participation level were found. Limitations in body functions hardly influenced capacity on activity level and did not influence participation in societal roles.

Implications for Rehabilitation

• People with LRD learn to accomplish many of the everyday tasks without great difficulty and do not report a low quality of participation in major life activities.

• Professionals working in rehabilitation medicine should focus on activity and participation rather than on body structure or functions. Therapy focused solely on increasing joint motion or strength does not lead to further improvement.

• For parents it will be reassuring to know that children with severe radial deficiencies can satisfactory fulfill social roles in later life.

     

Community-based study of health-related quality of life in spinal cord injury,muscular dystrophy,multiple sclerosis,and cerebral palsy

Purpose: To assess health-related quality of life (HRQOL) in adults with spinal cord injury (SCI), muscular dystrophy (MD), multiple sclerosis (MS), and cerebral palsy (CP). Methods: This is a multicenter, community-based, cross-sectional study of adults diagnosed with CP (94), MD (99), MS (98), SCI (99), and healthy adults (105). The WHOQOL-BREF and WHOQOL-DIS questionnaire were used. Results: Significant differences in physical functioning between adults with CP and SCI and adults with MS (p?=?0.003 and p < 0.001, respectively), as well as between adults with SCI and MD (p?=?0.001) were found. Univariate tests revealed significant psychological functioning differences between adults with SCI and MD (p?=?0.02) and SCI and MS (p?=?0.001). There was a significant difference in physical functioning between controls and adults with SCI (p?=?0.049) and a significant difference in psychological functioning between controls and adults with MS (p?=?0.039). No statistically significant differences were found between the groups in social and environmental domains. Conclusions: Physical and physiological functioning were affected to various degrees in the studied neurodisabilities, while all groups reported similar levels of functioning and well-being in social and environmental domains.

Implications for Rehabilitation

• Health-related quality of life (HRQOL) in adults with neurodisabilities living in a community differs from HRQOL in these individuals sampled in clinical and/or rehabilitation settings.

• Psychosocial aspects of HRQOL relevant to physical disability were similarly affected across those groups.

• Physical and physiological domains in HRQOL were affected to various degrees among adults with neurodisabilities living in a community.

• Levels of functioning and well-being in social and environment domains of HRQOL are similar among adults with neurodisabilities living in a community.

• Community-based study of health-related quality of life in spinal cord injury, muscular dystrophy, multiple sclerosis, and cerebral palsy.

     

Adapted Tango improves aspects of participation in older adults versus individuals with Parkinson’s disease

Purpose: Our aims were to determine (1) the impact of aging versus combined aging and disease on participation and (2) participation before and after a 12-week, Adapted Tango dance intervention (AT) in older adults with and without Parkinson’s disease (PD).

Methods: Participant responses to open and closed-ended questions on the Impact on Participation and Autonomy questionnaire (IPA) were recorded before, one-week-after, and three-months after 20 lessons of AT. Twenty-five older individuals with PD and 63 older adults without PD were initially enrolled and assessed, and 44 older adults and 22 individuals with PD finished the program with post-testing.

Results: Thematic analysis revealed major themes of difficulty with mobility, transportation and financial management, feelings of being forced to limit activities, and interest in work or volunteering for both groups at baseline and post-test. At post-test, additional emphasis on resilience in the face of challenges was noted. No differences were noted between groups on the IPA subscales at baseline. Quantitative analysis with a 2 (group)?×?3 (time) MANOVA revealed a main effect of time (p?p?p?=?0.073), and Family Role (p?=?0.057).

Conclusions: Adapted Tango improved aspects of participation for these cohorts of older adults with and without PD.

• Implications for Rehabilitation

• Both Parkinson’s disease and neurotypical aging can negatively impact participation in life’s activities in older adults.

• Adapted Tango is an alternative therapy that has improved quality of life and mobility in people with PD and older adults.

• Quantitative data show that Adapted Tango may improve some aspects of participation for older adults with and without PD.

• Open-ended responses reveal aging and combined aging and disease-related issues have a lasting impact upon participation.

     

The construct validity of the Dutch version of the activity card sort

Purpose: Establishing construct validity of the ACS-NL in individuals with Parkinson’s disease (PD).

Method: Discriminative validity was established in 191 community-dwelling individuals with PD using an extreme groups design (Hoehn and Yahr stages 1 and 3). Convergent validity was determined by relating the performance scores of the ACS-NL to the scores of the Canadian Occupational Performance Measure (COPM) and the Parkinson’s Disease Questionnaire (PDQ-39) scores, and relating ACS-NL satisfaction scores to the COPM scores and to the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P).

Results: The ACS-NL discriminated between individuals with PD with H&;Y stages 1 and 3 (U?=?524.5, Z?=??5.453). ACS-NL performance scores correlated weakly with COPM scores (r?=?(0).19) and moderately with PDQ-39 scores (r?=?0.44–0.55). The ACS-NL satisfaction scores correlated weakly with COPM scores (r?= 0.23), and moderately with USER-P scores (r?≥?0.40).

Conclusions: This study contributed to the validation of the ACS-NL. The assessment enhances the possibility of monitoring participation in activities in individuals with PD.

• Implications for Rehabilitation

• The ACS-NL appears to hold good potential for use in the assessment of participation in activities in individuals with PD.

• The ACS-NL has added value parallel to administration of other instruments measuring participation (COPM) and quality of life (PDQ-39).

• This study demonstrates the capacity of the ACS to measure a unique construct of participation and helps to improve the psychometric properties and administration of the ACS-NL in practice.

     

Validity and reliability of a novel measure of activity performance and participation

Purpose: To develop and evaluate an innovative clinician-rated measure, which produces global numerical ratings of activity performance and participation. Method: Repeated measures study with 48 community-dwelling participants investigating clinical sensibility, comprehensiveness, practicality, inter-rater reliability, responsiveness, sensitivity and concurrent validity with Barthel Index. Results: Important clinimetric characteristics including comprehensiveness and ease of use were rated >8/10 by clinicians. Inter-rater reliability was excellent on the summary scores (intraclass correlation of 0.95–0.98). There was good evidence that the new outcome measure distinguished between known high and low functional scoring groups, including both responsiveness to change and sensitivity at the same time point in numerous tests. Concurrent validity with the Barthel Index was fair to high (Spearman Rank Order Correlation 0.32–0.85, p?>?0.05). The new measure’s summary scores were nearly twice as responsive to change compared with the Barthel Index. Other more detailed data could also be generated by the new measure. Conclusions: The Activity Performance Measure is an innovative outcome instrument that showed good clinimetric qualities in this initial study. Some of the results were strong, given the sample size, and further trial and evaluation is appropriate.

• Implications for Rehabilitation

• The Activity Performance Measure is an innovative outcome measure covering activity performance and participation.

• In an initial evaluation, it showed good clinimetric qualities including responsiveness to change, sensitivity, practicality, clinical sensibility, item coverage, inter-rater reliability and concurrent validity with the Barthel Index.

• Further trial and evaluation is appropriate.