Responsiveness of four participation measures to changes during and after outpatient rehabilitation.

Objective: To assess the responsiveness of 4 participation measures.

Design: Longitudinal study with repeated measurements at the start (t1) and at the end (t2) of a multidisciplinary out-patient rehabilitation programme, and at 4 months follow-up (t3).

Subjects: Outpatients with different diagnoses (n=395) from 5 rehabilitation centres in The Netherlands.

Methods: Measures were the Frenchay Activities Index (FAI), the Participation subscale of the ICF Measure of Participation and Activities Screener (IMPACT-SP), the Participation Scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation). Responsiveness was analysed using the effect size and the standardized response mean.

Results: Comparing scores at t1 and t2, the standardized response mean was 0.54 for the USER-Participation Restriction scale, 0.41 for the FAI, 0.40 for the IMPACT-SP, 0.39 for the USER-Participation Satisfaction scale, -0.36 for the Participation Scale, and 0.21 for the USER-Participation Frequency scale. Effect size values were generally somewhat smaller than standardized response mean values. Effect size and standardized response mean values were negligible between t2 and t3. Responsiveness parameters varied between diagnostic groups, with participants with acquired brain injury showing the largest change and participants with neuro-muscular disease or chronic pain showing least change.

Conclusion: Overall and across the different diagnostic groups, the USER-Participation Restriction scale showed the best responsiveness.