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Home and Community Environment

Home and Community Environment

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Purpose

The HACE is a self-report measure focusing on aspects of the home and community environment which influence community participation. The instrument assesses barriers and facilitators in the patient's environment.

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Instrument Details

Acronym HACE

Area of Assessment

Activities of Daily Living
Functional Mobility
Social Relationships

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Brain Injury
  • Cerebral Palsy
  • Multiple Sclerosis
  • Parkinson's Disease + Neurologic Rehabilitation
  • Spinal Cord Injury

Key Descriptions

  • The HACE is composed of 6 Domains.
  • Home mobility: 9 items assess architectural barriers within the patient's home.
  • Community mobility: 5 items assess the presence of architectural barriers within the patient's community.
  • Basic mobility devices: 9 items assess the number of assistive technologies available to the patient.
  • Communication devices: 4 items assess the number of communication devices available to the patient.
  • Transportation factors: 5 items assess driving and transportation.
  • Attitudes: 6 items assess the patient's perceptions of other people's attitudes toward disability.

Number of Items

36

Time to Administer

6-30 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated with references for the TBI population by Sue Saliga, PT, DHSc, CEEAA, Anna de Joya, PT, DSc, NCS, and the TBI EDGE task force of the Neurology Section of the APTA in 2012.

ICF Domain

Participation
Environment

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

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

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)

TBI EDGE

No

No

No

Not reported

Considerations

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

Mixed Populations

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Normative Data

Complex medical, orthopedic, & neurologic conditions (Keysor et al, 2006; n = 342; mean age = 68 (14) years; assessed 1 month after discharge)

 

HACE Norms:

 

 

 

Domain

Range

Mean (SD)

Home mobility barriers

0 to 9

3.0 (2.1)

Community mobility barriers

0 to 4

0.7 (0.9)

Mobility technology facilitators

0 to 9

3.9 (2.0)

Communication technology facilitators

0 to 4

1.0 (1.0)

Transportation facilitators

0 to 5

3.2 (1.2)

Social support

0 to 100

83 (19)

Test/Retest Reliability

Complex medical, orthopedic, & neurologic conditions: (Keysor et al, 2006; n = 342; mean age = 68 (14) years; assessed 1 month and 6 months after discharge) –Assessed with Participation Measure for Post Acute Care (PM-PAC)

  • 1 month after discharge: a greater home mobility barriers (P<.01) was associated with less social and home participation; greater community mobility barriers (P<.01) and more social support (P<.001) were associated with greater participation
  • 6 months after discharge, social support was the only environmental factor associated with participation

Content Validity

Two experts examined a prototype version of the HACE to assess its ability to adequately measure important aspects of the patients home and community environments.  Revisions were made on the final version of the HACE based on this feedback.

 

Instrument pilot tested with 62 individuals and items removed based on inadequate response, and Kappa statistics indicating moderate agreement . (Keysor et al, 2005)

Face Validity

During the measure's construction, items with 20% or fewer respondents answering, “don’t know” and having not reached a moderate level of agreement were eliminated from the final version of the HACE.

Older Adults and Geriatric Care

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Test/Retest Reliability

Elderly Adults: (Keysor et al, 2005; = 62; mean age = 70 (17) years, 85% of the sample recruited from the community, 15% recruited from a rehabilitation facility)

HACE Test retest reliability:

 

 

 

 

Domain

Items

Median percent agreement (Range)

Median Kappa (range)

Home mobility

9

89% (71–100)

0.66 (0.28–1.0)

Community mobility

5

75% (58–92)

0.47 (0.20–0.64)

Basic mobility devices

9

92% (75–100)

0.65 (0.45–1.0)

Communication devices

4

94% (88–96)

0.79 (0.75–0.83)

Transportation

5

100% (67–100)

1.0 (0.29–1.0)

Attitudes

4

88% (84–95)

0.62 (0.51–0.77)

Construct Validity

Elderly Adults: (Keysor et al, 2005):

Patients living in single or multi-family dwellings reported significantly more obstacles than patients residing in other living situations (See table below)

 

Home mobility

Items

Total Sample

Percent (n)

Single or multi-family home

Percent (n)

Multi-unit complex dwelling

Percent (n)

p

 

(n = 62)

(n = 19)

(n = 43)

 

1 or more obstacle at the main door

48 (30)

100 (19)

100 (19)

<0.001

1 or more obstacle from the main door to main living area

10 (6)

26 (5)

2 (1)

0.009

1 or more obstacle inside main living area barriers

16 (10)

56 (10)

0 (0)

<0.001

1 or more home mobility obstacle (summary score)

48 (30)

100 (19)

26 (11)

<0.001

 

Bibliography

Keysor, J., Jette, A., et al. (2005). "Development of the home and community environment (HACE) instrument." J Rehabil Med 37(1): 37-44. Find it on PubMed

Keysor, J. J., Jette, A. M., et al. (2006). "Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort." Arch Phys Med Rehabil 87(12): 1566-1575. Find it on PubMed

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