Article
Measuring activity limitations in climbing stairs: development of a hierarchical scale for patients with lower-extremity disorders living at home1,

https://doi.org/10.1016/j.apmr.2003.11.018Get rights and content

Abstract

Roorda LD, Roebroeck ME, van Tilburg T, Lankhorst GJ, Bouter LM, Measuring Mobility Study Group. Measuring activity limitations in climbing stairs: development of a hierarchical scale for patients with lower-extremity disorders living at home. Arch Phys Med Rehabil 2004;85:967–71.

Objective

To develop a hierarchical scale that measures activity limitations in climbing stairs in patients with lower-extremity disorders living at home.

Design

Cross-sectional study with Mokken scale analysis of 15 dichotomous items.

Setting

Outpatient clinics of secondary and tertiary care centers.

Participants

Patients (N=759; mean age ± standard deviation, 59.8±15.0y; 48% men) living at home, with different lower-extremity disorders: stroke, poliomyelitis, osteoarthritis, amputation, complex regional pain syndrome type I, and diabetic foot problems.

Interventions

Not applicable.

Main outcome measures

(1) Fit of the monotone homogeneity model, indicating whether items can be used for measuring patients; (2) fit of the double monotonicity model, indicating invariant (hierarchical) item ordering; (3) intratest reliability, indicating repeatability of the sum score; and (4) differential item functioning, addressing the validity of comparisons between subgroups of patients.

Results

There was (1) good fit of the monotone homogeneity model (coefficient H=.50) for all items for all patients, and for subgroups defined by age, gender, and diagnosis; (2) good fit of the double monotonicity model (coefficient HT=.58); (3) good intratest reliability (coefficient ρ=.90); and (4) no differential item functioning with respect to age and gender, but differential item functioning for 4 items in amputees compared with nonamputees.

Conclusions

A hierarchical scale, with excellent scaling characteristics, has been developed for measuring activity limitations in climbing stairs in patients with lower-extremity disorders who live at home. However, measurements should be interpreted with caution when comparisons are made between patients with and without amputation.

Section snippets

Instrument development

To create a detailed measurement instrument, items were derived from an extensive literature review on climbing stairs. A first-draft version of the scale was subjected to the opinions of experts (physicians, physical and occupational therapists, sociologists), and pretested. A second draft version was tested in 345 patients with orthopedic and rheumatologic disorders of the lower extremity,13, 14 resulting in rewording of some items. The final version of the instrument that was tested was a

Participants

Of the 822 patients enrolled in our study, 63 stated that they did not climb stairs at all. These 63 patients were excluded from the scale analysis. As a consequence, data on 759 patients were included in the scale analysis. The mean age ± standard deviation of these patients was 59.8±15.0 years, and the gender of 48% (n=364) of the patients was male. Patients had the following diagnoses: stroke (n=65)15; poliomyelitis (n=89)16; hip OA (n=203)17; knee OA (n=79); transfemoral amputation (n=74);

Discussion

The objective of our study was to develop and test a measurement instrument to provide a detailed assessment of activity limitations in climbing stairs for patients with lower-extremity disorders living at home. To test the instrument on patients living at home, only outpatients were sampled for this study. In addition, and in order to test the instrument on patients with different lower-extremity disorders, the patients who were sampled had different disorders of the lower extremity,

Conclusions

A measurement instrument with excellent scaling characteristics has been developed to provide a detailed assessment of activity limitations in climbing stairs in patients with different lower-extremity disorders living at home. However, the results of the measurements made with this instrument should be interpreted with some caution when comparing amputees and nonamputees.

Acknowledgements

We thank Dr. Ivo W. Molenaar for his comments on the manuscript. Other members of the Measuring Mobility Study Group are Fred A. de Laat, MD, Roessingh Research and Development, Enschede, and Rehabilitation Center Tolbrug, ‘s Hertogenbosch; Ide C. Heyligers, MD, PhD, VU University Medical Center, Amsterdam; Jacob J. Caron, MD, Onze Lieve Vrouwe Gasthuis, Amsterdam; Bart J. Burger, MD, PhD, Medisch Centrum Alkmaar, Alkmaar; Frans Nollet, MD, PhD, VU University Medical Center, Amsterdam; Irene E.

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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