Discussion
The Chinese version of the PaArticular Scales is a patient-relevant
outcome assessment tool and satisfies the objectivity, reliability, and
validity of interval scale measurements. This study found that the
Activity subscale had 3 factors (i.e., latent variables) and the
Participation subscale had a single factor. The 3 factors in the
Activity subscale were lower-limb activity, upper-limb activity, and
self-care activity; and the 1 factor in the Participation subscale was
participation. The 2 subscales explained 75.176% and 62.825% of the
variance in the scale, respectively, indicating that the results had
practical significance.
The Chinese version of the PaArticular Scales had excellent internal
consistency and reliability. Cronbach’s α coefficients for the
Activity subscale and Participation subscale were .97 and .94,
respectively, which were slightly higher than those found by Müller et
al. for 191 elderly residents with joint contractures in German LTC
facilities (α = .96 and .92).12 Although the 2
studies were carried out in different countries, the αcoefficient values were found to be very close. According to the
standard set by Nunnally and Bernstein (α coefficient ≥
.80),38 the PaArticular Scales have excellent internal
consistency and reliability across ethnic groups.
The criterion validity tests showed that for individuals older than 64
years with severe joint contractures, strong evidence indicates that the
Chinese version of the PaArticular Scales is linearly related to the
WHODAS 2.0-36 items (r = .770, p < .001). The
Pearson correlation coefficient is large. These results show that,
similar to the WHODAS 2.0 ̵̵36 items, the PaArticular Scales developed
using the ICF of the WHO as the standard can be another simple tool for
the clinical measurement of activity and participation, and it addresses
the gap for measuring patients with joint
contractures.5 However, although the Chinese version
of the PaArticular Scales is also based on the ICF, it is mainly used
for patients with joint contractures, which is different from the widely
used WHODAS 2.0 ̵̵36 items. Perhaps this difference can explain why the
correlation between the 2 scales was not very high. Another reason may
be that the majority of the participants in this study were
institutionalized residents and required nursing care. Obviously, these
characteristics are not considered to be associated with the applicable
subjects of the WHODAS 2.0 ̵̵36 items; therefore, the result may be caused
by many different composition characteristics (for example, physical
conditions).
Criterion validity was also assessed to test the correlation between the
Chinese version of the PaArticular Scales and the established Chinese
version of the WHOQOL-BREF. For individuals older than 64 years with
severe joint contractures, very strong evidence indicates that the
Chinese version of the PaArticular Scales is linearly related to the
WHOQOL-BREF (r = -.553, p < .001). The Pearson
correlation coefficient is large. The newly developed scale demonstrated
criterion validity, which was consistent with findings by Chen et
al.10 The study noted that activity and participation,
personal factors, and body function and structure are determinants of
QOL for elderly residents in LTC facilities. Among them, activity and
participation have the best explanatory power, up to 52.1%, indicating
that activity and participation have practical significance for the QOL
of elderly residents. The results also echo the view of Rantanen et al.
that providing outdoor activities for elderly residents with severely
limited mobility may positively affect QOL.11
Some potential limitations should be considered. First, the data in this
study were from a self-reported questionnaire. Although most of the
responses were fully validated, it is still difficult to predict or
estimate the subjective bias of reported data. For example, in the
analysis of the reported data, there might be deviations in the actual
experience of the participants. Second, the participants were recruited
from LTC facilities, and the design considerations of this study could
only reflect the view of these ethnic groups. Although the demographic
variables, such as the participants’ age, gender, education, and
visitation rate, were controlled, caution should be used when
generalizing these findings to other settings or to other elderly
populations. Third, although the sample size of this study satisfied the
requirements for establishing stable person and item estimates and power
analysis,16 it is still necessary to study the Chinese
version of the PaArticular Scales with a larger sample size to obtain
more complete and reliable data. Finally, to ensure that the Chinese
version has applicability and generalizability, the samples in future
studies should be more representative and more inclusive, for example,
additional studies in different domains.
This study demonstrated that the Chinese version of the PaArticular
Scales is a reliable and effective tool for measuring the activity and
participation of elderly individuals with joint contractures. As a good
sound outcome measurement tool, the Chinese version of the PaArticular
Scales developed in this study not only fills the gap in assessing the
activity and participation of elderly Chinese individuals but also makes
the evaluation of elderly individuals with joint contractures more
comprehensive, which can be the basis for improving their activity,
participation, and QOL. Furthermore, this tool can also be used in the
treatment, rehabilitation, prevention, and research programmes of LTC
facilities.