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Responsiveness and Predictive Validity of the Participation Measure–3 Domains, 4 Dimensions in Survivors of Stroke

  • Feng-Hang Chang
    Correspondence
    Corresponding author Feng-Hang Chang, ScD, OTR/L, Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei City 11031, Taiwan.
    Affiliations
    Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Pengsheng Ni
    Affiliations
    Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
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Published:August 14, 2019DOI:https://doi.org/10.1016/j.apmr.2019.06.018

      Abstract

      Objectives

      To examine the responsiveness and predictive validity of the Participation Measure–3 Domains, 4 Dimensions (PM-3D4D) in people receiving outpatient rehabilitation following stroke.

      Design

      Prospective cohort observational study.

      Setting

      Outpatient rehabilitation settings.

      Participants

      Volunteer patients (N=269) with stroke (mean age ± SD [y], 55.36±12.46; 70.26% male).

      Interventions

      Not applicable.

      Main Outcome Measures

      The PM-3D4D was designed to measure 3 domains (Productivity, Social, and Community) and 4 dimensions (Diversity, Frequency, Desire for change, and Difficulty) of participation in individuals with rehabilitation needs. All participants completed the PM-3D4D, the Participation Assessment with Recombined Tools-Objective (PART-O), the Participation Measure for Post-Acute Care (PM-PAC), and the EuroQol-5-Dimension (EQ-5D) at the baseline assessment and again following 3 months of outpatient rehabilitation.

      Results

      Significant mean changes in scores were observed for most of the PM-3D4D subscales, with the largest score change observed in the Difficulty subscale (standardized response mean=0.57∼0.88). The minimal detectable change and meaningful clinically important differences were calculated for each subscale. The Frequency and Difficulty dimensions of the PM-3D4D demonstrated significantly greater responsiveness than the PART-O and PM-PAC, respectively. The baseline PM-3D4D scores, except for Desire for change subscales, were significantly correlated with the PART-O, PM-PAC, and EQ-5D scores after 3 months of rehabilitation.

      Conclusions

      This study provides evidence supporting the responsiveness and predictive validity of the PM-3D4D in survivors of stroke. Among all subscales of the PM-3D4D, the Difficulty dimensional scale demonstrated the greatest responsiveness. The Desire for change dimension of the PM-3D4D showed less responsiveness, and we recommend that it be used as a goal-setting tool rather than an outcome measure. The PM-3D4D can potentially be used to predict participation outcomes and the health-related quality of life following rehabilitation interventions.

      Keywords

      List of abbreviations:

      CI (confidence interval), EQ-5D (EuroQol-5-Dimension), HRQoL (health-related quality of life), MDC (minimal detectable change), MDC90 (minimal detectable change with a confidence level of 90%), MCID (meaningful clinically important difference), PART-O (Participation Assessment with Recombined Tools-Objective), PM-3D4D (Participation Measure–3 Domains, 4 Dimensions), PM-PAC (Participation Measure for Post-Acute Care), SRM (standardized response mean), USER-Participation (Utrecht Scale for Evaluation of Rehabilitation Participation)
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