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Assessment of Life Habits

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Purpose

The Life-H assesses participants on 77 life habits from daily activities to social participation across 12 domains. It is a self-report based on one’s perception of difficulty and assistance required.

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Instrument Details

Acronym Life-H

Area of Assessment

Activities of Daily Living
Communication
Eating
Executive Functioning
Life Participation
Quality of Life

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Information about purchasing the LIFE-H can be found at http://www.ripph.qc.ca/?rub2=4&rub=15&lang=en

Diagnosis/Conditions

  • Cerebral Palsy
  • Multiple Sclerosis
  • Spinal Cord Injury
  • Stroke Recovery

Key Descriptions

  • The LIFE-H is composed of two scales.
  • The first scale assesses accomplishments rated across 2 dimensions:
    1) The degree of difficulty experienced
    2) The kind of assistance required (help, technical assistance, physical arrangements)
  • Life-H Accomplishments Scale:
    9 - Accomplished with no difficulty and no assistance
    8 - Accomplished with no difficulty and an assistive device or adaptation
    7 - Accomplished with difficulty and no assistance
    6 - Accomplished with difficulty and an assistive device or adaptation
    5 - Accomplished with no difficulty and human assistance
    4 - Accomplished with no difficulty and an assistive device or adaptation and human assistance
    3 - Accomplished with difficulty and human assistance
    2 - Accomplished with difficulty and an assistive device or adaptation and human assistance
    1 - Accomplished by a proxy
    0 - Not accomplished
    N/A - Not applicable
  • The second scale assesses the patient's satisfaction with daily activities or social roles. The satisfaction can range from 1 to 5 (with 5 indicating a high level of satisfaction)
  • Life-H Daily Activities Domain:
    1) Nutrition - preparing your meal; eating in restaurants
    2) Fitness - sleep; participating in physical activities to maintain or improve your health
    3) Personal care - attending to your personal hygiene; using a bathroom or toilet other than those in your home
    4) Communication - communicating with another person at home or in the community; written communication
    5) Housing - maintaining your home; doing major household tasks
    6) Mobility - getting around on slippery or uneven surfaces; driving a vehicle
  • Life-H Social Roles Domain:
    1) Responsibility - making purchases; taking care of your children
    2) Interpersonal relationships - maintaining friendships; having a sexual relationship
    3) Community life - getting to public buildings in your community; participating in spiritual or religious practices
    4) Education - participating in educational activities or vocational training; undertaking vocational training
    5) Work - holding a paid job; carrying out familial or homemaking tasks as your main occupation
    6) Recreation - participating in sporting or recreational activities; taking part in outdoor activities

Number of Items

Long: 242
Short: 77
Long (children): 240
Short (children): 62

Equipment Required

  • Find a sample of the manual http://www.ripph.qc.ca/sites/default/files/uploads/documents/M_14-99_ANa_Mhavie_14-99_anglais_abrege_no-reproduction.pdf

Time to Administer

2 hours

LIFE-H 3.1 short form: 20-40 minutes
LIFE H 3.0 long form: 20-120 minutes

Required Training

Reading an Article/Manual

Age Ranges

Infant

0 - 2

years

Preschool Child

2 - 5

years

Child

6 - 12

years

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated by Sue Saliga, PT, MS, DHSc, Anna de Joya, PT, MS, NCS, and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Ashley Marrapode, SPT, Taylor McCulloch. SPT, Kristy Samra, SPT in 11/2012. Reviewed by Rie Yoshida and Heather Anderson as part of StrokEDGE task force of the Neurology Section of the APTA in 2016.

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

 

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 months post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

NR

R

R

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

NR

R

R

R

R

TBI EDGE

NR

NR

NR

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

 

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

Recommendations for entry-level physical therapy education and use in research:

 

 

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

StrokEDGE

No

Yes

Yes

Not reported

TBI EDGE

No

Yes

Yes

Not reported

Considerations

Evidence Based Review for Research (Magasi et al, 2007). The group identified the following considerations:
-Low ceiling effects
-The satisfaction scale appears to have little empirical support
-Limited use in clinical practice and research
-Conceptual foundation not widely known.

Translations Available:
-Danish
-French
-German
-Italian
-Swedish

Stroke:

(Poulin and Desrosiers, 2008; nstroke = 40, nproxy = 40; mean age of stroke patients = 73.6 (8.4) years; mean time post stroke = 43.5 (32.0) months; French sample, Stroke)

  • Excellent level of agreement between stroke patients and their proxies (ICC = 0.82) suggests that proxies are able to complete LIFE-H when stroke patients are unable to respond

LIFE-H

ICC

Level of Reliability

Nutrition

0.76

Excellent

Fitness

0.61

Adequate

Personal Care

0.93

Excellent

Communication

0.59

Adequate

Housing

0.83

Excellent

Mobility

0.86

Excellent

Daily activities sub-score

0.87

Excellent

Responsibilities

0.63

Adequate

Interpersonal relationships

0.41

Adequate

Community life

0.92

Excellent

Leisure

0.82

Excellent

Education/Employment

N/A

N/A

Social roles sub-score

0.73

Adequate

Total Score

0.82

Excellent

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Older Adults and Geriatric Care

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Standard Error of Measurement (SEM)

Older Adults:

(Lemmens et al, 2006; n = 85 adults with functional limitations and = 40 healthy adults; sample included various chronic illnesses; dutch sample, Older Adults)

Life-H Standard Error of Measurement:

LIFE-H categories

SEM

Nutrition

1.25

Fitness

1.51

Personal care

0.89

Communication

0.89

Residence

1.25

Mobility

1.60

Responsibility

1.38

Social relations

1.60

Community

0.99

Education

N/A

Employment

N/A

Recreation

1.56

Daily activities

0.78

Social roles

0.92

Total score

0.76

SEM = standard error of measurement

Older Adults with disabilities:

(Noreau et al, 2004; n=40; mean age = 76.5(8.6) years; calculated from standard deviation and ICC values given in Table 4)

LIFE-H

SEM

Personal care

0.47

Nutrition

0.70

Housing

0.56

Mobility

1.03

Communication

0.55

Fitness

1.34

Daily Activities Sub-score

0.24

Responsibility

0.40

Community life

0.78

Recreation

2.15

Interpersonal relationships

--

Education/Employment

N/A

Social Roles Sub-score

0.49

Total Score

0.25

LIFE-H

SEM

Personal care

0.47

Nutrition

0.70

Minimal Detectable Change (MDC)

Older Adults with Disabilities:

(Noreau et al, 2004; = 40; mean age = 76.5 (8.6) years; calculated from standard deviation and ICC values given in Table 4, Older Adults with Disabilities)

LIFE-H

MDC

Personal care

1.30

Nutrition

1.93

Housing

1.56

Mobility

2.85

Communication

1.52

Fitness

3.71

Daily Activities Sub-score

0.67

Responsibility

1.10

Community life

2.17

Recreation

5.95

Interpersonal relationships

--

Education/Employment

N/A

Social Roles Sub-score

1.36

Total Score

0.68

Normative Data

Older Adults:

(Desrosiers et al, 2009; n = 350 randomly recruited community-dwelling elderly adults, Older Adults)

Life-H Norms by Age Group:

   

Age Range

Daily activities

p

65–69

70–74

75–79

80–84

85+

Nutrition

0.97

8.1 (1.3)

7.9 (1.2)

8.0 (1.4)

8.0 (1.4)

7.9 (1.1)

Fitness

0.06

8.6 (0.9)

8.6 (0.5)

8.7 (0.5)

8.4 (0.8)

8.4 (0.8)

Personal care

< 0.001

8.9 (0.2)

8.8 (0.3)

8.8 (0.3)

8.7 (0.3)

8.6 (0.4)

Communication

< 0.001

8.8 (0.3)

8.6 (0.6)

8.7 (0.4)

8.5 (0.7)

8.3 (0.9)

Housing

0.003

7.6 (0.9)

7.3 (0.9)

7.2 (0.8)

7.5 (0.9)

7.1 (0.9)

Mobility

< 0.001

8.6 (0.7)

8.6 (0.6)

8.2 (1.1)

7.9 (1.2)

7.5 (1.7)

Daily activities subscore

< 0.001

8.4 (0.3)

8.3 (0.3)

8.3 (0.4)

8.2 (0.4)

8.0 (0.5)

Social roles

p

65–69

70–74

75–79

80–84

85+

Responsibilities

0.09

8.3 (0.8)

8.3 (0.8)

8.5 (0.7)

8.5 (0.9)

8.2 (1.0)

Interpersonal relationships

0.46

8.5 (0.8)

8.6 (0.8)

8.5 (1.0)

8.7 (0.7)

8.4 (1.0)

Community life

< 0.001

8.8 (0.7)

8.7 (0.6)

8.6 (0.8)

8.5 (1.0)

8.1 (1.6)

Leisure

< 0.001

7.5 (1.5)

7.9 (1.3)

7.0 (2.2)

7.4 (2.0)

6.4 (2.5)

Social roles subscore

< 0.001

8.4 (0.5)

8.5 (0.5)

8.3 (0.6)

8.4 (0.7)

7.9 (1.0)

Total score

< 0.001

8.4 (0.3)

8.4 (0.3)

8.3 (0.4)

8.3 (0.5)

8.0 (0.6)

Test/Retest Reliability

Elderly People with Disabilities:

(Noreau et al, 2004; test-retest study = 40; mean age = 76.5 (8.6); gender = female 29 (72.5); interval between 2 time frames = 5-10 days, Elderly People with Disabilities)

  • Total Score: ICC = 0.95 (Excellent)
  • Daily Activities Subscore: ICC = 0.96 (Excellent)
  • Social Roles Subscore: ICC = 0.76 (Adequate)

 

LIFE-H Categories

 

ICC

Daily Activities

   

Personal Care

Excellent

0.97

Nutrition

Excellent

0.90

Housing

Excellent

0.78

Mobility

Excellent

0.76

Communication

Excellent

0.75

Fitness

Poor

0.30

Subscore

Excellent

0.96

Social Roles

   

Responsibility

Excellent

0.89

Community Life

Excellent

0.83

Recreation

 

0.55

Interpersonal Relationships

Limited info

--

Subscore

Excellent

0.76

Total Score

Excellent

0.95

Older Adults with Disabilities:

(Poulin & Desrosiers, 2009; = 30; mean age 79.4 (7.1); 56.7% female; having significant functional disabilities according to SMAF; recruitment from inpatient rehab unit or short-term geriatric care unit of HSSC-UIGS (Canadian sample) in last 5 years, Older Adults with Disabilities)

  • Excellent test-retest reliability for total score (ICC = 0.88)
  • Categorical test-retest reliability:
    • Excellent for communication (ICC = 0.88)
    • Excellent for fitness (ICC = 0.76)
    • Excellent for housing (ICC = 0.75)
    • Adequate for personal care (0.73)
    • Adequate for nutrition (ICC = 0.69)
    • Adequate for mobility (ICC = 0.69)
    • Excellent for daily activities (ICC = 0.84)
    • Excellent for leisure (ICC = 0.87)
    • Excellent for interpersonal relationships (ICC = 0.87)
    • Excellent for responsibilities (ICC = 0.80)
    • Adequate for community life (ICC = 0.65)
    • Excellent for social roles (ICC = 0.85)

Older Adults with Stroke :

(Lemmens, et al, 2007; = 35; mean age = 59 (7.7); gender = male 49%, Older Adults with Stroke)

  • The Dutch LIFE-H showed excellent test-retest reliability (ICC = 0.80) for the total score
  • ICC values for subscale scores varied: ranging from 0.21 for social relationships to 0.88 for personal care

LIFE-H Categories

 

ICC

Nutrition

Adequate

0.72

Fitness

Adequate

0.47

Personal Care

Excellent

0.88

Communication

Excellent

0.81

Residence

Adequate

0.57

Mobility

Adequate

0.55

Responsibility

Adequate

0.68

Social Relations

Poor

0.21

Community

Excellent

0.87

Education

 

NA

Employment

 

NA

Recreation

Adequate

0.66

Daily Activities

Excellent

0.78

Social Roles

Excellent

0.78

Total Score

Excellent

0.80

 

Interrater/Intrarater Reliability

Elderly with Physical Disabilities:

(Noreau et al, 2004; = 44; mean age = 80.0(7.7) years, Elderly with Physical Disabilities)

  • Excellent interrater reliability (ICC = 0.89)

LIFE-H

ICC

Level of Reliability

Nutrition

0.72

Adequate

Fitness

0.33

Poor

Personal Care

0.95

Excellent

Communication

--

---

Housing

0.49

Adequate

Mobility

0.61

Adequate

Daily activities sub-score

0.91

Excellent

Responsibilities

0.72

Adequate

Interpersonal relationships

--

---

Community life

0.70

Adequate

Leisure/Recreation

0.55

Adequate

Education/Employment

N/A

N/A

Social roles sub-score

0.64

Adequate

Total Score

0.89

Excellent

 

Construct Validity

Children and Adults with impairments :

(Noreau et al, 2002; Review of studies regarding social participation with various impairments in adults and children, Children and Adults with Impairments)

Between Life-H and CHART

  • N = 482 Adults SCI
  • Spearman’s rho
  • Physical independence

Excellent 0.76

  • Occupation

Adequate 0.36

  • Mobility

Adequate 0.33

  • Social integration

Poor 0.14

Between Life-H and CIQ

  • N = 30 adults TBI
  • Home integration

Adequate 0.56

  • Social integration

Adequate 0.54

  • Productive activities

Excellent 0.75

Older Adults with Functional Limitations:

Convergent Validity

(Desrosiers et al., 2004; = 87; mean age = 78.0 (8.2), Older Adults with Functional Limitations)

Adequate correlations found between LIFE-H and the Functional Autonomy Measurement System (SMAF) total scores (0.70, p < 0.0001)

 

Discriminant Validity

(Desrosiers et al., 2004; = 87; mean age = 78.0 (8.2), Older Adults with Functional Limitations)

  • Participants living in private nursing homes obtained higher scores, followed by those living at home and finally by those living in long-term care units. These variations in scores between the living environments, which are supported by differences in disability levels (SMAF scores), indicate a good level of discriminant validity for the nLIFE-H, particularly in the daily activities.

Pediatric Disorders

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Test/Retest Reliability

Children and Adults with impairments:

(Noreau et al, 2002; Review of studies regarding social participation with various impairments in adults and children; = 24 children & 25 adults with SCI, Children and Adults with Impairments)

  • Short form total score
    • Adequate for children (ICC = 0.67)
    • Excellent for adults (ICC = 0.83)
  • Long form total score
    • Excellent for children (ICC = 0.80)
    • Excellent for adults (ICC = 0.89)


Children with Cerebal Palsy:

(Sakzewski et al, 2007; Review of participation measures for children with CP aged 5 to 13; = 48, Children with CP)

  • Total Score Short Form
    • Poor ICC = 0.67
  • Total Score Long Form
    • Adequate ICC= 0.73

Interrater/Intrarater Reliability

Children (Cerebral palsy, myelomeningocoele, sensory-motor neuropathy, traumatic brain injury, developmental delay):

(Noreau et al, 2007; n=91 parents, Children with Disabilities)

Dimensions

 

ICC

 

ICC

Daily Activities

       

Communication

Excellent

0.95

Excellent

0.91

Personal Care

Excellent

0.94

Excellent

0.92

Housing

Excellent

0.93

Excellent

0.93

Mobility

Excellent

0.91

Excellent

0.88

Nutrition

Excellent

0.86

Excellent

0.82

Fitness

Excellent

0.83

Excellent

0.80

Social Roles

       

Recreation

Excellent

0.92

Excellent

0.87

Responsibility

Excellent

0.90

Excellent

0.91

Education

Excellent

0.90

Excellent

0.82

Community Life

Excellent

0.78

Excellent

0.78

Interpersonal Relationships

Adequate

0.58

Adequate

0.63

(Sakzewski et al, 2007; Review of participation measures for children with CP aged 5 to 13; = 48, Children with CP)Children with Cerebral Palsy:

  • Intrarater ICC
    • Daily Activities 0.82-0.96 Excellent
    • Social Roles > 0.90 Excellent
    • Interpersonal relationships 0.64 Adequate
  • Interrater ICC
    • 0.70-0.91 Adequate to Excellent
    • Interpersonal relationships 0.62 Adequate

Internal Consistency

Children and Adults with Impairments:

(Noreau et al, 2002; Review of studies regarding social participation with various impairments in adults and children; n= 24 children & 25 adults with SCI, Children and Adults with Impairments)

  • Short form Cronbach alpha ≥ 0.82
    • Excellent
  • Long form Cronbach alpha ≥ 0.90
    • Excellent

Children with Cerebral Palsy:

(Sakzewski et al, 2007; Review of participation measures for children with CP aged 5 to 13; = 48, Children with CP)

  • Daily Activities
    • Excellent alpha 0.97
  • Social Roles
    • Excellent alpha 0.90
  • Categories
    • Moderate to Excellent alpha 0.73-0.90
  • Interpersonal relationships
    • Poor alpha 0.40

Criterion Validity (Predictive/Concurrent)

Children with Cerebral Palsy:

(Sakzewski et al, 2007; Review of participation measures for children with CP aged 5 to 13; = 48, Children with CP)

  • Domains of PEDI, WeeFIM, Life-H
    • Self-care r = 0.83-0.94
    • Education/recreation: 0.79-0.91

Construct Validity

Children and Adults with impairments :

(Noreau et al, 2002; Review of studies regarding social participation with various impairments in adults and children, Children and Adults with Impairments)

Between Life-H and CHART

  • N = 482 Adults SCI
  • Spearman’s rho
  • Physical independence

Excellent 0.76

  • Occupation

Adequate 0.36

  • Mobility

Adequate 0.33

  • Social integration

Poor 0.14

Between Life-H and CIQ

  • N = 30 adults TBI
  • Home integration

Adequate 0.56

  • Social integration

Adequate 0.54

  • Productive activities

Excellent 0.75

 

Children with Disabilities (Cerebral palsy, myelomeningocoele, sensory-motor neuropathy, traumatic brain injury, developmental delay):

(Noreau et al, 2007; = 91 parents, Children with Disabilities)

Covergent validity:

  • Pediatric Evaluation of Disability Inventory (PEDI) Self-care and Mobility dimensions (Functional Skills scale) were strongly associated with LIFE-H Personal care and Housing dimensions (0.79 << 0.88) and PEDI Social function was strongly associated with LIFE-H categories, Communication and Responsibility ( = 0.80-0.81)
  • High correlations between LIFE-H Housing and Personal care with Functional Independence Measure for Children (WeeFIM) Self-care, = 0.90-0.94; LIFE-H and WeeFIM communication, = 0.89)

Divergent validity:

  • Associations of all PEDI dimensions with some LIFE-H dimensions were weaker (Interpersonal relationships and Community life), supporting a distinctiveness between the two constructs: activities of daily living (ADL) and social roles

WeeFIM cognitive dimensions (communication and social cognition) showed a lower association with LIFE-H motor dimensions (i.e. mobility, = 0.43-0.49 respectively).

Children with Disabilities:

Convergent Validity

(Noreau, 2007; = 94 parents of children with disabilities; children: 36 males, 58 females; mean age 8y 10mo (2y 6),Children with Disabilities)

LIFE-H for Children

 

 

  PEDI Functional Skills     PEDI Caregiver Assistance    
 

Self-Care

Mobility

Social Function

Self-care

Mobility

Social Function

Nutrition

0.71

0.67

0.70

0.71

0.64

0.69

Fitness

0.68

0.69

0.63

0.70

0.73

0.56

Personal care

0.79

0.82

0.61

0.88

0.80

0.57

Communication

0.76

0.61

0.81

0.75

0.62

0.79

Housing

0.79

0.88

0.61

0.81

0.84

0.55

mobility

0.56

0.68

0.40

0.63

0.65

0.32

Responsibility

0.70

0.67

0.80

0.71

0.66

0.76

Interpersonal Relationships

0.51

0.50

0.66

0.50

0.48

0.63

Community Life

0.54

0.53

0.47

0.58

0.52

0.44

Education

0.69

0.69

0.60

0.74

0.65

0.56

Recreation

0.68

0.71

0.60

0.74

0.68

0.53

Associations between LIFE-H for children and PEDI (Pediatric Evaluation of Disability Inventory) as measured by Pearson’s correlation coefficient; n = 94

Content Validity

Evaluated by an extensive development process involving consultation with 12 international experts including researchers, services providers, and consumer representatives. Experts concluded that the LIFE-H items covered most of a person's life habits (ADL and social roles) and it could be used to determine the appearance of handicap situations. The instrument was refined based on clinical evaluation (Fougeyrollas et al, 1998)

LIFE-H for children (Cerebral palsy, myelomeningocoele, sensory-motor neuropathy, traumatic brain injury, developmental delay) :

(Noreau et al, 2007, Children with Disabilities)

  • Content validity was established with the help of an expert panel (n = 29), comprising parents of children with functional limitations (= 11), experienced pediatric clinicians (= 15), and researchers (= 3)
  • The panel reviewed the content of the LIFE-H for its overall relevance for children from 5 to 13 years old
  • They assessed the comprehensiveness and clarity of the wording of the measure

Acording to Tse et al (2012) the LIFE-H has content validity because it is based on the Disability Creation Process Model and was developed and reviewed by experts

Face Validity

Acording to Tse et al (2012) the LIFE-H has face validity because it is based on the Disability Creation Process Model and was developed and reviewed by experts

Floor/Ceiling Effects

Children With Congenital Hemiplegia:

(Sakzewski et al, 2011; n = 64; mean age = 10.2 (2.7) years, Children with Congenital Hemiplegia)

  • Ceiling effects were observed with LIFE-H categories including community life and interpersonal relationships

Stroke

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Test/Retest Reliability

Older Adults with Stroke :

(Lemmens, et al, 2007; = 35; mean age = 59 (7.7); gender = male 49%, Older Adults with Stroke)

  • The Dutch LIFE-H showed excellent test-retest reliability (ICC = 0.80) for the total score
  • ICC values for subscale scores varied: ranging from 0.21 for social relationships to 0.88 for personal care

LIFE-H Categories

 

ICC

Nutrition

Adequate

0.72

Fitness

Adequate

0.47

Personal Care

Excellent

0.88

Communication

Excellent

0.81

Residence

Adequate

0.57

Mobility

Adequate

0.55

Responsibility

Adequate

0.68

Social Relations

Poor

0.21

Community

Excellent

0.87

Education

 

NA

Employment

 

NA

Recreation

Adequate

0.66

Daily Activities

Excellent

0.78

Social Roles

Excellent

0.78

Total Score

Excellent

0.80

Construct Validity

Stroke:

(Desrosiers et al, 2003; n = 132; mean age = 69.9 (13.5); mean rehab stay = 79.0 (45.5) days; 2-week (T3) and 6 month (T4) post rehabilitation, Acute Stroke)

 

LIFE-H, SMAF & FIM Correlations:

 

Time 3 (n = 118)

   

Time 4 (n = 102)

   

LIFE-H Domain

SMAF (total score)

FIM (total score)

pvalue

SMAF (total score)

FIM (total score)

pvalue

LIFE-H (total score)

0.85*

0.79

0.001

0.89

0.85

0.006

Personal care

0.87

0.85

0.13

0.92

0.90

0.08

Housing

0.70

0.65

0.02

0.77

0.74

0.11

Nutrition

0.69

0.63

0.009

0.63

0.61

0.17

Mobility

0.59

0.52

0.005

0.62

0.58

0.08

Communication

0.52

0.52

1.00

0.56

0.56

1.00

Fitness

0.38

0.38

1.00

0.58

0.58

1.00

Daily activities subscore

0.89

0.85

0.007

0.91

0.88

0.03

Responsibility

0.68

0.63

0.03

0.72

0.64

0.001

Community

0.66

0.57

0.001

0.74

0.67

0.001

Education/ employment

0.45

0.35

0.001

0.49

0.43

0.02

Leisure

0.22

0.21

0.73

0.32

0.31

0.71

Interpersonal relationships

0.06

0.05

1.00

0.30

0.33

0.26

Social roles subscore

0.66

0.57

0.001

0.77

0.71

0.006

 

SMAF = syste`me de mesure de l’autonomie fonctionnelle
FIM = functional independence measure
* Pearson correlation coefficients: at time 3, all significant at the 0.001 level

(Desrosiers et al, 2005; nstroke= 46, nhealthy= 46; mean agestroke= 72.5 (11.5) years, mean age healthy= 73.0 (11.4)years; time post stroke = 4-6 years; French and English sample, Stroke)

Stroke :

LIFE-H- Comparison between stroke patients and healthy elderly

Difference (1-ratio) and (95% CI)

Nutrition

0.45 (0.35-0.55)

Fitness

0.25 (0.18-0.31)

Personal Care

0.39 (0.30-0.47)

Communication

0.21 (0.09-0.32)

Housing

0.31 (0.22-0.39)

Mobility

0.33 (0.21-0.44)

Daily activities sub-score

0.33 (0.26-0.39)

Responsibilities

0.19 (0.09-0.28)

Interpersonal relationships

0.01 (-0.08-0.06)

Community life

0.47 (0.35-0.48)

Leisure/Recreation

0.38 (0.12-0.63)

Education/Employment

0.69 (0.44-0.95)

Social roles sub-score

0.24 (0.16-0.31)

Total Score

0.29 (0.22-0.36)

Responsiveness

Spouses of Individuals with First Time Stroke:

(Rochette et al, 2007; = 54 spouses; time periods of assessment = before stroke (retrospectively), at 2 weeks, and at 6 months post stroke, Spouses of Individuals with First Time Stroke)

  • At 2 weeks (T1): moderate effect size for LIFE-H total score (0.53), small for ADL sub core (0.0) and large for social roles subscore (0.90)
  • At 6 months post stroke (T2): small effect side for LIFE H Total score (0.38), ADL subscore (0.13), and moderate for Social role subscore (0.76)
  • Changes in participation were larger for personal relationships (T1 = 0.67; T2 = 0.83),, employment (T1 = 0.68; T2 = 0.63), and recreation ( T1 = 1.16; T2 = 0.93) , showing moderate to large effect sizes

Stroke:

(Rochette et al, 2007 (= 35; mean age = 72.3 (10.5); gender = male 42.9%; time periods of assessment = before stroke (retrospectively), at 2 weeks, at 3 months, and at 6 months post stroke, Mild Stroke)

  • At 2 weeks: Large effect size for LIFE-H total score (1.21), ADL (1.15) and Social Roles (1.24) subscores
  • 6 months post stroke and 2 weeks post stroke: moderate effect sizes for LIFE-H total score (0.60), ADL sub sore (0.64) and Social role sub score (0.56)
  • 6 months post-stroke and before the stroke: moderate effect sizes for LIFE-H total score (0.62), ADL sub score (0.58) and Social role sub score (0.70)

(Rochette et al, 2007; n = 35; mean age = 72.3(10.5) years; time post stroke = 2-3 weeks (T1), 3 months (T2), and 6 months (T3); severity > 8.5 on Canadian Neurological Scale; French and English sample, Stroke)

The LIFE-H is able to detect changes (total score effect size = 0.60)

LIFE-H

Effect Size T3-T1

Nutrition

0.35

Fitness

0.54

Personal Care

0.67

Communication

0.35

Housing

0.67

Mobility

0.44

Daily activities sub-score

0.64

Responsibilities

0.29

Interpersonal relationships

0.33

Community life

0.60

Leisure/Recreation

1.41

Education/Employment

0.14

Social roles sub-score

0.56

Total Score

0.60

Spinal Injuries

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Test/Retest Reliability

Spinal Cord Disorders (Adult and Pediatrics):

(Fougeyrollas et al. 1998; = 49, children = 24, adults n = 25; mean age years = children: 10.9 (4.7), adults: 42.5 (13.1); duration of injury = children: 10.9 (4.7) years, adults: 12.2 (8.2) years; gender = children: 16 female, 8 male; adults: 3 female, 22 male, Spinal Cord Disorders)

  • Adequate level of reliability for the children and the adult samples (ICC = 0.73 and 0.74, respectively).
  • Taken individually, a majority of life habit categories have shown a adequate to excellent reliability level (ICC >= 0.50) while a few life habit categories such as the interpersonal relationship or nutrition showed a poor reliability level
  • Adults with Spinal Cord Injury: ICC = 0.83-0.95

Internal Consistency

SCI:

(Noonan et al, 2009; Review of SCI instruments, SCI)

  • Excellent: Short Form Internal Consistency (alpha > 0.82)
  • Adequate: Short Form Internal Consistency (ICC = 0.83)
  • Excellent: Long Form Internal Consistency (alpha > 0.90)
  • Adequate: Long Form Internal Consistency (ICC = 0.74)

Construct Validity

Spinal Cord Injury:

(Dumont et al, 2003; = 1771; current mean age = 44.5 (15); gender=male 81.4%, SCI)

  • Rasch analysis showed satisfactory measurement properties (person reliability = 0.91), and high agreement with expert opinion (items hierarchy = 0.89)
  • Item difficulty hierarchy from spinal cord injury experts differed from hierarchy from traumatic brain injury experts, suggesting that the construct varies across impairment groups

 

Convergent Validity

(Noreau et al, 1998; = 482; mean age = 42 (12) years; no other information available; information from abstract, SCI)

  • Convergent validity was demonstrated by correlations between grouped LIFE-H items and corresponding CHART dimensions: 0.14 for social integration, through 0.33 and 0.36 for mobility and occupation, to 0.76 for physical independence

Floor/Ceiling Effects

SCI:

(Noreau & Fougeyrollas, 2000; n = 482; mean age = 42.4 (12.1); time since injury = 13 (6.8) years; type of injury = Complete Tetraplegia 24.6%, Incomplete Tetraplegia 19.5%, Complete Paraplegia 38.0%, Incomplete Paraplegia 18.3%Chronic SCI)

  • The LIFE-H has demonstrated low ceiling effects

Neuromuscular Conditions

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Test/Retest Reliability

Myotonic Dystrophy:

(Gagnon et al, 2006; n = 28; mean age of 52.7 (10.01) years; diagnosed with myotonic dystrophy confirmed by DNA; 2 weeks between assessments, Myotonic Dystrophy)

LIFE-H Test re-test Reliability

Category

T1 Mean (SD)

T2 Mean (SD)

Strength

ICC

Nutrition

8.1 (2.1)

8.4 (1.9)

Excellent

0.92

Personal Care

8.8 (1.4)

9.0 (1.1)

Adequate

0.86

Mobility

6.2 (3.4)

6.5 (2.8)

Adequate

0.79

Housing

6.1 (1.9)

6.7* (1.4)

Poor

0.73

Fitness

8.5 (1.5)

9.1* (1.2)

Poor

0.20

Communication

9.5 (0.6)

9.6 (0.4)

Poor

0.12

Daily Activities Subscore

8.0 (1.3)

8.3* (1.0)

Adequate

0.80

Interpersonal Relationships

8.6 (1.6)

8.6 (1.7)

Adequate

0.87

Community Life

6.6 (3.6)

6.6 (3.5)

Adequate

0.83

Recreation

6.3 (3.0)

7.4* (3.5)

Adequate

0.79

Responsibility

8.1 (2.2)

8.5 (1.7)

Adequate

0.76

Social Roles Subscore

7.2 (2.2)

7.4 (1.9)

Excellent

0.91

LIFE_ (total score)

7.7 (1.6)

7.9* (1.3)

Adequate

0.86

*p < 0.05

Interrater/Intrarater Reliability

Myotonic Dystrophy:

(Gagnon et al, 2006; n = 26; mean age of 52.7 (10.01) years; diagnosed with myotonic dystrophy confirmed by DNA; 2 weeks between assessments)

 

LIFE-H Inter-rater reliability

Category

T2 Mean (SD)

T3 Mean (SD)

Strength

ICC

Personal care

9.0 (1.1)

8.7 (1.4)

Adequate

0.87

Mobility

6.2 (2.8)

6.3 (2.7)

Adequate

0.84

Housing

6.6 (1.4)

6.7 (1.8)

Adequate

0.76

Nutrition

8.3 (1.9)

8.5 (1.6)

Poor

0.68

Communication

9.6 (0.4)

9.5 (0.6)

Poor

0.47

Fitness

9.1 (1.2)

8.4* (1.3)

Poor

0.21

Daily activities subscore

8.3 (1.0)

8.0 (1.3)

Adequate

0.86

Responsibility

8.5 (1.7)

9.2* (1.0)

Poor

0.56

Interpersonal relationships

8.6 (1.7)

8.7 (1.7)

Adequate

0.84

Community life

6.5 (3.5)

6.5 (3.7)

Excellent

0.93

Recreation

7.0 (3.7)

6.8 (3.4)

Adequate

0.75

Social roles subscore

7.4 (1.9)

7.6 (1.9)

Excellent

0.92

LIFE-H (total score)

7.9 (1.3)

7.8 (1.5)

Excellent

0.90

*p < 0.05

Mixed Populations

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Construct Validity

Multiple diagnosis (Neurologic, amputation, coronary, pulmonary, rheumatic disorder , other):

Convergent Validity

(Lemmens, et al, 2007; n = 63, mean age = 69 (7.7), chronic illness n = 66 (7.9); gender = male 56%, Multiple Diagnoses)

The correlations between the LIFE-H categories and total scores and the Impact on Participation and Autonomy Questionnaire (0.80-0.82) and London Handicap Scale (0.89-0.92) were excellent.

 

 

IPA

LHS

LIFE-H

LIFE-H

0.82

0.92

1

LIFE-H daily activities

0.82

0.90

0.99

LIFE-H social roles

0.80

0.89

0.93

IPA=Impact on Participation and Autonomy, LHS= London Handicap Scale

 

Discriminant Validity

(Lemmens, et al, 2007; n = 120, healthy older adults n = 40, patients with chronic illness n = 80; mean age healthy adults = 69 (7.7), chronic illness n = 66 (8.3); gender = healthy adults male 60%, chronic illness male 55%, Multiple Diagnoses)

Significant differences between the healthy and ill subjects for the 10 separate categories (P < 0.01) and the total score (P < 0.001)

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