The Measurement Properties of the Dutch Keele Assessment of Participation Questionnaire in Older Adults with Joint Pain and Comorbidity

Hermsen, Lotte; Terwee, Caroline B.; Leone, Stephanie S.; vd Zwaard, Babette; Smalbrugge, Martin; Dekker, Joost; vd Horst, Henriëtte; Wilkie, Ross

Abstract

Background: Social participation provides an account of the wider influence of musculoskeletal conditions on functioning and captures the personal and social impact. Maintaining social participation is important to individuals with musculoskeletal conditions. The Keele Assessment of Participation (KAP) questionnaire measures problems in social participation, in 11 areas of life. This study determined the measurement properties of the Dutch KAP questionnaire in older adults with joint pain and comorbidity (≥2 chronic conditions); in particular we focused on exploring the use of a continuous scoring for application in longitudinal studies in the UK and the Netherlands.

Methods: The original KAP was translated into Dutch and additional filters were added in 3 items to aid classification of restrictions in participation. A longitudinal cohort of older adults, aged 65 and over, with joint pain and comorbidity provided baseline data (n = 407), follow-up data at 6 months (n = 364) and test-retest data (n = 121), to examine the following measurement properties: structural validity [factor analyses (FA)], internal consistency (Cronbach's alpha), construct validity (hypothesis testing; comparison with SF-36, Impact on Participation and Autonomy, IADL index), reliability [Intra-class Correlation Coefficient (ICC)], responsiveness [anchor-based approach, Area Under the Curve (AUC)] and cross-cultural validity (multi-group confirmatory FA (CFA) and DIF analyses).

Results: FA revealed two domains: (i) everyday participation (6 items) and (ii) discretionary participation (3 items), with Cronbach's alpha's of 0.74 and 0.57 and ICC's of 0.63 (95% CI 0.49, 0.73) and 0.57 (95% CI 0.44, 0.68), respectively. Construct testing confirmed about 75% of the hypotheses. The AUC for discrimination between stable and deteriorated participants was 0.62 for everyday participation and 0.54 for discretionary participation. The multi-group CFA showed some measurement invariance (RMSEA = 0.106, CFI = 0.967, TLI = 0.973) and DIF testing on item level showed uniform DIF in 7 out of 11 items (64%).

Conclusions: The domain everyday participation showed good convergent validity and moderate reliability, suggesting it could be applied to measure participation in research studies. However, the results suggest that the items of discretionary participation (i.e. work, education and social activities) may be best applied as single items. The poor responsiveness and high levels of uniform DIF question the application of the KAP domains in longitudinal studies, however further testing is required (e.g. in a larger sample, with a longer follow-up period).

Citation

Hermsen, L., Terwee, C. B., Leone, S. S., vd Zwaard, B., Smalbrugge, M., Dekker, J., …Wilkie, R. (2013, April). The Measurement Properties of the Dutch Keele Assessment of Participation Questionnaire in Older Adults with Joint Pain and Comorbidity. Poster presented at Rheumatology 2013

• Presentation Conference Type: Poster
• Conference Name: Rheumatology 2013
• Start Date: Apr 23, 2013
• End Date: Apr 25, 2013
• Deposit Date: Oct 16, 2023
• Publisher URL: https://academic.oup.com/rheumatology/article/52/suppl_1/i95/1929057