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Psychometric properties of the impact on Participation and Autonomy Questionnaire☆,☆☆,★

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Abstract

Cardol M, de Haan RJ, de Jong BA, van den Bos GAM, de Groot IJM. Psychometric properties of the impact on participation and autonomy questionnaire. Arch Phys Med Rehabil 2001;82:210-6. Objective: To examine the homogeneity, test-retest reliability, construct validity, and concurrent validity of the Impact on Participation and Autonomy Questionnaire (IPAQ). Design: Cross-sectional study with a test-retest subsample. Patients: One hundred twenty-six persons from 5 diagnostic groups recruited from the outpatients clinics of 2 rehabilitation centers and the rehabilitation department of an academic hospital. Interventions: The IPAQ and 3 other self-administered questionnaires (Sickness Impact Profile [68-item version], London Handicap Scale [LHS], Medical Outcome Study Short-Form Health Survey). The IPAQ was completed twice by 75 respondents within approximately 2 weeks. Results: The IPAQ addresses autonomy and participation in 5 domains: autonomy indoors, family role, autonomy outdoors, social relations, and work and educational opportunities. Cronbach's alpha for the several domains ranged between.81 and.91, indicating good homogeneity. On item level, weighted kappas ranged between.56 and.90. On domain level, the test-retest reliability of the IPAQ was good: intraclass correlation coefficients ranged between.83 and.91. Convergent validity was largely supported by the correlations between 4 domains of the LHS and the IPAQ. Discriminant validity was best demonstrated by low correlations between the IPAQ and 2 domains of the LHS representing theoretically different constructs. Conclusion: The IPAQ is a reliable and valid instrument for assessing autonomy and participation in chronic disorders. Its responsiveness requires further study.

Section snippets

Study population

The IPAQ was tested in 5 diagnostic groups of regular consumers of rehabilitation treatment: persons with respectively, neuromuscular disease, stroke, spinal cord injury (SCI), rheumatoid arthritis, or fibromyalgia. Excluded were persons younger than 18 years or older than 75 years, and people with difficulty in comprehending the Dutch language.

We included 150 consecutive individuals, 30 persons in each group. The participants were recruited from the outpatient clinics of a general

Study population

A total of 257 questionnaires were mailed; 126 questionnaires were returned (response rate, 49%). Response rates of the various diagnostic groups differed: 86% response for neuromuscular disease, 47% for SCI, 45% for stroke, 42% for rheumatoid arthritis, and 37% for fibromyalgia. Mean age ± standard deviation of the study population was 52.6 ± 13.4 years; 78 of the respondents were women. Median duration of disease ranged between 2 and 12 years, with the smallest range in the group with stroke.

Discussion

Many authors have emphasized that it is not the instrument that has to be validated, but its application for a certain purpose in a certain population.6, 27, 28, 29, 30 Because the IPAQ is meant to be a generic questionnaire, its psychometric properties were evaluated in a heterogeneous study population. In our sample, the response rate for persons with fibromyalgia was especially low. Response rates tend to be lower among the sick and the elderly, and to quantify the impact of nonresponse one

Conclusion

Based on our findings, we conclude that the IPAQ is related to other health status questionnaires as described above, but differs from them because of its focus on autonomy and participation as perceived by the person. The IPAQ can be regarded as complementary to health status instruments and important for rehabilitation practice, because optimizing participation is the ultimate goal in the rehabilitation of the chronically ill. Furthermore, the IPAQ can be considered a reliable and valid

Acknowledgements

The authors thank the respondents who took part in the study and the rehabilitation centers Revalidatie Centrum Amsterdam and Jan van Breemen Instituut for their cooperation in recruiting participants for this study. We also thank Anita Beelen for general support, and Professor C.D. Ward for translating the IPAQ.

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    Supported in part by the Albert Heijn Trust Fund.

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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    Reprint requests to Mieke Cardol, Dept of Rehabilitation, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands, e-mail: [email protected].

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    Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.