Abstract
Objectives
To develop a measure of perceived systems, services, and policies facilitators (see
Chapter 5 of the International Classification of Functioning, Disability and Health) for people with neurologic disabilities and to evaluate the effect of perceived
systems, services, and policies facilitators on health-related quality of life.
Design
Qualitative approaches to develop and refine items. Confirmatory factor analysis including
1-factor confirmatory factor analysis and bifactor analysis to evaluate unidimensionality
of items. Rasch analysis to identify misfitting items. Correlational and analysis
of variance methods to evaluate construct validity.
Setting
Community-dwelling individuals participated in telephone interviews or traveled to
the academic medical centers where this research took place.
Participants
Participants (N=571) had a diagnosis of spinal cord injury, stroke, or traumatic brain
injury. They were 18 years or older and English speaking.
Interventions
Not applicable.
Main Outcome Measures
An item bank to evaluate environmental access and support levels of services, systems,
and policies for people with disabilities.
Results
We identified a general factor defined as “access and support levels of the services, systems, and policies at the
level of community living” and 3 local factors defined as “health services,” “community living,” and “community resources.” The
systems, services, and policies measure correlated moderately with participation measures:
Community Participation Indicators (CPI) – Involvement, CPI – Control over Participation,
Quality of Life in Neurological Disorders – Ability to Participate, Quality of Life
in Neurological Disorders – Satisfaction with Role Participation, Patient-Reported
Outcomes Measurement Information System (PROMIS) Ability to Participate, PROMIS Satisfaction
with Role Participation, and PROMIS Isolation.
Conclusions
The measure of systems, services, and policies facilitators contains items pertaining
to health services, community living, and community resources. Investigators and clinicians
can measure perceptions of systems, services, and policies resources reliably with
the items described here. Moderate relations between systems, services, and policies
facilitators and PROMIS and CPI variables provide support for the measurement and
theory of environmental effects on social functioning related to participation.
Keywords
List of abbreviations:
CFI (comparative fit index), CPI (Community Participation Indicators), DIF (differential item functioning), NeuroQoL (Quality of Life in Neurological Disorders), PROMIS (Patient-Reported Outcomes Measurement Information System), RMSEA (root mean square error of approximation), SCI (spinal cord injury), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 13, 2016
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research through a Rehabilitation Research and Training Center on Improving Measurement of Medical Rehabilitation Outcomes grant (grant no. H133B090024).
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
