The context of measuring disability: Does it matter whether capability or performance is measured?

doi:10.1016/0895-4356(96)00214-4

Journal of Clinical Epidemiology

Volume 49, Issue 10, October 1996, Pages 1097-1101

https://doi.org/10.1016/0895-4356(96)00214-4 Get rights and content

Abstract

This study assesses the differences between two methods of conceptually framing physical disability questions, using two scenarios (capability and performance). The relationship between capability and performance was explored on the basis of the literature and empirically tested by administering two versions of the Activities Scale for Kids (ASK) to 28 physically disabled children. The capability version asked children what they “could do,” whereas the performance version asked what they “did do.” Capability was found to exceed performance (p < 0.001) by approximately 18%. The difference may relate to a difference in environmental contexts between the two versions, with performance reflecting abilities in usual (or real life) circumstances and capability reflecting abilities in a defined situation apart from real life. Researchers must, therefore, consider carefully the environmental circumstances in which they wish to evaluate outcomes, and use this information to decide whether to measure capability, performance, or both.

References (29)

RF Meenan
Health status assessment in pediatric rheumatology
Rheum Dis Clin North Am
(1987)
NL Young et al.
The role of children in reporting their physical disability
Arch Phys Med Rehabil
(1995)
JG Wright et al.
A comparative contrast of clinimetric and psychometric methods for constructing indexes and rating scales
J Clin Epidemiol
(1992)
JA Kopec
Concepts of disability: The activity space model
Soc Sci Med
(1995)
B Spilker
Quality of Life Assessments in Clinical Trials
(1990)
SM Haley et al.
Pediatric functional outcome measures
Phys Med Rehabil Clin North Am
(1991)
SM Haley et al.
Measuring physical disablement: The contextual challenge
Phys Ther
(1994)
GH Williams
Disablement and the social context of daily activity
Int Disabil Stud
(1987)
AR Feinstein et al.
Scientific and clinical problems in indexes of functional disability
Ann Intern Med
(1986)
I McDowel et al.
Measuring Health: A Guide to Rating Scales and Questionnaires
(1987)

DL Patrick et al.

Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation

(1993)

RM McFall

The essential role of theory in psychological assessment

JP Anderson et al.

JC Spencer

The usefulness of qualitative methods in rehabilitation: Issues of meaning, of context, and of change

Arch Phys Med Rehabil

(1993)

Cited by (118)

Construct validity of the Single Arm Military Press (SAMP) test for upper limb function in patients with neck pain
2023, Musculoskeletal Science and Practice
Citation Excerpt :
The sources of bias are often related to the patients’ over or under estimation of their functional capacity (Rose et al., 2008; Stratford et al., 2010). Evidence from the literature suggests that patients often have difficulties in estimating their ability to perform activities that they did not undertake during the last week because of pain, and their estimations often exceed their actual abilities (Young et al., 1996). Other patients perform their daily activities using compensatory mechanisms which is likely to influence the magnitude of their disability and thus the score of a subjective measure (Bialocerkowski, 2002).
Neck pain (NP) is often associated with upper limb disability (ULD). A clinically feasible measure to evaluate ULD in NP patients is necessary. The Single Arm Military Press (SAMP) is a ULD performance-based measure, specifically for NP patients. The validity of the SAMP in patients is still unknown.
To explore the construct validity (hypotheses testing) of the SAMP in NP patients.
A total of 210 NP patients and 81 controls were recruited. The SAMP; Disability of the Arm, Shoulder, and Hand (DASH); and Neck Disability Index (NDI) were completed at baseline and 4–7 days later. The Visual Analogue Scale (VAS) was used to measure NP and ULD severity pre-testing in both occasions. Patients were divided into 4-subgroups based on their NDI score. Convergent validity was examined using Pearson correlation. The t-test and analysis of variance (ANOVA) were used to evaluate discriminant and known groups’ validity. To determine SAMP cut-off scores, the sensitivity and specificity were explored.
A negative correlation between the SAMP and DASH/NDI scores was found in the patient group (r = −0.91 and −0.87, p < 0.01). The t-test revealed substantial differences (t = −23.96) in score between patients and controls. Also, ANOVA revealed substantial differences (f = 20.86) between the patients’ subgroups. The area under the curve (AUC) for patients and controls exceeded 0.90 when sensitivity and specificity were at equal importance.
The SAMP can distinguish between NP patients and controls, and between different NP disability levels. The responsiveness of the SAMP needs to be investigated.
The effects of COVID-19 restrictions on physical activity and mental health of children and young adults with physical and/or intellectual disabilities
2021, Disability and Health Journal
Citation Excerpt :
Since some children would not have been able to provide an assessment of their physical activity and mental health, it was decided that respondents would be the parents/carers to allow children and young adults with intellectual disabilities and non-verbal communication to be represented in the study.16 Parent reporting has previously been shown to demonstrate excellent agreement and concordance with child reported scores of activity levels in those with a disability.17 All respondents gave their electronic informed consent before being directed to the survey questions.
COVID-19 has caused unprecedented restrictions, significantly affecting the most vulnerable groups in society, such as those with a disability.
The aim of the study was to investigate the effects of COVID-19 lockdown restrictions on physical activity and mental health of children and young adults with physical and/or intellectual disabilities.
The study was a cross-sectional design. Parents/carers completed an electronic survey in the UK between June–July 2020 on behalf of their child. Through Likert scales and free-text questions, the survey asked about physical activity levels and mental health during lockdown compared to before, access to specialist facilities and equipment to aid with physical activity, and the short- and long-term concerns around ongoing lockdown restrictions.
Generally, respondents reported negative effects of lockdown restrictions, with 61% reporting a reduction in physical activity levels and over 90% reporting a negative impact on mental health (including poorer behaviour, mood, fitness and social and learning regression). Many respondents cited a lack of access to specialist facilities, therapies and equipment as reasons for this, and raised concerns about the long-term effects of this lack of access on their child’s mental health and physical activity levels.
The survey highlights the negative impact of the COVID-19 lockdown on the physical activity levels and mental health of children and young adults with disabilities and highlights the importance of addressing the needs of the disabled community as restrictions are eased.
Interrater Reliability of Activity Questionnaires After an Intensive Motor-Skill Learning Intervention for Children With Cerebral Palsy
2019, Archives of Physical Medicine and Rehabilitation
To investigate the reliability of parents-reported activity questionnaires after a motor-skill learning intervention for children with cerebral palsy (CP). We hypothesize that the intervention process might influence parental judgment.
Double-blind randomized trial.
Conventional therapy was delivered in the usual context while intensive intervention was provided at the Catholic University of Louvain.
Children with CP (N=41; age range 5-18y, Gross Motor Function Classification System I-IV) were randomized to a control group (CG) (n=21, 2 dropouts) receiving conventional therapy or an intervention group (IG) (n=20) receiving hand-arm bimanual intensive therapy—including lower extremities (HABIT-ILE).
Conventional therapy (mostly neurodevelopmental) was delivered as ongoing treatment (1-5 times/wk). HABIT-ILE, based on motor-skill learning, was delivered over 2 weeks. All children were assessed at T1 (baseline), T2 (3wk after baseline) and T3 (4mo after baseline).
ABILHAND-Kids and ACTIVLIM-CP questionnaires rated by parents (perception) and 2 examiners (videotapes).
Agreement (level/range) between examiners was systematically almost perfect (P≤.001). At baseline, moderate to almost perfect agreement (level/range) was observed between parents and examiners (P≤.001). At T2 and T3, a similar agreement (level/range) was observed for the CG. For the IG, a similar level of agreement was observed, but the range of agreement varied from poor to almost perfect (P≤.001), with parents estimating higher performance measures compared to examiners after intervention. Higher performance was associated with higher satisfaction scores of the child’s functional goals at T3.
Parents and examiners have a similar perception of the child’s performance at baseline and during conventional therapy. Their perceptions are less congruent after a motor-skill learning intervention, probably due to the goal-oriented process of the intervention. Therefore, our results favor the use of blind observations of home-videotaped items after intensive motor-skill learning interventions.
Outcome measures
2019, Pediatric Hand Therapy
The assessment of upper extremity limitations in children requires careful attention to the components of the test and their measurement properties. The purpose of assessment in children includes screening, evaluation, benchmarking, goal setting, reimbursement, monitoring outcomes, comparing outcomes, data-driven decision making, and long-term monitoring across the lifespan. This chapter provides an overview of different types of outcome instruments and a detailed description of the measurement properties along with their interpretation. The chapter then describes the considerations for therapists during administration, scoring, interpretation, and selection of outcome measures. An overview of the functional outcome measures used for the pediatric upper extremity is provided for measures available in the traditional format using classical and modern methods of measurement, the contemporary dynamic computerized adaptive format, and fixed-length short forms. Finally, the chapter provides resources for therapists to maintain ongoing competency in assessment of the pediatric upper extremity.
Sitting Capacity and Performance in Infants with Typical Development and Infants with Motor Delay
2024, Physical and Occupational Therapy in Pediatrics
Translation, cross-cultural adaptation, validity and reliability of the Brazilian Portuguese version of Activity Scale for Kids questionnaire
2023, Child: Care, Health and Development

View all citing articles on Scopus

¹: N. L. Young is supported by an Ontario Ministry of Health Fellowship.

²: K. K. Yoshida is supported by an Ontario Ministry of Health Career Scientist Award.

³: J. G. Wright is supported by a Medical Research Council of Canada Scholarship.

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Original articleThe context of measuring disability: Does it matter whether capability or performance is measured?

Abstract

Rheum Dis Clin North Am

Arch Phys Med Rehabil

J Clin Epidemiol

Soc Sci Med

Quality of Life Assessments in Clinical Trials

Pediatric functional outcome measures

Phys Med Rehabil Clin North Am

Measuring physical disablement: The contextual challenge

Phys Ther

Disablement and the social context of daily activity

Int Disabil Stud

Scientific and clinical problems in indexes of functional disability

Ann Intern Med

Measuring Health: A Guide to Rating Scales and Questionnaires

Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation

The essential role of theory in psychological assessment

The usefulness of qualitative methods in rehabilitation: Issues of meaning, of context, and of change

Arch Phys Med Rehabil

Original article
The context of measuring disability: Does it matter whether capability or performance is measured?