Participation measure for post-acute care

Last Updated

January 22, 2013

Purpose

Assesses participation outcomes in outpatient or home care settings based on the ICF classification scheme.

Link to Instrument

instrument details

Acronym PM-PAC

Area of Assessment

Communication
Coordination
Functional Mobility
Occupational Performance
Quality of Life
Social Relationships
Social Support

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

Brain Injury Recovery
Parkinson's Disease & Movement Disorders
Pediatric + Adolescent Rehabilitation
Spinal Cord Injury

Spinal Injuries

Mixed Populations

The short form asks patients to rate their participation restrictions across 7 domains:

Mobility
Community, social and civic life
Role functioning Self-care/domestic life
Home management and finances
Social relationships
Communication

Scoring:
7 domain scores and 2 overall scores (Social and home participation and Community participation)
Scoring algorithm not published

Number of Items

15 minutes

A computerized adaptive test version of the participation measure for post-acute care (PMPAC- CAT) requires an average completion time of 6 minutes.

Required Training

No Training

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated with references for the TBI population by Anna de Joya, PT, DSc, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 5/2012.

ICF Domain

Participation

Measurement Domain

Activities of Daily Living

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
*LS / UR*	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	N/A	N/A	N/A	N/A

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
TBI EDGE	No	No	No	Not reported

Considerations

The PARTS/M is long and complex
Scoring is complex (although an adaptive version is available)
One quarter of PARTS/M items are related to self-care
Combines objective and subjective ratings as a single construct and has uneven content coverage across domains
May be inappropriate for people with cognitive impairments
No scoring algorithm is publicly available
Copyright fees

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Standard Error of Measurement (SEM)

Spinal Injury: (Noonan et al 2010; n = 545; age's ranged from 21 to 90 years; mean time from discharge to follow-up = 4 years)

PM-PAC Standard Error of Measurement (SEM)
Domain	Cronbach’s alpha	ICC (95% CI)	SEM
Communication	0.91	0.59 (0.47, 0.69)	0.29
Mobility	0.93	0.91 (0.87, 0.93)	0.26
Domestic Life	0.85	0.81 (0.74, 0.86)	0.34
Interpersonal Relationships	0.85	0.76 (0.68, 0.82)	0.42
Role Functioning	0.92	0.74 (0.65, 0.81)	0.58
Work & Employment	0.90	0.78 (0.66, 0.86)	0.42
Education	0.84	0.88 (0.65, 0.96)	0.19
Economic Life	0.84	0.77 (0.69, 0.83)	0.30
Community, Social & Civic Life	0.90	0.83 (0.77, 0.88)	0.34

Minimal Detectable Change (MDC)

Spinal Injury: (Noonan et al 2010)

PM-PAC MDC's*
Domain	MDC	MDC %
Communication	0.80	20.0
Mobility	0.73	18.3
Domestic Life	0.94	23.5
Interpersonal Relationships	1.17	29.3
Role Functioning	1.61	40.3
Work & Employment	1.16	29.0
Education	0.54	13.5
Economic Life	0.84	21.0
Community, Social & Civic Life	0.93	23.3
*MDC: minimal detectable change

Normative Data

Spinal Injury: (Noonan et al 2010)

PM-PCA Floor and Ceiling Effects:
PM-PCA Domain	Overall mean (SD)	Overall range
Communication	4.63 (0.66)	1.00–5.00
Mobility	4.26 (0.93)	1.00–5.00
Domestic Life	4.32 (0.87)	1.00–5.00
Interpersonal Relationships	4.08 (0.94)	1.00–5.00
Role Functioning	3.54 (1.19)	1.00–5.00
Work & Employment	4.19 (0.97)	1.00–5.00
Education	4.43 (0.78)	2.00–5.00
Economic Life	4.59 (0.76)	1.00–5.00
Community, Social & Civic Life	4.03 (0.90)	1.17–5.00

Floor/Ceiling Effects

Spinal Injury: (Noonan et al 2010)

PM-PCA Floor and Ceiling Effects:
PM-PCA Domain	% Worst possible score	% Best possible score
Communication	0.4	58.2
Mobility	0.2	43.3
Domestic Life	0.6	44.8
Interpersonal Relationships	0.4	30.8
Role Functioning	4.0	16.7
Work & Employment	1.0	39.1
Education	0.0	43.8
Economic Life	0.6	66.6
Community, Social & Civic Life	0.0	15.0

Test/Retest Reliability

Musculoskeletal, Neurologic and medically complex disorders (Gandek et al, 2007; n = 36; mean age = 60 (range = 18 to 100) years; assessed 1–15 days (mean = 4 days) of the initial interview)

PM-PAC Test-retest Reliability
Domain	Strength	ICC
Mobility	Adequate	0.85
Role Functioning	Poor	0.61
Community, Social, and Civic Life	Adequate	0.86
Domestic Life	Poor	0.74
Economic Life	Poor	0.62
Interpersonal Relationships	Adequate	0.75
Communication	Adequate	0.85
PM-PAC Test-retest Reliability

Internal Consistency

Musculoskeletal, Neurologic and medically complex disorders (Gandek et al, 2007)

PM-PAC Internal Consistency
Domain	Strength	alpha*
Mobility	Excellent	0.85
Role Functioning	Excellent	0.83
Community, Social, and Civic Life	Excellent	0.89
Domestic Life	Adequate	0.76
Economic Life	Excellent	0.82
Interpersonal Relationships	Adequate	0.72
Communication	Adequate	0.79
*Cronbach’s alpha

Construct Validity

Literature Review: (Magasi & Post, 2010)

Confirmatory Factor Analysis (CFA) suggested a 7-factor model (however, some factors were highly correlated)
Principle Component Analysis (PCA) resulted in a 2 factor solution

Musculoskeletal, Neurologic and medically complex disorders (Gandek et al, 2007)

Participant with different diagnosis differed significantly (P < 0.001) on all scales (except domestic life)
Participants with higher Rankin scores tended to score lower in the mobility, role functioning, and community, social, and civic life domains.

Multiple Diagnoses: (Keysor et al, 2006 (n=342; diagnoses: complex medical (eg, COPD, MI, heart surgery, post-surgical debility), orthopedic (eg, fractures or amputations), neurologic (eg, stroke, Guillain-Barré syndrome, Parkinson’s disease, multiple sclerosis, traumatic brain injury) from acute care and inpatient rehabilitation; mean age=68 (14); 49% female)

Pearson Correlation Coefficients of Home and Community Environment with Community Participation and Social and Home Participation

	1 Month (n=342)		6 Months (n=270)
Home and Community Environment	Social and Home Participation	Community Participation	Social and Home Participation	Community Participation
Home mobility barriers	NS	NS	NS	NS
Community Mobility barriers	.116*	-.127*	NS	NS
Mobility technology barriers	.170***	-.330***	NS	-.283***
Communication technology barriers	NS	NS	NS	.148**
Transportation facilitators	NS	.279***	NS	.134*
Social support	.408***	.137**	.344***	.154**

NS: Not significant; *P<.05, **P<.01, ***P<.001

After adjusting for covariates, 1 month after discharge, a greater presence of home mobility barriers (P <.01) was associated with less social and home participation; greater community mobility barriers (P<.01) and more social support (P<.001) were associated with greater participation
At 6 months, social support was the only environmental factor associated with participation after adjusting for covariates.

Multiple Diagnoses: (Jette et al, 2005; n=435; diagnoses: complex medical (eg,COPD, MI, heart surgery, post surgical debility) , orthopedic (eg, fractures or amputations), neurologic (eg, stroke, Guillain-Barré syndrome, Parkinson’s disease, multiple sclerosis, traumatic brain injury) from acute care and inpatient rehabilitation; mean age=67.4; 50.8% female)

Activity limitations (Movement/physical, Personal care & instrumental, Applied cognitive) were the dominant factors that explained much of the variance in the extent of community participation achieved by patients.
Personal (psychological, persistence, age, gender, race)and social environmental factors (social support) played a major role in predicting levels of social and home participation.

Content Validity

The development of the PM-PAC was guided by the ICIDH-2 and then reconciled with the ICF.
Qualitative item review was based on focus groups with rehabilitation patients.
Pilot tested with a sample of 8 people with disabilities; feedback also obtained from 8 rehabilitation researchers

Floor/Ceiling Effects

Literature Review: (Magasi & Post, 2010)

Many items are intended for lower functioning patients. The most informative items tend to vary by the severity of disability experienced by the patient

Responsiveness

Literature Review: (Magasi & Post, 2010)

The PM-PAC-CAT (Computer Adaptive Test) was highly correlated with the traditional PM-PAC
(ICC = .71 to .81). Only minor decrements in sensitivity and responsiveness were observed.

Bibliography

Gandek, B., Sinclair, S. J., et al. (2007). "Development and initial psychometric evaluation of the participation measure for post-acute care (PM-PAC)." Am J Phys Med Rehabil 86(1): 57-71.

Jette, A. M. and Haley, S. M. (2005). "Contemporary measurement techniques for rehabilitation outcomes assessment." J Rehabil Med 37(6): 339-345.

Jette, A. M., Keysor, J., et al. (2005). "Beyond function: predicting participation in a rehabilitation cohort." Arch Phys Med Rehabil 86(11): 2087-2094.

Keysor, J. J., Jette, A. M., et al. (2006). "Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort." Arch Phys Med Rehabil 87(12): 1566-1575.

Magasi, S. and Post, M. W. (2010). "A comparative review of contemporary participation measures' psychometric properties and content coverage." Arch Phys Med Rehabil 91(9 Suppl): S17-28.

Noonan, V. K., Kopec, J. A., et al. (2010). "Comparing the reliability of five participation instruments in persons with spinal conditions." J Rehabil Med 42(8): 735-743.

Last Updated

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Normative Data

Floor/Ceiling Effects

Test/Retest Reliability

Internal Consistency

Construct Validity

Content Validity

Floor/Ceiling Effects

Responsiveness

Bibliography

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