Pittsburgh Rehabilitation Participation Scale

Last Updated

January 22, 2013

Purpose

The PRPS is a clinician-rated instrument designed to assess a patient's participation in therapy.

Link to Instrument

Instrument Details

Acronym PRPS

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

Spinal Cord Injury
Stroke Recovery

Mixed Populations

Joint Pain and Fractures

Participation in the RPS is assessed on a 6-point Likert-type scale reflecting the therapists observations of patient participation:
1) None: patient refused entire session, or did not participate in any exercises in session.
2) Poor: patient refused or did not participate in at least half of session.
3) Fair: patient participated in most or all of exercises*, but did not show maximal effort or finish most exercises*, or required much encouragement to finish exercises*.
4) Good: patient participated in all exercises* with good effort and finished most but not all exercises* and passively followed directions (rather than actively taking interest in exercises* and future therapy).
5) Very good: patient participated in all exercises* with maximal effort and finished all exercises, but passively followed directions (rather than actively taking interest in exercises* and future therapy).
6) Excellent: patient participated in all exercises* with maximal effort, finished all exercises*, and actively took interest in exercises* and/or future therapy sessions.
This version is specifically for PT. For the OT form "exercises" should be replaced with "activities".

Number of Items

5 minutes

Per session

Required Training

No Training

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated by Anna de Joya PT, MS, NCS and the TBI EDGE task force of the Neurology section of the APTA in 2012.

ICF Domain

Body Function
Participation

Measurement Domain

Motor

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 (Vestibular EDGE) 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 PRPS does not assess different elements of participation and thus only provide a summary evaluation of each therapy session.
Assessments made by therapists between diagnostic groups may demonstrate some degree of differential validity. For example in one study evaluations made for stroke patients were more predictive our outcomes than for elective joint replacement (Lenze, 2004).
Only baseline disability (standardized β=.35, P=.02) and executive functions (standardized β=-40, P=.005) were significant predictors of rehabilitation participation, (F4,32=9.35; R2=.54, P=.001)(Skidmore et al., 2010)

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Cut-Off Scores

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.

Normative 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

Interrater/Intrarater Reliability

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)

Criterion Validity (Predictive/Concurrent)

Acute Inpatients: (Lenze et al, 2004)

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

Construct Validity

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.

Content Validity

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

Normative Data

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

Criterion Validity (Predictive/Concurrent)

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

Bibliography

Lenze, E. J., Munin, M. C., et al. (2004). "The Pittsburgh Rehabilitation Participation Scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation." Archives of physical medicine and rehabilitation 85(3): 380-384. Find it on PubMed

Munin, M. C., Seligman, K., et al. (2005). "Effect of rehabilitation site on functional recovery after hip fracture." Archives of physical medicine and rehabilitation 86(3): 367-372. Find it on PubMed

Paolucci, S., Di Vita, A., et al. (2012). "Impact of participation on rehabilitation results: a multivariate study." Eur J Phys Rehabil Med 48(3): 455-466. Find it on PubMed

Talkowski, J. B., Lenze, E. J., et al. (2009). "Patient participation and physical activity during rehabilitation and future functional outcomes in patients after hip fracture." Archives of physical medicine and rehabilitation 90(4): 618-622. Find it on PubMed

Last Updated

Purpose

Link to Instrument

Assessment Type

Administration Mode

Cost

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Cut-Off Scores

Normative Data

Interrater/Intrarater Reliability

Criterion Validity (Predictive/Concurrent)

Construct Validity

Content Validity

Normative Data

Criterion Validity (Predictive/Concurrent)

Bibliography

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