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A comparison of participation instruments based on the International Classification of Functioning, Disability and Health Noonan, Vanessa Karine


Purpose and Objectives: The purpose of this study was to compare participation instruments based on the International Classification of Functioning, Disability and Health (ICF). It was hypothesized that information from these instruments would not be equivalent due to differences in how the concept of participation was operationalized. Methods: Eleven participation instruments were identified in the literature. Content validity was assessed by mapping the content in 8 of 11 instruments to the ICF classification. Individuals treated for spinal conditions at an acute hospital were followed-up and 545 took part in the empirical study. Subjects completed five participation instruments [Impact on Participation and Autonomy (IPA), Keele Assessment of Participation (KAP), Participation Measure-Post Acute Care (PM-PAC), Participation Objective Participation Subjective (POPS), World Health Organization Disability Assessment Schedule II (WHODAS II)]. A sub-sample (n=139) was used to assess test-retest reliability. Measurement properties, including score distribution, internal consistency, test-retest reliability, dimensionality, convergent/discriminant validity and known-group validity were assessed. Results: The eight participation instruments adequately covered the concept of participation but two instruments (Participation Scale, WHODAS II) contained irrelevant content. In the empirical study all instruments demonstrated considerable ceiling effects, except for the POPS. Internal consistency of the domains was ≥0.70. The IPA and WHODAS II had the highest values for test-retest reliability, with intraclass correlation coefficients ≥0.70. The minimal detectable change, as a percentage of the scale score range was on average between 20% and 30%. A confirmatory factor analysis of the IPA, PM-PAC and WHODAS II demonstrated adequate model fit. Correlations were generally higher among similar domains of the WHODAS II, IPA, KAP and PM-PAC and as expected the lowest correlations were observed with the objective domains of the POPS. All instruments demonstrated known-group validity. Conclusions: More direct comparisons of these instruments are needed to advance our understanding of this concept and assist users. The IPA, PM-PAC and WHODAS II have similar measurement properties. The KAP was designed for population-based studies and the POPS includes objective and subjective information, which may explain some of the differences observed. To date, there is no gold standard and future studies should continue testing these instruments.

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