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Published on: February 8, 2019
Measuring activity limitations in walking: development of a hierarchical scale for patients with lower-extremity
Leo D Roorda1, Marij E Roebroeck, Theo van Tilburg
1Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. ld.roorda@vumc.nl
Objective:
To develop a hierarchical scale that measures activity limitations in walking in patients with lower-extremity disorders who live at home.
Design:
Cross-sectional study.
Setting:
Orthopedic workshops and outpatient clinics of secondary and tertiary care centers.
Participants:
Patients (N=981; mean age +/- standard deviation, 58.6+/-15.4 y; 46% men) living at home, with different lower-extremity disorders: stroke, poliomyelitis, osteoarthritis, amputation, complex regional pain syndrome type I, and diabetic and degenerative foot disorders.
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; (4) robustness, addressing the clinimetric properties within subgroups of patients; and (5) differential item functioning, addressing the validity of comparisons between subgroups of patients.
Results:
Thirty-five of 41 dichotomous items had (1) good fit of the monotone homogeneity model (coefficient H=.50), (2) good fit of the double monotonicity model (coefficient H(T)=.33), (3) good intratest reliability (coefficient rho=.95), (4) satisfactory robustness (within subgroups of patients defined by age, sex, and diagnosis), and (5) some differential item functioning (6 items in amputees compared with nonamputees).
Conclusions:
A hierarchical scale, with excellent scaling characteristics, was developed to measure activity limitations in walking in patients with lower-extremity disorders who live at home. The measurements should be interpreted cautiously when making comparisons between amputees and nonamputees.
