Pittsburgh Rehabilitation Participation Scale

Stroke, Other Neurological Disorders, & Orthopedic Pathologies: (Iosa et al., 2021; n = 32; age ≥ 18; mean age = 60.3 (18) years; patients receiving physical therapy in neurorehabilitation hospital: stroke (37.5%), other neurological disorders (28.1%), orthopedic pathologies (34.4%); SEM calculated using the average standard deviation of two therapists first sessions; Italian translation of PRPS)

• SEM (calculated using ICC for interrater reliability) = 0.326

Stroke, Other Neurological Disorders, & Orthopedic Pathologies: (calculated from Iosa et al., 2021; Italian translation of PRPS)

• MDC (calculated using ICC for interrater reliability) = 0.90

Acute In-Patient: (Lenze et al, 2004; n=242; diagnoses: elderly with neurologic, (eg, stroke), orthopedic (eg, fracture, joint replacement), or debility)

• Good participators=<5%
• Occasional Poor participators=5%-25%
• Frequently poor participators=>25%

These cut offs were based on visual examination of the distribution and natural breaks in the data.

Acute Inpatients: (Lenze et al, 2004, n = 242; various diagnosis admitted for inpatient rehabilitation)

• Mean PRPS scores = 4.73 (0.76)

Acute Rehabilitation patients: ( Paolucci et al, 1012: n=348; mean age 59.41± 12.85, diagnoses: CVA, orthopedic , lower limb amputation.)

PRPS mean score

Mean early score

Mean late score

CVA patients

3.77±1.02

4.17±0.98

Orthopedic patients

4.17±0.86

4.30±0.89

P value

Z=3.92

P=0.000

Z=4.68

P=0.000

Acute Inpatients: (Lenze et al, 2004; Three occupational therapists and five physical therapists participated, 2 therapists independently rated each patient’s therapy session)

• Excellent among occupational therapists (ICC = 0.91)
• Excellent among physical therapists (ICC = 0.96)

Stroke, Other Neurological Disorders, & Orthopedic Pathologies: (Iosa et al., 2021; inter-rater reliability assessed by having 26 of the 32 patients further evaluated in their first session by a second therapist blind to the scoring of the first, while intra-rater reliability was assessed by a single therapist separately evaluating the 10 first and 10 last sessions of 32 patients; Italian translation of PRPS)

• Excellent inter-rater reliability: (ICC = 0.926)
• Excellent intra-rater reliability:
  • First 10 sessions: (ICC = 0.844)
  • Last 10 session: (ICC = 0.756)

Stroke, Other Neurological Disorders, & Orthopedic Pathologies: (Iosa et al., 2021; Italian translation of PRPS)

• Excellent internal consistency for the first 10 sessions: Cronbach’s alpha = 0.982
• Excellent internal consistency for the last 10 sessions: Cronbach’s alpha = 0.969

Predictive validity:

Acute Inpatients: (Lenze et al, 2004)

• Mean PRPS scores predicted changes in motor FIM scores (r = 0.32, p <.0001)

Stroke, Other Neurological Disorders, & Orthopedic Pathologies: (Iosa et al., 2021; Italian translation of PRPS)

• Adequate predictive validity between the PRPS and BI-effectiveness (R = 0.358, p = 0.045) with BI-effectiveness
• Poor predictive validity between the PRPS and SF-36PH-effectiveness (R = 0.222, p = 0.222)
• Poor predictive validity between the PRPS and SF-36MH-effectiveness (R = 0.035, p = 0.851)

Concurrent validity: 

Stroke, Other Neurological Disorders, & Orthopedic Pathologies: (Iosa et al., 2021; Italian translation of PRPS)

• Excellent concurrent validity between the score on the PRPS and the Barthel Index (R = 0.633, p < 0.001)
• Adequate concurrent validity between the score on the PRPS and the 36-Item Short Form Survey-Physical Health (SF-36PH) (R = 0.518, p = 0.002)
• Adequate concurrent validity between the score on the PRPS and the 36-Item Short Form Survey-Mental Health (SF-36MH) (R = 0.433, p = 0.013)

Acute Inpatients: (Lenze et al, 2004)

PRPS Scores and Motor FIM Change in the 3 Impairment Subgroups

Group

n

PRPS Mean (SD)

Motor FIM Change Mean (SD)

Bivariate Correlation

Debility

73

4.55 (0.70)

20.3 (8.5)

.34*

CVA

38

4.62 (0.93)

23.0 (10.4)

.51†

Elective hip/knee

56

4.96 (0.60)

25.0 (6.4)

.11

Entire group

242

4.73 (0.76)

22.0 (8.8)

.32†

*p = .01
†p = .001

Stroke in Acute in-patient rehab: (Skidmore et al, 2010; n=44; mean age=73.6 (7.9); stroke onset, days=9.1(7.3))

Measure

PRPS (r)

Digit Span

-.12

HVLT

.11

Executive Interview

-.55*

Hamilton Rating Scale for Depression

-.39*

Apathy Evaluation Scale

-.27

FIM, baseline

.56*

Time (days since stroke)

-.30

*p <.01

• Age (r=-17, P=.28), race (r=-.19, P_.23), education (r=.27, P=.08), and stroke location (Cramer’s V=.70, P=.98) were not reliably correlated with rehabilitation participation.

To ensure the measure demonstrated adequate psychometric properties, developers conducted interviews with therapists as well as observed therapy sessions to better quantify different levels of participation

Older Adults & Geriatric Care: (Morghen et al., 2017; n = 556; mean age w/poor functional gain at discharge = 81.6 (7.4) years; mean age w/good functional gain at discharge = 78.2 (6.7) years; calculated SEM)

• SEM with poor functional gain at discharge (n = 284): 0.180
• SEM with good functional gain at discharge (n = 272): 0.180

Older Adults & Geriatric Care: (calculated from Morghen et al., 2017)

• MDC with poor functional gain at discharge (n  = 284): 0.50
• MDC with good functional gain at discharge (n  = 272): 0.50

Community Dwelling Adults: (Talkowski et al, 2009; n = 18, participants all >60 years old; Longitudinal with three and  six month follow-ups)

Characteristics of Participants by Facility Type:

IRFs

(n = 16)

SNFs

(n = 2)

Age in years (mean)

78.0

86.0

Minutes in therapy (mean)

150.0

75.5

Activity counts per minute (median)

36.8

48.2

PRPS scores (mean)

5.0

5.2

Baseline HFRS (mean)

95.6

93.5

IRF = Inpatient Rehabilitation Facilities
SNF = Skilled Nursing Facilities
HFRS = Hip Fracture Functional Recovery Scale
PRPS = Pittsburgh Participation Rating Scale

Predictive validity: 

Older Adults & Geriatric Care: (Morghen et al., 2017; n = 556; mean age w/poor functional gain at discharge = 81.6 (7.4) years; mean age w/good functional gain at discharge = 78.2 (6.7) years; functional gain evaluated using the Montebello rehabilitation factor score (MRFS efficacy): good vs. poor functional gain = above or below median MRFS efficacy value for whole sample, respectively)

• Significant association between PRPS score and functional status at discharge (odds ratio [OR] = 1.51, 95 % confidence interval [CI] 1.19–1.91; p = .001)

Hip Fracture: (Munin, 2005, n = 42 inpatient rehabilitation facilities, 34 = skilled nursing facilities; hip fracture patients undergoing rehabilitation, patients > 60 years old, had surgical stabilization of the fracture, and were living in the community when the fracture sustained)

Baseline Demographics and Clinical Measures:

Inpatient rehabilitation facilities

Skilled nursing facilities

Demographics

n

mean (SD)

min / max

n

mean (SD)

min / max

Age (years)

42

80.2 (8.4)

61 / 94

34

83.9 (9.4)

63 / 105

Female (%)

35

83.3

27

79.4

White (%)

40

95.2

30

88.2

Social support

41

18.5 (9.9)

2 / 37

32

13.5 (6.9)

1 / 31

Cognitive measures

MMSE

41

25.2 (3.8)

16 / 30

34

23.0 (5.3)

9 / 30

HAMD

41

9.5 (5.2)

2 / 24

33

11.6 (5.9)

4 / 26

Delirium Rating Scale

41

5.8 (5.7)

2 / 24

33

8.3 (6.6)

2 / 26

Clinical measures

CIRS

38

9.2 (3.1)

3 / 18

31

10.2 (2.9)

5 / 16

Rehabilitation participation

37

4.6 (0.8)

2.1 / 6

22

4.3 (1.1)

2.4 / 6

Hospital LOS

40

5.0 (1.9)

2 / 12

31

6.4 (3.7)

3 / 21

Rehabilitation LOS

36

12.8 (6.9)

4 / 38

24

36.2 (20.5)

15 / 90

min / max = minimum and maximum scores
MMSE = The Mini-Mental Status Examination
HAMD = The Hamilton Depression Rating Scale
CIRS = Cumulative Illness Rating Scale
LOS = Length of Stay