Original article| Volume 92, ISSUE 12, P2012-2017, December 2011

Assessing Physical Activity in Inpatient Rehabilitation: Validity, Practicality, and Sensitivity to Change in the Physical Activity in Inpatient Rehabilitation Assessment


      Denkinger MD, Lindemann U, Nicolai S, Igl W, Jamour M, Nikolaus T. Assessing physical activity in inpatient rehabilitation: validity, practicality, and sensitivity to change in the Physical Activity in Inpatient Rehabilitation Assessment.


      To validate a novel assessment of inpatient physical activity.


      Prospective cohort study for the evaluation of a novel questionnaire for physical activity in geriatric inpatients.


      German geriatric inpatient rehabilitation unit.


      Patients (N=96; 67 [72%] women; median age, 81y) with a variety of main underlying diagnoses, including musculoskeletal diseases, hip fracture, cardiovascular diseases, stroke, and others.


      Not applicable.

      Main Outcome Measures

      Ceiling and floor effects and administration time were measured. For criterion-related concurrent validity (convergent and discriminative), the Physical Activity in Inpatient Rehabilitation Assessment (PAIR) was administered in parallel to self-rated, proxy-rated, and performance-based measures of physical function at admission. Measurements were repeated at discharge and 4-month follow-up in the home environment, including a standard physical activity questionnaire to determine predictive validity. Spearman correlation coefficients were calculated to describe associations between parameters. Sensitivity to change was estimated using standardized response means (SRMs).


      Administration time of the PAIR ranged from less than 1 to 4 minutes. Ceiling effects occurred mainly at discharge (5%–14%), and floor effects (5%–11%), at admission. There were no missing values. Associations between convergent and predictive validity measures and functional measures (r=.43–.53, r=.49–.54, respectively) were clearly better when cognition was intact. Discriminative validity expressed as effect sizes ranged from .27 to 1.44. The SRM to describe sensitivity to change was .65 for the total score.


      The PAIR is the first validated questionnaire to assess physical activity in geriatric inpatients. It is practical and its validity and sensitivity to change are similar to existing physical activity questionnaires for community-dwelling older persons.

      Key Words

      List of Abbreviations:

      BAS (Brief Alzheimer Scale), BI (Barthel Index), IRIE (Inpatient Rehabilitation in Ehingen (study)), PAIR (Physical Activity in Inpatient Rehabilitation Assessment), PASE (Physical Activity Scale for the Elderly), SF-LLFDI (Short Form-Late Life Function and Disability Index), SPPB (Short Physical Performance Battery), SRM (standardized response mean)
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        • Motl R.W.
        • McAuley E.
        Physical activity, disability, and quality of life in older adults.
        Phys Med Rehabil Clin N Am. 2010; 21: 299-308
        • Jerome G.J.
        • Glass T.A.
        • Mielke M.
        • et al.
        Physical activity participation by presence and type of functional deficits in older women: the Women's Health and Aging Studies.
        J Gerontol A Biol Sci Med Sci. 2006; 61: 1171-1176
        • Jørstad-Stein E.C.
        • Hauer K.
        • Becker C.
        • et al.
        Suitability of physical activity questionnaires for older adults in fall-prevention trials: a systematic review.
        J Aging Phys Activity. 2005; 13: 461-481
        • Purser J.L.
        • Kuchibhatla M.N.
        • Fillenbaum G.G.
        • et al.
        Identifying frailty in hospitalized older adults with significant coronary artery disease.
        J Am Geriatr Soc. 2006; 54: 1674-1681
        • Denkinger M.D.
        • Coll-Planas L.
        • Jamour M.
        • Nikolaus T.
        The assessment of physical activity in inpatient rehabilitation—an important aspect of the identification of frailty in hospitalized older people.
        J Am Geriatr Soc. 2007; 55: 967-968
        • Denkinger M.D.
        [Prevention through physical activity in old age—what is known and what needs to be done?].
        MMW Fortschr Med. 2008; 150 (quiz 38): 34-37
        • Nelson M.E.
        • Rejeski W.J.
        • Blair S.N.
        • et al.
        Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.
        Med Sci Sports Exerc. 2007; 39: 1435-1445
        • Harada N.D.
        • Chiu V.
        • King A.C.
        • Stewart A.L.
        An evaluation of three self-report physical activity instruments for older adults.
        Med Sci Sports Exerc. 2001; 33: 962-970
        • Colbert L.H.
        • Matthews C.E.
        • Havighurst T.C.
        • Kim K.
        • Schoeller D.A.
        Comparative validity of physical activity measures in older adults.
        Med Sci Sports Exerc. 2011; 43: 867-876
        • Talkowski J.B.
        • Lenze E.J.
        • Munin M.C.
        • Harrison C.
        • Brach J.S.
        Patient participation and physical activity during rehabilitation and future functional outcomes in patients after hip fracture.
        Arch Phys Med Rehabil. 2009; 90: 618-622
        • Taraldsen K.
        • Askim T.
        • Sletvold O.
        • et al.
        Evaluation of a body-worn sensor system to measure physical activity in older people with impaired function.
        Phys Ther. 2011; 91: 277-285
        • Denkinger M.D.
        • Igl W.
        • Lukas A.
        • et al.
        Relationship between fear of falling and outcomes of an inpatient geriatric rehabilitation population—fear of the fear of falling.
        J Am Geriatr Soc. 2010; 58: 664-673
        • Bilney B.
        • Morris M.
        • Webster K.
        Concurrent related validity of the GAITRite walkway system for quantification of the spatial and temporal parameters of gait.
        Gait Posture. 2003; 17: 68-74
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A Short Physical Performance Battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-M94
        • Lübke N.
        • Meinck M.
        [Current appraisal of external quality assurance procedures in geriatric rehabilitation].
        Rehabilitation (Stuttg). 2008; 47: 39-48
        • McAuley E.
        • Konopack J.F.
        • Motl R.W.
        • Rosengren K.
        • Morris K.S.
        Measuring disability and function in older women: psychometric properties of the late-life function and disability instrument.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 901-909
        • Denkinger M.D.
        • Igl W.
        • Coll-Planas L.
        • et al.
        Evaluation of the Short Form of the Late-Life Function and Disability Instrument in geriatric inpatients—validity, responsiveness, and sensitivity to change.
        J Am Geriatr Soc. 2009; 57: 309-314
        • Mendiondo M.S.
        • Ashford J.W.
        • Kryscio R.J.
        • Schmitt F.A.
        Designing a Brief Alzheimer Screen (BAS).
        J Alzheimers Dis. 2003; 5: 391-398
        • 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
        • Washburn R.A.
        • McAuley E.
        • Katula J.
        • Mihalko S.L.
        • Boileau R.A.
        The Physical Activity Scale for the Elderly (PASE): evidence for validity.
        J Clin Epidemiol. 1999; 52: 643-651
        • Liang M.H.
        Evaluating measurement responsiveness.
        J Rheumatol. 1995; 22: 1191-1192
        • Wissler C.
        The Spearman correlation formula.
        Science. 1905; 22: 309-311
        • Trochim W.
        • Donnelly J.P.
        The research methods knowledge base.
        3rd ed. Atomic Dog Publishers, Cincinnatti2006
        • Yardley L.
        • Beyer N.
        • Hauer K.
        • et al.
        Development and initial validation of the Falls Efficacy Scale-International (FES-I).
        Age Ageing. 2005; 34: 614-619
        • Cohen J.
        A power primer.
        Psychol Bull. 1992; 112: 155-159
        • Trögner J.
        • Tümena T.
        • Schramm A.
        • Heinrich R.
        • Sieber C.
        [Geriatrics in Bavaria-Database (GiB-DAT): basic data analysis of geriatric rehabilitation in Bavaria and analysis of inter-clinic variability (part II)].
        Z Gerontol Geriatr. 2006; 39: 134-142
        • Forsén L.
        • Loland N.W.
        • Vuillemin A.
        • et al.
        Self-administered physical activity questionnaires for the elderly: a systematic review of measurement properties.
        Sports Med. 2010; 40: 601-623
        • Stucki G.
        • Cieza A.
        • Ewert T.
        • et al.
        Application of the International Classification of Functioning, Disability and Health (ICF) in clinical practice.
        Disabil Rehabil. 2002; 24: 281-282
        • World Health Organization
        International Classification of Functioning, Disability and Health.
        World Health Organization, Geneva2001
        • Greaves C.J.
        • Farbus L.
        Effects of creative and social activity on the health and well-being of socially isolated older people: outcomes from a multi-method observational study.
        J R Soc Health. 2006; 126: 134-142