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Development of the Participation Measure–3 Domains, 4 Dimensions (PM-3D4D): A New Outcome Measure for Rehabilitation

  • Feng-Hang Chang
    Correspondence
    Corresponding author Feng-Hang Chang, ScD, OTR/L, Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, 250 Wu-Hsing St, Taipei City 110, Taiwan.
    Affiliations
    Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei City, Taiwan
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  • Tsan-Hon Liou
    Affiliations
    Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei City, Taiwan

    Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei City, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
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  • Pengsheng Ni
    Affiliations
    Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
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  • Kwang-Hwa Chang
    Affiliations
    Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei City, Taiwan

    Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
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  • Chien-Hung Lai
    Affiliations
    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan

    Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan
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Published:September 01, 2016DOI:https://doi.org/10.1016/j.apmr.2016.08.462

      Abstract

      Objectives

      To describe the development of a participation measure that assesses 3 domains (productivity, social, and community) and 4 dimensions (frequency, diversity, desire for change, and perceived difficulty) of participation and to evaluate the initial psychometric properties in rehabilitation outpatients.

      Design

      A mixed-method approach included a literature review, item selection, expert reviews, cognitive interviews, and field testing with rehabilitation outpatients. Confirmatory factor analysis (CFA) and Rasch analysis were used to validate the construct validity of the difficulty dimension of the instrument.

      Setting

      Outpatient rehabilitation programs.

      Participants

      An expert panel consisting of 12 rehabilitation and measurement experts contributed to measurement development; 20 rehabilitation outpatients participated in cognitive interviews; and a sample of rehabilitation outpatients (N=556) (average age, 61.36±23.62y; 53% men) participated in field testing.

      Interventions

      Not applicable.

      Main Outcome Measure

      The Participation Measure–3 Domains, 4 Dimensions (PM-3D4D).

      Results

      A scoring method for each dimension of the PM-3D4D was established. The instrument displayed good overall model fit in the CFA and unidimensionality across 3 domains after removing and collapsing locally dependent items identified from a principal component analysis. However, considering the poor personal reliability of the social subscale and its high correlation with the community subscale, we decided to merge the 2 subscales into 1. The combined subscale showed improved reliability and good construct validity by demonstrating a good model fit (comparative fit index, .985; Tucker-Lewis Index, .982, root mean square error of approximation, .061) and item fit.

      Conclusions

      The PM-3D4D is a newly developed participation measure designed to assess multiple domains and dimensions of participation by rehabilitation patients. The psychometric analysis results supported the construct of the instrument and helped item revision. Further examination of the validity and reliability of the PM-3D4D will be conducted.

      Keywords

      List of abbreviations:

      CFA (confirmatory factor analysis), CFI (comparative fit index), PCA (principal component analysis), PM-3D4D (Participation Measure–3 Domains, 4 Dimensions), RMSEA (root mean square error of approximation), TLI (Tucker-Lewis Index)
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