The ambiguity of the concept of participation in measurement instruments: operationalization of participation influences research outcomes

Hillegonda A Stallinga; Pieter U Dijkstra; Isaac Bos; Yvonne F Heerkens; Petrie F Roodbol

doi:10.1177/0269215514537092

The ambiguity of the concept of participation in measurement instruments: operationalization of participation influences research outcomes

Clin Rehabil. 2014 Dec;28(12):1225-36. doi: 10.1177/0269215514537092. Epub 2014 Jun 10.

Authors

Hillegonda A Stallinga¹, Pieter U Dijkstra², Isaac Bos³, Yvonne F Heerkens⁴, Petrie F Roodbol⁵

Affiliations

¹ Wenckebach Institute, University of Groningen, Groningen, The Netherlands h.a.stallinga@umcg.nl.
² Department of Rehabilitation Medicine, University of Groningen, Groningen, The Netherlands Department of Oral and Maxillofacial Surgery, University of Groningen, Groningen, The Netherlands.
³ Department of Neurology, University of Groningen, Groningen, The Netherlands.
⁴ Dutch Institute of Allied Health Professions, Amersfoort, The Netherlands Department of Occupation and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
⁵ Wenckebach Institute, University of Groningen, Groningen, The Netherlands.

PMID: 24917587
DOI: 10.1177/0269215514537092

Abstract

Objective: This study explores, based on the International Classification of Functioning, Disability and Health, the consequences of different operationalizations of participation in regression models predicting participation in one sample of patients.

Design: Cross-sectional, comparative study.

Setting: Department of Neurology of a University Hospital.

Subjects: A total of 677 patients with a Neuromuscular Disease.

Measures: Participation was measured using the Neuromuscular Disease Impact Profile questionnaire, the RAND-36 Item Health Survey (social functioning, role limitations-physical, role limitations-emotional) and the Impact on Participation and Autonomy questionnaire (autonomy outdoors, social relations). Potential predictors of participation included type of neuromuscular disease, body functions (measured with Neuromuscular Disease Impact Profile), activities (measured with Neuromuscular Disease Impact Profile), environmental factors (measured with Neuromuscular Disease Impact Profile), and personal factors (measured with the 13-item Sense of Coherence questionnaire). The results were controlled for patient characteristics.

Results: Participation was statistically predicted by different determinants depending on the operationalization used for participation. Additionally, the regression coefficients differed significantly. Body functions and activities were predictors in five out of six operationalizations of participation. Sense of coherence predicted participation in all of the operationalizations. The explained variance of the different models ranged from 25% (RAND-36 role limitations-emotional) to 65% (Neuromuscular Disease Impact Profile).

Conclusions: Different operationalizations of participation result in different prediction models. Lack of conceptual consensus makes participation an ambiguous concept in research, and this ambiguity makes evidence-based decisions directed at enhancing participation difficult. Participation needs to be operationalized in an unambiguous and standard way in order to improve the comparability of outcomes.

Keywords: Disability and Health (ICF); International Classification of Functioning; measurement instruments; neuromuscular disease; participation; regression models.

MeSH terms

Cross-Sectional Studies
Epidemiologic Research Design*
Female
Humans
International Classification of Functioning, Disability and Health*
Male
Middle Aged
Netherlands
Neuromuscular Diseases*
Regression Analysis
Sickness Impact Profile*
Surveys and Questionnaires