Special communication
Difficult to Measure Constructs: Conceptual and Methodological Issues Concerning Participation and Environmental Factors

Presented to the Annual Meeting of the American Congress of Rehabilitation Medicine, Washington, DC, October 3–7, 2007; and as the Norington Lecture to the Annual Meeting of the Autralasian Faculty of Rehabilitation Medicine, Queenstown, New Zealand, July 24, 2009.
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Abstract

Whiteneck G, Dijkers MP. Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors.

For rehabilitation and disability research, participation and environment are 2 crucial constructs that have been placed center stage by the International Classification of Functioning, Disability and Health (ICF). However, neither construct is adequately conceptualized by the ICF, and both are difficult to measure. This article addresses conceptual and methodologic issues related to these ICF constructs, and recommends an improved distinction between activities and participation, as well as elaboration of environment. A division of the combined ICF categories for activity and participation into 2 separate taxonomies is proposed to guide future research. The issue of measuring participation from objective and subjective perspectives is examined, and maintaining these distinct conceptual domains in the measurement of participation is recommended. The methodological issues contributing to the difficulty of measuring participation are discussed, including potential dimensionality, alternative metrics, and the appropriateness of various measurement models. For environment, the need for theory to focus research on those aspects of the environment that interact with individuals' impairments and functional limitations in affecting activities and participation is discussed, along with potential measurement models for those aspects. The limitations resulting from reliance on research participants as reporters on their own environment are set forth. Addressing these conceptual and methodological issues is required before the measurement of participation and environmental factors can advance and these important constructs can be used more effectively in rehabilitation and disability observational research and trials.

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

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  • Cited by (0)

    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.

    Reprints are not be available from the author.

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