Construct Validity and Test-Retest Reliability of the Climbing Stairs Questionnaire in Lower-Limb Amputees


      de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Climbing Stairs Questionnaire in lower-limb amputees.


      To investigate the construct validity and test-retest reliability of the Climbing Stairs Questionnaire, a patient-reported measure of activity limitations in climbing stairs, in lower-limb amputees.


      A cross-sectional study.


      Outpatient department of a rehabilitation center.


      Lower-limb amputees (N=172; mean ± SD age, 65±12y; 71% men; 82% vascular cause) participated in the study; 33 participated in the reliability study.


      Not applicable.

      Main Outcome Measure(s)

      Construct validity was investigated by testing 10 hypotheses: limitations in climbing stairs according to the Climbing Stairs Questionnaire will be greater in lower-limb amputees who: (1) are older, (2) have a vascular cause of amputation, (3) have a bilateral amputation, (4) have a higher level of amputation, (5) have more comorbid conditions, (6) had their rehabilitation treatment in a nursing home, and (7) climb fewer flights of stairs. Furthermore, limitations in climbing stairs will be related positively to activity limitations according to: (8) the Locomotor Capabilities Index, (9) the Questionnaire Rising and Sitting down, and (10) the Walking Questionnaire. Construct validity was quantified by using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified using the intraclass correlation coefficient (ICC).


      Construct validity (8 of 10 null hypotheses not rejected) and test-retest reliability were good (ICC=.79; 95% confidence interval, .57–.90).


      The Climbing Stairs Questionnaire has good construct validity and test-retest reliability in lower-limb amputees.

      Key Words

      List of Abbreviations:

      CI (confidence interval), FCI (Functional Comorbidity Index), GRCQ (Global Rating of Change Questionnaire), ICC (intraclass correlation coefficient), LCI (Locomotor Capabilities Index)
      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


        • Rommers G.M.
        • Vos L.D.
        • Groothoff J.W.
        • Eisma W.H.
        Mobility of people with lower limb amputations: scales and questionnaires: a review.
        Clin Rehabil. 2001; 15: 92-102
        • Legro M.W.
        • Reiber G.
        • del Aguila M.
        • et al.
        Issues of importance reported by persons with lower limb amputations and prostheses.
        J Rehabil Res Dev. 1999; 36: 155-163
        • Rommers G.M.
        • Vos L.D.
        • Groothoff J.W.
        • Eisma W.H.
        Elderly people with a lower limb amputation: do they use their prosthesis?.
        in: The elderly amputee: rehabilitation and functional outcome [thesis]. Univ Groningen, Groninger2000: 59-75
        • Van Twillert S.
        • Postema K.
        • Geertzen J.H.
        • Hemminga T.
        • Lettinga A.
        Improving rehabilitation treatment in a local setting: a case study of prosthetic rehabilitation.
        Clin Rehabil. 2009; 22: 938-947
        • 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
        • Perron M.
        • Malouin F.
        • Moffet H.
        Assessing advanced locomotor recovery after total hip arthroplasty with the timed stair test.
        Clin Rehabil. 2003; 17: 780-786
        • Hafner B.J.
        • Willingham L.L.
        • Buell N.C.
        • Allyn K.J.
        • Smith D.G.
        Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee.
        Arch Phys Med Rehabil. 2007; 88: 207-217
        • Kahle J.T.
        • Highsmith J.
        • Hubbard S.L.
        Comparison of nonmicroprocessor knee mechanism versus C-leg on Prosthesis Evaluation Questionnaire, stumbles, falls, walking tests, stair descent, and knee preference.
        J Rehabil Res Dev. 2008; 45: 1-14
        • Bussmann J.B.
        • Stam H.J.
        Techniques for measurement and assessment of mobility in rehabilitation: a theoretical approach.
        Clin Rehabil. 1998; 12: 455-464
        • Roorda L.D.
        • Roebroeck M.E.
        • van Tilburg T.
        • Lankhorst G.J.
        • Bouter L.M.
        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: 967-971
        • Perez R.S.
        • Roorda L.D.
        • Zuurmond W.W.A.
        • Bannink I.I.
        • Vranken J.H.
        • de Lange J.J.
        Measuring perceived activity limitations in lower extremity complex regional pain syndrome type I (CRPS I): test-retest reliability of two questionnaires.
        Clin Rehabil. 2002; 16: 454-460
        • Grise M.C.L.
        • Gauthier-Gagnon C.
        • Martineau G.G.
        Prosthetic profile of people with lower extremity amputation: conception and design of a follow-up questionnaire.
        Arch Phys Med Rehabil. 1993; 74: 862-870
        • Gauthier-Gagnon C.
        • Grisé M.C.
        Prosthetic profile of the amputee questionnaire: validity and reliability.
        Arch Phys Med Rehabil. 1994; 75: 1309-1314
        • Streppel K.R.
        • de Vries J.
        • van Harten W.H.
        Functional status and prosthesis use in amputees, measured with the Prosthetic Profile of the Amputee (PPA) and the short version of the Sickness Impact Profile (SIP68).
        Int J Rehabil Res. 2001; 24: 251-256
        • Roorda L.D.
        • Roebroeck M.E.
        • Lankhorst G.J.
        • van Tilburg T.
        • Bouter L.M.
        Measuring functional limitations in rising and sitting down: development of a questionnaire.
        Arch Phys Med Rehabil. 1996; 77: 663-669
        • Roorda L.D.
        • Molenaar I.W.
        • Lankhorst G.J.
        • Bouter L.M.
        Improvement of a questionnaire measuring activity limitations in rising and sitting down in patients with lower-extremity disorders living at home.
        Arch Phys Med Rehabil. 2005; 86: 2204-2210
        • Roorda L.D.
        • Roebroeck M.E.
        • van Tilburg T.
        • Molenaar I.W.
        • Lankhorst G.J.
        • Bouter L.M.
        Measuring activity limitations in walking: development of a hierarchical scale for patients with lower-extremity disorders living at home.
        Arch Phys Med Rehabil. 2005; 86: 2277-2283
        • Groll D.L.
        • To T.
        • Bombardier C.
        • Wright J.G.
        The development of a comorbidity index with physical function as the outcome.
        J Clin Epidemiol. 2005; 58: 595-602
        • Fortin M.
        • Hudon C.
        • Dubois M.F.
        • Lapointe L.
        • Soubhi H.
        Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life.
        Health Qual Life Outcomes. 2005; 3: 74
        • Keith R.A.
        Conceptual basis of outcome measures.
        Am J Phys Med Rehabil. 1995; 74: 73-80
        • Miller W.C.
        • Deathe A.B.
        • Speechley M.
        Lower extremity prosthetic mobility: a comparison of 3 self-report scales.
        Arch Phys Med Rehabil. 2001; 82: 1432-1440
        • Sansam K.
        • Neumann V.
        • O'Connor R.
        • Bhakta B.
        Predicting walking ability following lower limb amputation: a systematic review of the literature.
        J Rehabil Med. 2009; 41: 593-603
        • Franchignoni F.
        • Orlandini D.
        • Ferriero G.
        • Moscato T.A.
        Reliability, validity, and responsiveness of the locomotor capabilities index in adults with lower-limb amputation undergoing prosthetic training.
        Arch Phys Med Rehabil. 2004; 85: 743-747
        • Pohjolainen T.
        • Alaranta H.
        Predictive factors of functional ability after a lower limb amputation.
        Ann Chir Gynaecol. 1991; 80: 36-39
        • Ng E.K.
        • Berbrayer D.
        • Hunter G.A.
        Transtibial amputation: preoperative vascular assessment and functional outcome.
        J Prosthet Orthot. 1996; 8: 123-129
        • Moore T.J.
        • Barron J.
        • Hutchinson F.
        • Golden C.
        • Ellis C.
        • Humphries D.
        Prosthetic usage following major lower extremity amputation.
        Clin Orthop Relat Res. 1989; 238: 219-224
        • De Vet H.C.
        • Terwee C.B.
        • Knol D.L.
        • Bouter L.M.
        When to use agreements versus reliability measures.
        J Clin Epidemiol. 2006; 59: 1033-1039
        • Scientific Advisory Committee of the Medical Outcome Trust
        Assessing health status and quality-of-life instruments: attributes and review criteria.
        Qual Life Res. 2002; 11: 193-205
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; I: 307-310
        • De Vet H.C.
        • Terwee C.B.
        • Bouter L.M.
        Current challenges in clinimetrics.
        J Clin Epidemiol. 2003; 56: 1137-1141
        • Rommers G.M.
        • Vos L.D.
        • Groothoff J.W.
        • Schuiling C.H.
        • Eisma W.H.
        Epidemiology of lower limb amputees in the north of the Netherlands: aetiology, discharge destination and prosthetic use.
        Prosthet Orthot Int. 1997; 21: 92-99
        • Pernot H.F.M.
        • Winnubst G.M.M.
        • Cluitmans J.J.M.
        • de Witte L.P.
        Amputees in Limburg: incidence, morbidity and mortality, prosthetic supply, care utilisation and functional level after one year.
        Prosthet Orthot Int. 2000; 24: 90-96
        • Yari P.
        • Dijkstra P.U.
        • Geertzen J.H.
        Functional outcome of hip disarticulation and hemipelvectomy: a cross-sectional national descriptive study in the Netherlands.
        Clin Rehabil. 2008; 22: 1127-1133
        • Verghese J.
        • Wang C.
        • Xue X.
        • Holtzer R.
        Self-reported difficulty in climbing up or down stairs in nondisabled elderly.
        Arch Phys Med Rehabil. 2008; 89: 100-104
        • Bean J.F.
        • Kiely D.K.
        • LaRose S.
        • Alian J.
        • Frontera W.R.
        Is stair climb power a clinically relevant measure of leg power impairments in at-risk older adults?.
        Arch Phys Med Rehabil. 2007; 88: 604-609
        • Stratford P.W.
        • Kennedy D.
        • Pagura S.M.
        • Gollish J.D.
        The relationship between self-report and performance-related measures: questioning the content validity of timed tests.
        Arthritis Rheum. 2003; 49: 535-540
        • Fernie G.R.
        • Holliday P.J.
        Volume fluctuations in the residual limbs of lower limb amputees.
        Arch Phys Med Rehabil. 1982; 63: 162-165