Participation Scale
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Participation Scale

Last Updated

Purpose

An 18-item interview-based tool to measure clients’ self-perception of their social integration and participation within rehabilitation and disability communities. Clients report the likelihood in which they participate in various social situations, as compared to their peers.

Link to Instrument

https://www.infontd.org/toolkits/nmd-toolkit/participation-scale

Acronym P-Scale

Area of Assessment

Life Participation

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Cost Description

Free to access with link to website

CDE Status

Not a CDE -- last searched 6/6/2023.

Populations

Skin Disorders
Mixed Populations

Key Descriptions

  • Number of items in the instrument: 18
  • Each question measures the level of participation compared with peers. For questions where responses indicate a lower level of participation, respondents are asked to indicate the extent to which they experience this as a problem using the following weighted response scale:
    1 = no problem
    2 = small problem
    3 = medium problem
    5 = large problem
  • Scores are added up; minimum and maximum scores: 0-90
  • Cut off score of 12 is needed for client to receive rehabilitation

Number of Items

18

Equipment Required

  • Participation Scale response form for client
  • Pen or pencil
  • User's Manual

Time to Administer

Approximately 20 minutes

Required Training

Reading an Article/Manual

Required Training Description

Preparations before using the Participation Scale:

1. Communicate your interest to use the new Participation Scale to the Participation Scale Development
Team (see Preface)

2. Obtain the latest version of the scale and the Training Manual

3. Translate the Participation Scale according to the translation protocol in Annex 4

4. Translate the Q/Q document

5. Decide how the scale will be used (who will be interviewed, who will do conduct the interviews)

6. Decide to whom people scoring positive on the scale will be referred and what will be the procedure for
deciding on rehabilitation assistance, if this is not already in place

7. Train the staff involved using this manual

The scale is intended for use by field workers, CBR workers, rehabilitation workers, paramedical workers, medical staff and other staff involved in (socio-economic) rehabilitation, including community-based rehabilitation. Staff should receive special instruction in the use of the scale, but specialist training is not necessary.

Age Ranges

Adolescent

15 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Alison Kale, Kat Taylor, Mckenzie Miller, and Samantha Spellman (Master of Occupational Therapy students)

Faculty mentor: Danbi Lee, PhD, OTD, OTR/L

Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle

ICF Domain

Participation

Measurement Domain

Activities of Daily Living
Participation & Activities

Professional Association Recommendation

There is no P-scale on NINDS – last searched 6/6/2023.

Considerations

Specifically designed for middle and low-income countries

There is a shortened version of the P-scale available.

The P-Scale has been translated into Amharic, Bahasa Indonesia, Bangla, Dutch, French, Hindi, Igbo, Jordanian Arabic, Nepali, Portuguese, Slovak, Spanish, and Tamil.

A systematic review recommended further testing of the cultural equivalence of participation instruments including the P-scale. This paper reviews the process of cross-cultural equivalence testing of instruments to measure participation in society (Stevelink & van Brakel, 2013).

Mixed Populations

back to Populations

Standard Error of Measurement (SEM)

Mixed population with disabilities (van der Zee et al., 2010; n = 47, musculoskeletal disease n = 8, traumatic brain injury n = 5, stroke n = 12, neuromuscular diseases n = 11, chronic pain n = 10, heart failure n = 1; mean age = 50.6 (11.8))

  • SEM for entire group (n = 47): 5.6

Minimal Detectable Change (MDC)

Mixed population with disabilities (van der Zee et al., 2010)

  • MCD for entire group (n = 47): 15.5

Cut-Off Scores

Disability and leprosy: (van Brakel et al., 2006; n ≈ 1260)

  • <13: no significant restriction
  • 13-22: mild restriction
  • 23-33: moderate restriction
  • 34-53: severe restriction
  • >53: extreme restriction

Normative Data

Mixed population with disabilities: (Stevelink et al., 2013; people with disabilities: n=153, mean age=38.6; people without disabilities: n=53, mean age = 38.6)

  • Median P-scale score for persons with a disability = 30
  • Mean (SD) P-scale score for persons with a disability = 36 (23)

Mixed population with disabilities: (van der Zee et al., 2010)

  • Median = 15.0,  IQR (6.0-27.0)
  • Mean (SD) = 17.1 (12.9)

Hearing Impairment: (Thammaiah et al., 2018; n = 103; mean age = 53.8 (19.8) years; gender (%), male = 68.9%, female = 31.1 %; hearing status (right ear %/ left ear %), normal = 2.9%/3.9%, conductive = 14.6%/18.4%, sensorineural = 58.2%/54.4%, mixed = 24.3%/23.3%; bilingual sample speaking both Kannada and English).

  • English P-Scale, English administration. Mean (SD) = 13.60 (14.3)
  • Kannada P-Scale (1st administration). Mean (SD) = 13.44 (13.8)
  • Kannada P-Scale (2nd administration 15 days post 1st administration).  Mean (SD) = 12.3 :(13.7)

Test/Retest Reliability

Mixed population with disabilities: (van der Zee et al., 2010)

  • Acceptable test-retest reliability: (ICC = 0.82)

Mixed population with disabilities: (Stevelink et al., 2013)

  • Excellent test-retest reliability: (ICC = 0.90)

Hearing Impairment: (Thammaiah, et al., 2018., n=103; mean age = 53.8 (19.8) years; Kannada P-scale)

  • Excellent test-retest reliability (2nd administration 15 days post 1st administration): ICC > 0.90 

Interrater/Intrarater Reliability

Disability and leprosy: (van Brakel et al., 2006)

  • Excellent inter-rater reliability (ICC = 0.80)
  • Excellent intra-rater reliability (ICC = 0.83)

Internal Consistency

Disability and leprosy: (van Brakel et al., 2006)

  • Excellent: Chronbach’s alpha = 0.92*

Mixed population with disabilities: (Stevelink et al., 2013)

  • Excellent: Cronbach’s alpha = 0.93*

Hearing Impairment: (Thammaiah, et al., 2018; Kannada P-scale)

  • Excellent: Cronbach’s alpha = 0.90*

Physical disability: (Chung et al., 2018; n = 264; 56.1% female; ages 18-65 years; rheumatoid arthritis n = 103, acquired brain damage n = 70, spinal cord injury, n = 46, ankylosing spondylitis n = 31, orthopaedic injuries n = 27, congenital physical disabilities n = 18; traditional Chinese translation)

  • Excellent: Cronbach’s alpha = 0.93*

*May indicate redundancy in the scale questions.

Construct Validity

Discriminant validity:

Mixed populations with disability (Stevelink et al., 2013)

  • Adequate: P-Scale and self-reported health scale (r = -0.51)

Hearing Impairment: (Thammaiah et al., 2018; Kannada P-Scale)

  •  85% of items with low inter-item correlation (rs = <0.60)

 

Convergent Validity:

Disability and leprosy: (van Brakel et al., 2006)

  • Adequate correlation between P-scale scores and expert participation restriction scoring (r = 0.44) and Eyes Hands Feet (EHF) score (r = 0.39)

Mixed populations with disability: (Stevelink et al., 2013)

  • Adequate: P-scale and Explanatory Model Interview Catalogue (EMIC) (r = 0.55)

Hearing Impairment: (Thammaiah et al., 2018; Kannada P-scale)

  • Adequate convergent validity with Hearing Handicap Questionnaire(HHQ) (ρ = 0.52);
  • Excellent convergent validity with Assessment of Quality of Life - 4 Dimensions Questionnaire (AQoL-4D) (ρ = 0.76).

Physical disability:  (Chung et al., 2018)

  • Adequate convergent validity with Explanatory Model Interview Catalogue (EMIC) (r = 0.48)

Content Validity

Items were developed via field observation, key informant interviews, and focus group discussion. van Brakel et al. (2006) concluded that “the content represents all key domains of the ICF Participation component. However, it was not designed to provide a comprehensive overview of problems in all areas of life.” (p.197)

Floor/Ceiling Effects

Mixed population with disability (van der Zee et al., 2010)

  • Excellent floor (0%) and ceiling (0%) effects

 

Mixed populations with disability (Stevelink et al., 2013)

  • Excellent ceiling effect (0%) and adequate floor effect (2%)

 

Hearing Impairment: (Thammaiah et al., 2018; Kannada P-scale)

  • Excellent ceiling effect (0%) and adequate floor effect (12.6%)

Skin Disorders

back to Populations

Normative Data

Former Buruli Ulcer Patients: (de Zeeuw et al., 2014; n = 386, patients n = 143, median age (IQR) Ghana = 27 (19-33) years, Benin = 25 (18-43) years; relatives n = 137; community control n = 106; median age (IQR) Ghana = 28.5 (21-37) years, Benin = 31 (24-41) years)

  • Former patients with BU with visible deformities (median = 19, IQR = 11 to 45)
  • Former patients with BU without visible deformities (median = 8.5, IQR = 3 to 25)
  • Former patients with BU with joint involvement (median = 18, IQR = 8 to 32)
  • Former patients with BU without joint involvement (median = 9.5, IQR = 3 to 27).
  • Former patients with BU that changed occupation (median = 16.5, IQR = 5 to 38)
  • Former patients with BU who continued the same occupation (median = 13, IQR = 5 to 29)

Internal Consistency

Former Buruli Ulcer Patients: (de Zeeuw et al., 2014)

  • Excellent: Cronbach’s alpha (Ghana) = 0.88, (Benin) = 0.87

 

Leprosy: (Ramasamy et al., 2018; n = 113 age range = 18-72; Hindi P-scale)

  • Excellent: Cronbach’s alpha range between .904-.919*

*May indicate redundancy in the scale questions.

Construct Validity

Former Buruli Ulcer Patients: (de Zeeuw et al., 2014)

  • Adequate convergent validity with Explanatory Model Interview Catalogue (EMIC) (r = 0.53)
  • Excellent convergent validity with Buruli Ulcer Functional Limitation Score (BUFLS) (r = 0.67)
  • Significantly higher scores among former patients with visible deformities compared to those without (p = 0.023)
  • Excellent correlation between sum scores of former patients and relatives (r = 0.80)

Floor/Ceiling Effects

Former Buruli Ulcer Patients: (de Zeeuw et al., 2014)

  • Excellent: no ceiling effects
  • Adequate: floor effects (6%)

Bibliography

Chung, E. Y., & Lam, G. (2018). Validation of two scales for measuring participation and perceived stigma in Chinese community-based rehabilitation programs. Health and Quality of Life Outcomes, 16(1), 105. https://doi.org/10.1186/s12955-018-0938-3

de Zeeuw, J., Douwstra, M., Omansen, T. F., Sopoh, G. E., Johnson, C., Phillips, R. O., Alferink, M., Saunderson, P., Van der Werf, T. S., Dijkstra, P. U., & Stienstra, Y. (2014). Psychometric properties of the participation scale among former buruli ulcer patients in Ghana and Benin. PLoS Neglected Tropical Diseases, 8(11), e3254. https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003254

Ramasamy, S., Govindharaj, P., Panneerselvam, S., & Kumar, A. (2018). Factors associated with social participation of women affected with leprosy reporting at a referral centre in Chhattisgarh, India. Leprosy Review, 89(1), 56–64. https://doi.org/10.47276/lr.89.1.56

Stevelink, S. A. M. & van Brakel, W. H. (2013). The cross-cultural equivalence of participation instruments: A systematic review, Disability and Rehabilitation, 35 (15), 1256-1268, https://doi.org/10.3109/09638288.2012.731132

Stevelink, S. A., Terwee, C. B., Banstola, N., & van Brakel, W. H. (2013). Testing the psychometric properties of the Participation Scale in Eastern Nepal. Quality of Life Research, 22(1), 137–144. https://link.springer.com/content/pdf/10.1007/s11136-012-0116-8

Thammaiah, S., Manchaiah, V., Easwar, V., Krishna, R., & McPherson, B. (2018). The Participation Scale: Psychometric properties of a South Indian translation with hearing-impaired respondents. Disability and Rehabilitation, 40(22), 2650–2657. https://pubmed.ncbi.nlm.nih.gov/28687058/

van Brakel, W. H., Anderson, A. M., Mutatkar, R. K., Bakirtzief, Z., Nicholls, P. G., Raju, M. S., & Das-Pattanayak, R. K. (2006). The Participation Scale: measuring a key concept in public health. Disability and Rehabilitation, 28(4), 193–203. https://doi.org/10.1080/09638280500192785

van der Zee C.H., Priesterbach A.R., van der Dussen L, Kap A, Schepers VPM, Visser-Meily JMA, & Post MWM. (2010). Reproducibility of three self-report participation measures: The ICF Measure of Participation and Activities Screener, the Participation Scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation. Journal of Rehabilitation Medicine, 42(8), 752–757. https://medicaljournals.se/jrm/content/abstract/10.2340/16501977-0589

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