Macdermid J1,2, Farzad M3, Furtado R2
1Hand and Upper Limb Centre, London, Canada, 2University of Western Ontario, Physical Therapy, London, Canada, 3The University of Social Welfare and Rehabilitation Sciences, Occupational Therapy, Tehran, Iran

Background: Participation is an important outcome and can be challenging to measure.

Purpose: This study used sequential cognitive interviewing to refine and cross-culturally adapt a participation outcome measure into an English North American context: the ABLE (Ability and Barriers to Life Engagement).

Methods: In phase 1, the developer (MF), an expert in outcome measure development (JM) and a graduate student (RF) met to discuss the construct of the participation measure (and each item) developed in Persian, and adapted it into an English draft version (literal translation). In Phase 2, a focus group was conducted with a sample of 9 researchers in order to identify measurements, clarity, and cross-cultural issues for creating an adapted English version. Edits to items and scale presentation were made to improve content validity, cultural validity and clarity. This beta version was evaluated using a cognitive interviewing approach on patients with upper [jm1] extremity problems (2 men; 5 women; age range: 42 to 78 years) and 6 clinicians. The dissonance between intended meaning and participant perception was coded into categories: Clarity/comprehension, Relevance, Inadequate response definition, Reference point, Perspective modifiers, and Calibration across items.

Results: The concept was clarified in the instructions as participants were often unclear about the construct. This was stated as “Participation or life engagement means being ABLE to take part in your important roles and life situations. Full participation means that you are able to do everything you want to do”. The scaling proved to be unclear or mis-aligned with the construct, and was refined by separating items that referred to the amount of participation versus the extent a factor interfered with participation. The final ABLE has 16 items that measure the extent that respondents can participate in life situations; and the second set of 14 items to rate potential barriers/facilitators of participating; focusing on a social view of disability. Most of the cognitive dissonance arose from lack of clarity and perspective modifiers. Cognitive interviews revealed wide variation in interpretation and contextual standards by which items were calibrated.

Conclusion(s): The ABLE was cross-culturally validated, but required substantial modification.

Implications: Further psychometric evaluation of the revised scale is required.

Keywords: Participation, outcome measure, cognitive interview

Funding acknowledgements: Joy MacDermid is supported a CIHR chair in Gender, Work and Health.

Topic: Outcome measurement; Disability & rehabilitation; Musculoskeletal: upper limb

Ethics approval required: Yes
Institution: University of Western Ontario
Ethics committee: Ethics Board
Ethics number: Title: Cognitive interviewing of outcome measures

All authors, affiliations and abstracts have been published as submitted.

Back to the listing