Original research| Volume 99, ISSUE 4, P652-659, April 2018

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Measuring Participation After Stroke in Africa: Development of the Participation Measurement Scale

Published:October 26, 2017DOI:



      To develop a valid stroke-specific tool, named the Participation Measurement Scale (PM-Scale), for the measurement of participation after stroke.


      Observational study and questionnaire development.


      Outpatient rehabilitation centers.


      Patients with stroke (N=276; mean age, 58.5±11.1y; 57% men).


      Not applicable.

      Main Outcome Measures

      Participants completed a 100-item experimental questionnaire of the PM-Scale. Items were scored as “not at all,” “weakly,” or “strongly.” The Hospital Anxiety and Depression Scale was used to evaluate depression, and the modified Rankin Scale was used to categorize the severity of disability on the basis of observation.


      After successive Rasch analyses using unrestricted partial credit parameterization, a valid, unidimensional, and linear 22-item scale for the measurement of participation was constructed. All 22 items fulfilled the measurement requirements of overall and individual item and person fits, category discrimination, invariance, and local response independence. The PM-Scale showed good internal consistency (person separation index, .93). The test-retest reliability of item difficulty hierarchy (r=.96; P<.001) and patient location (r=.99; P<.001) were excellent. This patient-based scale covers all 9 International Classification of Functioning, Disability and Health domains of participation.


      The PM-Scale has good psychometric qualities and provides accurate measures of participation in patients with stroke in Africa.


      List of abbreviations:

      DIF (differential item functioning), HADS (Hospital Anxiety and Depression Scale), ICF (International Classification of Functioning, Disability and Health), mRS (modified Rankin Scale), PM-Scale (Participation Measurement Scale), PSI (person separation index)
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