Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 11, Supplement , Pages S22-S35, November 2009

Difficult to Measure Constructs: Conceptual and Methodological Issues Concerning Participation and Environmental Factors

Presented to the Annual Meeting of the American Congress of Rehabilitation Medicine, Washington, DC, October 3–7, 2007; and as the Norington Lecture to the Annual Meeting of the Autralasian Faculty of Rehabilitation Medicine, Queenstown, New Zealand, July 24, 2009.

  • Gale Whiteneck, PhD

      Affiliations

    • Craig Hospital, Englewood, CO
    • Corresponding Author InformationCorrespondence to Gale Whiteneck, PhD, Craig Hospital, Dept of Research, 3425 S Clarkson St, Englewood, CO 80113
  • ,
  • Marcel P. Dijkers, PhD

      Affiliations

    • Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY

Abstract 

Whiteneck G, Dijkers MP. Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors.

For rehabilitation and disability research, participation and environment are 2 crucial constructs that have been placed center stage by the International Classification of Functioning, Disability and Health (ICF). However, neither construct is adequately conceptualized by the ICF, and both are difficult to measure. This article addresses conceptual and methodologic issues related to these ICF constructs, and recommends an improved distinction between activities and participation, as well as elaboration of environment. A division of the combined ICF categories for activity and participation into 2 separate taxonomies is proposed to guide future research. The issue of measuring participation from objective and subjective perspectives is examined, and maintaining these distinct conceptual domains in the measurement of participation is recommended. The methodological issues contributing to the difficulty of measuring participation are discussed, including potential dimensionality, alternative metrics, and the appropriateness of various measurement models. For environment, the need for theory to focus research on those aspects of the environment that interact with individuals' impairments and functional limitations in affecting activities and participation is discussed, along with potential measurement models for those aspects. The limitations resulting from reliance on research participants as reporters on their own environment are set forth. Addressing these conceptual and methodological issues is required before the measurement of participation and environmental factors can advance and these important constructs can be used more effectively in rehabilitation and disability observational research and trials.

Key Words: Environment, Reproducibility of results, Rehabilitation, Social environment

List of Abbreviations: ADLs, activities of daily living, CHART, Craig Hospital Assessment and Reporting Technique, CHEC, Community Health Environment Checklist, CHIEF, Craig Inventory of Environmental Factors, ICC, intraclass correlation coefficient, ICF, International Classification of Functioning, Disability and Health, ICIDH, International Classification of Impairments, Disabilities, and Handicaps, IOM, Institute of Medicine, IQ, intelligence quotient, IRT, item response theory, POPS, Participation Objective, Participation Subjective, QOL, quality of life, WHO, World Health Organization

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 Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitation Services, U.S. Department of Education, to Craig Hospital (grant nos. H133N060005 and H133A070022), and the Mount Sinai School of Medicine (grant nos. H133B040033 and H133N060027).

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

 Reprints are not be available from the author.

PII: S0003-9993(09)00610-8

doi:10.1016/j.apmr.2009.06.009

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 11, Supplement , Pages S22-S35, November 2009