Preliminary Results for the PAR-PRO: A Measure of Home and Community Participation

doi:10.1016/j.apmr.2006.04.024

Archives of Physical Medicine and Rehabilitation

Volume 87, Issue 8, August 2006, Pages 1043-1051

https://doi.org/10.1016/j.apmr.2006.04.024 Get rights and content

Abstract

Ostir GV, Granger CV, Black T, Roberts P, Burgos L, Martinkewiz P, Ottenbacher KJ. Preliminary results for the PAR-PRO: a measure of home and community participation.

Objective

To develop a measure of home and community participation related to the World Health Organization’s International Classification of Functioning, Disability and Health.

Design

Cross-sectional analysis of survey data.

Setting

Nine medical inpatient rehabilitation facilities from 6 states.

Participants

A total of 594 patients of mixed impairment type admitted for inpatient rehabilitation in 2002. Mean age was 74.0 years and 61.4% were women.

Interventions

Not applicable.

Main Outcome Measures

Reliability and validity of the participation instrument.

Results

A 20-item instrument of home and community participation was developed (PAR-PRO). The instrument showed good internal consistency and good Rasch person and item fit statistics. Four subfactors were identified beyond the unidimensional construct of participation including domestic management, socialization, physical vigor, and generative activities. The PAR-PRO total participation score correlated inversely with age (r=−.31, P<.001) but did not differ by sex.

Conclusions

The 20-item PAR-PRO instrument of home and community participation displayed good psychometric characteristics. The instrument shows promise as a broad measure of home and community involvement for persons with disabilities. Further work is needed to support its application for people without disability.

Section snippets

Sample and Participants

In 2002, 20 health care facilities subscribing to the Uniform Data System for Medical Rehabilitation (UDSmr) expressed an interest in helping to develop a broad measure of home and community participation. Of these, 9 facilities participated in data collection. The 9 facilities were representative of the national inpatient rehabilitation facilities experience: operating bed sizes ranged from 12 to 60 (mean bed size, 30); 6 of 9 facilities were CARF-accredited; and 7 of 9 were accredited by the

Results

The final sample included 594 subjects from 9 facilities located in 6 states.

The mean age was 74.0 years and 61.4% were women. The ages ranged from 19 to 99 years and were distributed evenly across the 9 facilities. Data on impairment group code was available for 416 patients (70% of total sample), and was similar to the general rehabilitation population²⁴ including orthopedic (31.9%), stroke (25.5%), neurologic (10.3%), brain injury (6%), cardiac and pain (4.8%), arthritis (4.6%), and the

Discussion

The 20-item PAR-PRO instrument of home and community participation, using a 3-level scoring system, was found to have good internal consistency, evidence of an underlying unidimensional participation construct, and an adequate range of endorsed frequency. The PAR-PRO participation instrument was shown to have a modest but statistically significant negative relationship with age. Although the PAR-PRO participation instrument was designed to minimize any age bias, it was expected that older

Conclusions

Patient-centered measures, such as satisfaction and participation, are increasingly being required by accreditation agencies, consumers, and third-party payers, as quality indicators of best practices.2, 3 Medical rehabilitation has a history and tradition of focusing on person-based outcomes rather than narrow organ-based measures. Translating the person-based philosophy of medical rehabilitation to address current practice will require the development and testing of new instruments and

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To identify biopsychosocial factors associated with participation outcomes for adults with stroke and to investigate factors associated with participation at different time points poststroke.
Medline, CINAHL, AMED, PyschINFO, and Web of Science were systematically searched using keywords stroke, participation, and outcomes and their synonyms on May 15, 2017.
Observational studies reporting on biopsychosocial factors and participation outcomes for community-dwelling adults with stroke were selected. Studies were eligible for inclusion if participation outcomes were measured using indices that mapped to the participation domain of the International Classification of Functioning, Disability and Health (ICF). Intervention studies were excluded. A second reviewer checked all studies against eligibility criteria at each stage.
Data were extracted on any statistically determined association between biopsychosocial factors and participation outcomes.
The proportion of studies reporting significant associations with variables was classified according to the ICF. The exact binomial test was used to determine the probability that the proportion of studies reporting significant associations was due to chance alone. Qualitative descriptive summaries of each study allowed consideration of interactions between variables and changes in participation over time points.
Although depressive symptoms, cognitive functioning, and mobility were found to have the strongest associations with participation, we found that other frequently occurring factors (such as fatigue and environmental factors) were less extensively considered. The diversity of outcome measures encountered within the review highlight the need for a consensus on a core set of outcome measures to evaluate long-term participation in life situations poststroke.
Use of local public transport among people with cognitive impairments - A literature review
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Being able to move around in the community including using different modes of transport is a prerequisite for being able to participate in activities outside home. This can be particular challenging for people with cognitive impairments. Still, research regarding public transport for people with cognitive impairments is scarce. In this narrative review scientific literature focusing on people with cognitive impairments and their needs in public transport, was identified and summarised. All aspects in the travel chain perspective were of interest. Literature search engines Scirus, Elin and Cinahl were used during the search.
Thirty-four articles were included and analysed according to which part of the travel chain they covered in the used model. The results showed that the articles were unevenly allocated to the different parts of the model. Future studies based on real-world experiences are essential, and more user-centred approaches should be adopted. Moreover, there is a need for the development and evaluation of evidence-based rehabilitation. Finally, more research is needed to foster societal awareness of the problems and needs in the public transport of people with cognitive impairments taking the whole travel chain into consideration.
Conceptualizing the construct of participation in adults with disabilities
2014, Archives of Physical Medicine and Rehabilitation
Participation is a key indicator of health and well-being and a critical rehabilitation goal for individuals with disabilities. Despite the numerous participation measures that have been developed, there is still an absence of agreement on the definition, domains, and dimensions of this construct. The result is that instruments intending to measure the same construct may actually measure quite different aspects of daily life and therefore yield significantly different findings. A solid conceptual model is needed to provide consistent guidance for measurement selection and development. In this article we identify the relevant content areas of participation and propose a conceptual model for adults that is intended to apply across diagnoses, conditions, and settings. We classified participation into 3 main domains: work and education, household, and community. Subdomains are defined within each. The model was reviewed using a semistructured survey by 8 rehabilitation measurement experts. Their feedback regarding the relevance, clarity, and comprehensiveness of the model led to the creation of an alternative structure in which the 3 main domains were recategorized as productivity, social, and community. The proposed conceptual model provides a clear framework for practitioners and researchers to understand the concept of participation and to guide selection or development of measures.
Community participation measures for people with disabilities: A systematic review of content from an international classification of functioning, disability and health perspective
2013, Archives of Physical Medicine and Rehabilitation
To identify instruments that measure community participation in people with disabilities and to evaluate which domains, to what extent, and how precisely they address this construct. The review aims to provide information to guide the selection of community participation instruments and to identify limitations of existing measures.
A systematic search was performed in PubMed, CINAHL, and PsychINFO in February and March 2012. The latest systematic reviews and references of searched articles were also reviewed to check for measures that were not identified in the initial search.
Instruments were included if they (1) were a self-report questionnaire; (2) measured community participation, participation, or community integration; (3) measured actual participation (rather than subjective experience); (4) had available information on the instrument content and measurement properties; (5) were designed for adults; and (6) were applicable for all disabled populations.
Instruments were obtained from identified full-text articles, reference lists, or websites. Two researchers independently reviewed each selected instrument to determine which of their items measure community participation. These items were then classified using 9 community participation domains from the International Classification of Functioning, Disability and Health to reflect each instrument's domain coverage.
Seventeen instruments were identified as containing community participation items, 2 of which were 100% composed of community participation items. The rest of the instruments included 8.7% to 73.1% items measuring community participation. The domain coverage varied from 3 to 8 domains across the instruments.
None of the 17 instruments covered the full breadth of community participation domains, but each addressed community participation to some extent. New instruments that evaluate community participation more comprehensively will be needed in the future.
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Citation Excerpt :
The distance between different categories of the rating scale in classical test theory cannot be applied to mathematical arithmetic calculation directly. Hence, the ordinal scale without computation characteristics makes the classical test theory difficult to carry out using an arithmetic procedure (Ostir et al., 2006; Zhu and Cole, 1996). This phenomenon becomes one of the major challenges in the application of the traditional Likert ordinal scale theory.
Bicycles and transit systems are considered to be the pinnacle of green transportation. The combined use of the two could provide a competitive alternative for an integrated, green, and seamless service, yet relatively few studies have investigated the multimodal integration problems of the entire service chain from the perspective of users. Users’ perceived inconvenience during travel can be regarded as a latent construct that describes an unobservable and immeasurable characteristic. Nevertheless, the traditional Likert method in an ordinal scale causes a misleading statistical inference. The Rasch model eliminates such bias generated by an ordinal scale through a logistic linear transformation, and it compares person parameters with item parameters, which are then subjected to a logarithmic transformation along a logit scale to clearly identify which service items’ inconvenience cannot be easily overcome by certain users. This empirical study demonstrates that perceived inconveniences differ based on the users’ sex, riding frequency, trip purpose, and environmental awareness. The differential item functioning analysis that was adopted in this study can identify the critical factors leading to the differences in perceived inconvenience. Our empirical results suggest that a male cyclist who is a commuter with a high monthly riding frequency and who is environmentally conscious has a better ability than their counterpart to overcome perceived inconveniences during travel using a bicycle-transit service. To effectively mitigate users’ perceived inconvenience, the Rasch analytical results suggest that the improvement of the intra-transit system factors in the short term and the improvement of external environmental factors in the long term will be successful. The information herein proves useful for transportation planners and policy makers when considering the special travel needs of certain groups to create a user-friendly bicycle-transit travel environment that promotes its usage.
The development and validation of the vestibular activities and participation measure
2012, Archives of Physical Medicine and Rehabilitation
Alghwiri AA, Whitney SL, Baker CE, Sparto PJ, Marchetti GF, Rogers JC, Furman JM. The development and validation of the Vestibular Activities and Participation measure.
To develop and validate a new self-report outcome measure named the Vestibular Activities and Participation (VAP) for people with vestibular disorders to examine their activities and participation according to the International Classification of Functioning Disability and Health.
Delphi iterative survey for the development of the VAP and validation study.
Tertiary balance clinic.
A panel of worldwide experts (n=17) in vestibular dysfunction participated in the development of the VAP, and patients (N=58) with vestibular disorders were enrolled in the validation of the VAP.
Not applicable.
For the development of the VAP, an Internet-based survey of 55 activities and participation items was presented to the panel of experts and the percentage agreement per item was calculated. For the validation of the VAP, the VAP was completed twice to examine the test-retest reliability, the World Health Organization Disability Assessment Schedule II (WHODAS II) was used to examine the concurrent validity with the VAP, and the Dizziness Handicap Inventory (DHI) was used to examine the convergent validity of the VAP.
After 2 rounds of the Delphi technique, the VAP was developed. The VAP total score had excellent test-retest reliability (intraclass correlation coefficient=.95; confidence interval=.91–.97) and good to excellent agreement per item indicated by the unweighted kappa (.41–.80) and the weighted kappa (.58–.94). The minimum detectable change at 95% confidence level of the VAP score was .58. The VAP had strong correlation (ρ=.70; P<.05) with the WHODAS II and moderate to strong correlations (ρ=.54–.74) with the DHI subscale and total scores. After adjustment for age, we found sex and self-reported imbalance to be independent explanatory variables of the transformed VAP total score.
The VAP measure was developed to examine the disabling effect of vestibular disorders on people's activities and participation based on a standardized framework (the International Classification of Functioning Disability and Health). The VAP demonstrated excellent reliability and was validated with external instruments in people with vestibular disorders.

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Supported by the American Heart Association (grant no. 0270045N), the National Institute of Child Health and Human Development, National Institutes of Health (NIH) (grant no. K01 HD046682), and National Institute on Aging, NIH (grant no. K02AG019736).

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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Original articlePreliminary Results for the PAR-PRO: A Measure of Home and Community Participation

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Sample and Participants

Results

Discussion

Conclusions

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

International classification of impairments, disabilities and handicaps

International classification of functioning, disability and health

2003 medical rehabilitation standards manual

Community integration and barriers to integration for individuals with brain injury

The Community Integration Questionnaire

Am J Phys Med Rehabil

Quantifying handicapa new measure of long-term rehabilitation outcomes

Arch Phys Med Rehabil

Community integration following multidisciplinary rehabilitation for traumatic brain injury

Brain Inj

Community integration after burn injuries

J Burn Care Rehabil

Community Integration Questionnaire for patients with brain tumora comparative study

Am J Phys Med Rehabil

Functional assessment and outcome measures for the rehabilitation health professional

Original article
Preliminary Results for the PAR-PRO: A Measure of Home and Community Participation