Archives of Physical Medicine and Rehabilitation
Special communicationDifficult to Measure Constructs: Conceptual and Methodological Issues Concerning Participation and Environmental Factors
Section snippets
Conceptualization of Participation
The current term participation was selected for use in the ICF as part of an effort to replace the negative terminology in the WHO's predecessor to the ICF—the ICIDH.4 The ICIDH term corresponding to participation was handicap, which was not only a negative term but also a pejorative expression for people with disabilities using the English language, and unacceptable to the disability rights movement. In the ICF, participation is viewed as the positive aspect of the concept, while participation
Measurement of Participation
One might argue that participation has been measured since the beginning of rehabilitation research with indicators like marital and employment status. However, the first true tools focusing on the concept came after the publication of the ICIDH and were often based on this taxonomy. For example, the CHART included items assessing the 6 domains of handicap articulated in the ICIDH.23, 24 The CHART asks the respondent to self-report relatively objective counts or frequencies relating to
Conceptualization of Environment
In his book Principles of Topological Psychology, Lewin30 stated that behavior is a function of the person and the person's environment, expressed in what is known as Lewin's equation: B=ƒ(P,E). This contradicted the prevailing theories of the time such as Freudian psychology, which referred to past and present intrapsychic processes to explain behavior. The formula and the underlying theorizing were well known to early pioneers of rehabilitation research, especially in psychology and related
Measurement of Environment
As indicated, the ICF offers a scheme for coding environmental factors; in fact, its authors envision more than the coding of absence versus presence of such factors. As barriers, they are rated from none to complete on a 5-point ordinal scale; as facilitators, the parallel scale runs from none to complete facilitator.1(p232) (The apparent contradiction with coding them as a problem, specified on page 222, is never explained.) Given the directive of coding “from the perspective of the person
Conclusions
This article discusses issues related to and makes suggestions for measurement of 2 concepts that are problematic, in the sense that our models of disablement suggest that they are key elements in studying rehabilitation and disability, but our theorizing let alone our measurement instruments are not up to the challenge: participation and environment. Most rehabilitation clinical trials to date have had a limited scope, focusing on how the rehabilitation process improved the performance of ADLs
References (93)
Enhancing the conceptual clarity of the activity and participation components of the International Classification of Functioning, Disability, and Health
Soc Sci Med
(2008)- et al.
A comparative contrast of clinimetric and psychometric methods for constructing indexes and rating scales
J Clin Epidemiol
(1992) - et al.
The interrater reliability of the Community Health Environment Checklist
Arch Phys Med Rehabil
(2008) - et al.
Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort
Arch Phys Med Rehabil
(2006) - et al.
Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers
Arch Phys Med Rehabil
(2004) - et al.
Participation survey/mobility: psychometric properties of a measure of participation for people with mobility impairments and limitations
Arch Phys Med Rehabil
(2006) - et al.
Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men
Arch Phys Med Rehabil
(2008) - et al.
Environmental barriers to and availability of healthy foods for people with mobility disabilities living in urban and suburban neighborhoods
Arch Phys Med Rehabil
(2008) Introduction—conceptualization of human environments
J Environ Psychol
(1998)- et al.
Promoting active living among people with physical disabilities evidence for neighborhood-level buoys
Am J Prev Med
(2008)
International classification of functioning, disability and health
Conceptual models of disability: past, present and future
The future of disability in America
International classification of impairments, disabilities and handicaps: a manual of classification relating to the consequences of disease
Are the ICF activity and participation dimensions distinct?
J Rehabil Med
Applying the International Classification of Functioning, Disability and Health (ICF) to measure childhood disability
Disabil Rehabil
Action theory, disability and ICF
Disabil Rehabil
Measuring participation according to the International Classification of Functioning, Disability and Health (ICF)
Disabil Rehabil
ICF: internal and external obstacles to implementation
The implementation of the International Classification of Functioning, Disability and Health in Germany: experiences and problems
Int J Rehabil Res
The environment in the International Classification of Functioning, Disability, and Health
J Appl Res Intell Disabil
Operationalizing the International Classification of Functioning, Disability and Health in clinical settings
Rehabil Psychol
Health measurement using the ICF: test-retest reliability study of ICF codes and qualifiers in geriatric care
Health Qual Life Outcomes
Domains of outcomes in spinal cord injury for clinical trials to improve neurological function
J Rehabil Res Dev
Disability in America: toward a national agenda for prevention
Enabling America: assessing the role of rehabilitation science and engineering
An epidemiology of disability among adults in the United States
Milbank Mem Fund Q Health Soc
Some conceptual issues in disability and rehabilitation
The social system
Disability concepts revisited: implications for prevention
Quantifying handicap: a new measure of long-term rehabilitation outcomes
Arch Phys Med Rehabil
Incorporating the cognitive independence domain into CHART
J Rehabil Outcomes Meas
Participation Objective, Participation Subjective: a measure of participation combining outsider and insider perspectives
J Head Trauma Rehabil
Study protocol for the world health organization project to develop a quality of life assessment instrument (WHOQOL)
Qual Life Res
Clinimetrics
An additional basic science for clinical medicine, IV: the development of clinimetrics
Ann Intern Med
A proposal for a new method of evaluation of the newborn infant
Curr Res Anesth Analg
Principles of topological psychology
Ecological psychology; concepts and methods for studying the environment of human behavior
Physical disability, a psychosocial approach
From disablement to enablement: conceptual models of disability in the 20th century
Disabil Rehabil
Understanding disability: from theory to practice
The social model of disability repossessed
Disabled people and social policy: from exclusion to inclusion
Redefining the disability problem
Crit Publ Health
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Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitation Services, U.S. Department of Education, to Craig Hospital (grant nos. H133N060005 and H133A070022), and the Mount Sinai School of Medicine (grant nos. H133B040033 and H133N060027).
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 authors or on any organization with which the authors are associated.
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