Measuring activity limitations in climbing stairs: development of a hierarchical scale for patients with lower-extremity disorders living at home1


      Roorda LD, Roebroeck ME, van Tilburg T, Lankhorst GJ, Bouter LM, Measuring Mobility Study Group. Measuring activity limitations in climbing stairs: development of a hierarchical scale for patients with lower-extremity disorders living at home. Arch Phys Med Rehabil 2004;85:967–71.


      To develop a hierarchical scale that measures activity limitations in climbing stairs in patients with lower-extremity disorders living at home.


      Cross-sectional study with Mokken scale analysis of 15 dichotomous items.


      Outpatient clinics of secondary and tertiary care centers.


      Patients (N=759; mean age ± standard deviation, 59.8±15.0y; 48% men) living at home, with different lower-extremity disorders: stroke, poliomyelitis, osteoarthritis, amputation, complex regional pain syndrome type I, and diabetic foot problems.


      Not applicable.

      Main outcome measures

      (1) Fit of the monotone homogeneity model, indicating whether items can be used for measuring patients; (2) fit of the double monotonicity model, indicating invariant (hierarchical) item ordering; (3) intratest reliability, indicating repeatability of the sum score; and (4) differential item functioning, addressing the validity of comparisons between subgroups of patients.


      There was (1) good fit of the monotone homogeneity model (coefficient H=.50) for all items for all patients, and for subgroups defined by age, gender, and diagnosis; (2) good fit of the double monotonicity model (coefficient HT=.58); (3) good intratest reliability (coefficient ρ=.90); and (4) no differential item functioning with respect to age and gender, but differential item functioning for 4 items in amputees compared with nonamputees.


      A hierarchical scale, with excellent scaling characteristics, has been developed for measuring activity limitations in climbing stairs in patients with lower-extremity disorders who live at home. However, measurements should be interpreted with caution when comparisons are made between patients with and without amputation.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Van Iersel M.B
        • Olde Rikkert M.G
        • Mulley G.P
        Is stair negotiation measured appropriately in functional assessment scales?.
        Clin Rehabil. 2003; 17: 325-333
        • Mahoney F.I
        • Barthel D.W
        Functional evaluation.
        Md State Med J. 1965; 14: 61-65
        • Hunt S.M
        • McKenna S.P
        • McEwen J
        • Backett E.M
        • Williams J
        • Papp E
        A quantitative approach to perceived health status.
        J Epidemiol Community Health. 1980; 34: 281-286
        • Bergner M
        • Bobbitt R.A
        • Carter W.B
        • Gilson B.S
        The Sickness Impact Profile.
        Med Care. 1981; 19: 787-805
        • De Bruin A.F
        • Diederiks J.P
        • de Witte L.P
        • Stevens F.C
        • Philipsen H
        The development of a short generic version of the Sickness Impact Profile.
        J Clin Epidemiol. 1994; 47: 407-418
        • Keith R.A
        • Granger C.V
        • Hamilton B.B
        • Sherwin F.S
        The functional independence measure.
        Adv Clin Rehabil. 1987; 1: 6-18
        • Ware Jr, J.E
        • Sherbourne C.D
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Harris W.H
        Traumatic arthritis of the hip after dislocation and acetabular fractures.
        J Bone Joint Surg Am. 1969; 51: 737-755
        • Fries J.F
        • Spitz P.W
        • Young D.Y
        The dimensions of health outcomes.
        J Rheumatol. 1982; 9: 789-793
        • Bellamy N
        • Buchanan W.W
        • Goldsmith C.H
        • Campbell J
        • Stitt L.W
        Validation study of WOMAC.
        J Rheumatol. 1988; 15: 1833-1840
        • Insall J.N
        • Dorr L.D
        • Scott R.D
        • Scott W.N
        Rationale of the Knee Society clinical rating system.
        Clin Orthop. 1989; (Nov): 13-14
        • Meenan R.F
        • Mason J.H
        • Anderson J.J
        • Guccione A.A
        • Kazis L.E
        AIMS2. The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire.
        Arthritis Rheum. 1992; 35: 1-10
        • Roorda L.D
        • Roebroeck M.E
        • Lankhorst G.J
        • van Tilburg T
        • Bouter L.M
        Measuring functional limitations in rising and sitting down.
        Arch Phys Med Rehabil. 1996; 77: 663-669
        • Roorda L.D
        • Roebroeck M.E
        • Lankhorst G.J
        • van Tilburg T.G
        De vragenlijst loopvaardigheid.
        Revalidata. 1996; 18: 34-38
        • Van Herk I.E
        • Arendzen J.H
        • Rispens P
        Ten-metre walk, with or without a turn?.
        Clin Rehabil. 1998; 12: 30-35
        • Nollet F
        • Beelen A
        • Prins M.H
        • et al.
        Disability and functional assessment in former polio patients with and without postpolio syndrome.
        Arch Phys Med Rehabil. 1999; 80: 136-143
        • Roorda L.D
        • Jones C.A
        • Waltz M
        • et al.
        Satisfactory crosscultural equivalence of Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty.
        Ann Rheum Dis. 2004; 63: 36-42
        • Perez R.S
        • Zuurmond W.W
        • Bezemer P.D
        • et al.
        The treatment of complex regional pain syndrome type I with free radical scavengers.
        Pain. 2003; 102: 297-307
        • Perez R.S
        • Roorda L.D
        • Zuurmond W.W
        • Bannink I.I
        • Vranken J.H
        • de Lange J.J
        Measuring perceived activity limitations in lower extremity Complex Regional Pain Syndrome type 1 (CRPS I).
        Clin Rehabil. 2002; 16: 454-460
        • Meijer J.W
        • Trip J
        • Jaegers S.M
        • et al.
        Quality of life in patients with diabetic foot ulcers.
        Disabil Rehabil. 2001; 23: 336-340
        • Rijken P.M
        • Dekker J
        • Lankhorst G.J
        • et al.
        Podiatric care for diabetic patients with foot problems.
        Int J Rehabil Res. 1999; 22: 181-188
        • Mokken R.J
        Nonparametric models for dichotomous responses.
        in: Van Der Linden W.J Hambleton R.K Handbook of modern item response theory. Springer, New York1997: 351-367
        • Molenaar I.W
        • Sijtsma K
        User’s manual MSP5 for Windows. iecProGAMMA, Groningen2000
        • Sijtsma K
        • Molenaar I.W
        Introduction to nonparametric item response theory. Sage, Thousand Oaks2002
        • Molenaar I.W
        Parametric and nonparametric item response theory models in health related quality of life measurements.
        in: Mesbah M Cole B.F Lee M.L Statistical methods for quality of life studies design, measurements and analysis. Kluwer Academic, Dordrecht2002: 143-154
        • Nunnally J.C
        • Bernstein I.H
        Psychometric theory. 3rd ed. McGraw-Hill, New York1994
        • Ryser L
        • Wright B.D
        • Aeschlimann A
        • Mariacher-Gehler S
        • Stucki G
        A new look at the Western Ontario and McMaster Universities Osteoarthritis Index using Rasch analysis.
        Arthritis Care Res. 1999; 12: 331-335
        • Roznowski M
        • Reith J
        Examining the measurement quality of tests containing differentially functioning items.
        Educ Psychol Meas. 1999; 29: 248-269