Abstract
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.
Objective
To develop a hierarchical scale that measures activity limitations in climbing stairs
in patients with lower-extremity disorders living at home.
Design
Cross-sectional study with Mokken scale analysis of 15 dichotomous items.
Setting
Outpatient clinics of secondary and tertiary care centers.
Participants
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.
Interventions
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Footnotes
☆Supported by the SGO Health Research Promotion Program.
Identification
Copyright
© 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
