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Updated: Jun 6, 2026
Evaluation of Respiratory Muscle Activation Using Respiratory Motor Control Assessment (RMCA) in Individuals with Chronic Spinal Cord Injury
Published on: July 19, 2013
Rasch analysis on the patient activation measure among people with spinal cord injury in China
Ziyu Ye1, Tiantian You2, Jianhui He3
1Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Study Design:
Cross-sectional study.
Objectives:
This study has three objectives: 1. to examine the validity of American Patient Activation Measure short form (PAM-13) in China by using Rasch measurement model; 2. to identify the PAM-13 items' difficulty/challenge in relation to the patient activation level among people with chronic spinal cord injury (SCI); 3. to find out the potential item bias in Chinese social environment.
Setting:
Shanghai Sunshine Rehabilitation Center (SSRC), China.
Methods:
Participants were 284 individuals who had at least one-half year post SCI in China. We did Principal Component Analysis and Confirmatory Factor Analysis to examine the PAM-13's unidimensionality and applied the Rasch analysis with maximum likelihood estimation by using WINSTEPS.
Results:
The study found PAM-13 has satisfied all the validity criteria, and it can successfully separate participants into four distinct strata of patient activation. The most challenging items of PAM-13 were those related to confidence in taking action to address medical treatment or health problems, while the least challenging items were those reflecting general opinions. The item 1 has different interpretations between urban and rural residents in China.
Conclusions:
Our study demonstrated the metric validity of the PAM-13 for assessing patient activation among people with SCI in China. However, caution is needed when comparing results across different cultural or social groups, as interpretations of self-reported items may differ.
