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Impact of Participation and Autonomy

Impact of Participation and Autonomy Questionnaire

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Purpose

The IPAQ is a questionnaire that focuses on autonomy and participation of people with chronic conditions. It was developed for use as a profile for disease severity assessment, needs assessment, and outcome assessment (evaluation).

Link to Instrument

Instrument Details

Acronym IPAQ

Area of Assessment

Life Participation

Cost

Not Free

Cost Description

Cost not known

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Parkinson's Disease + Neurologic Rehabilitation
  • Spinal Cord Injury
  • Stroke Recovery

Key Descriptions

  • 39 questions in 5 domains:
    1) Autonomy indoors
    2) Autonomy outdoors
    3) Family roles
    4) Social relationships
    5) Paid work and education
  • Each question is scored from 0 (very good) to 4 (very poor). The scores that relate to each domain are averaged to get an overall score for that domain.
  • Participants based on the scale choose how likely they feel they will be able to participate in a described activity or how their disability impacts their ability to participate.
  • Copies of the English IPA can be obtained from the link above or from:
    1) Paula Kersten, PhD Senior Lecturer in Rehabilitation School of Health Professions and Rehabilitation Sciences University of Southampton Highfield Southampton SO17 1BJ P.Kersten@soton.ac.uk
    2) Cardol M, de Haan RJ, de Jong BA, van den Bos GAM, de Groot IJM. (2001). Psychometric properties of the impact on participation and autonomy questionnaire. Arch Phys Med Rehabil. 82:210-6.

Number of Items

39

Time to Administer

20-30 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Christopher Newman, PT, MPT, NCS, Phyllis Palma, PT, DPT, and the SCI EDGE task force in 8/2012 and Anna de Joya, PT, DSc, NCS and the TBI EDGE task force in 5/2012 of the Neurology Section of the APTA.

ICF Domain

Participation

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 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

LS

LS

LS

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 based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

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)

SCI EDGE

No

No

No

Not reported

TBI EDGE

No

Yes

Yes

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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Test/Retest Reliability

Combined 5 diagnostic groups (neuromuscular disease, stroke, SCI, rheumatoid arthritis, fibromyalgia):

(Cardol et al, 2001, = 126; 21 SCI, mean age 46.1(13.5), 1-27 years post injury)

Test-retest Reliability by IPA Domain (Weighted K)

 

 

 

 

Domain

Weighted K range

n

Degree of reliability*

Autonomy indoors

0.70-0.84

72

Adequate to Excellent

Autonomy outdoors

0.69-0.84

72

Adequate to Excellent

Family role

0.56-0.81

71

Adequate to Excellent

Social life and relationships

0.71-0.77

72

Adequate to Excellent

Work and education

0.79-0.90

28 work; 11 education

Adequate to Excellent

*Adequate to Excellent K value for problem experience scores: 0.59-0.87.

 

Test-retest Reliability by IPA Domain (ICC)

 

 

 

Domain (IPA range of scores)

ICC

Degree of reliability

Autonomy indoors

0.87

Excellent

Autonomy outdoors

0.83

Excellent

Family role

0.91

Excellent

Social life and relationships

0.89

Excellent

 

Multiple Diagnoses:

(Sibley et al, 2005; n = 213; multiple sclerosis, spinal cord injury, rheumatoid arthritis and general practice; median age = 54) 

  • Item to total subscale correlations 
  • Indoor autonomy Item-total subscale correlations range: 0.73-0.89 
  • Family role Item-total subscale correlations range: 0.73-0.84 (except item 4a item-total subscale correlation = 0.34) 
  • Outdoor autonomy Item-total subscale correlations range: 0.69-0.83 
  • Social life and relationships Item-total subscale correlations range: 0.52-0.76 
  • Work and education Item-total subscale correlations range: 0.52-0.77 
  • Test retest for all items: Weighted Kappa statistic were greater than 0.6 (range: 0.64-0.92) 
  • Excellent Test-Retest Reliability at the Subscale level 
    • Indoor autonomy: 0.95 
    • Family role: 0.97 
    • Outdoor autonomy: 0.97 
    • Social life and relationships: 0.94
    • Work and education: 0.91

Internal Consistency

Consecutive outpatients with a variety of diagnosis:

(Cardol, et al, 1999, = 100; 3 SCI, mean age = 47.9(14.6))

Internal Consistency by IPA Subscale

 

 

 

Subscale

Cronbach's α

Degree of Consistency

Social relationships

0.86

Excellent

Self care/ appearance

0.87

Excellent

Family role

0.84

Excellent

Mobility

0.86

Excellent

Leisure

Could not be calculated; < 2 items

 

Financial Independence

Could not be calculated; < 2 items

 

 

Neuromuscular disease, stroke, spinal cord injury (SCI), rheumatoid arthritis, or fibromyalgia:

(Cardol et al, 2001; n = 126; Response rates of the various diagnostic groups differed: 86% response for neuromuscular disease, 47% for SCI, 45% for stroke, 42% for rheumatoid arthritis, and 37% for fibromyalgia. Mean age of the study population= 52.6(13.4) years; 78 of the respondents were women. Median duration of disease ranged between 2 and 12 years.) 

  • Excellent internal consistency (Cronbach’s Alpha): 
    • 0.91 (autonomy indoors) 
    • 0.90 (family role)
    • 0.81 (autonomy outdoors)
    • 0.86 (social relations) 
    • 0.91 (work and educational opportunities)

 

Multiple Diagnoses:

(Sibley et al, 2006; n = 213; multiple sclerosis, spinal cord injury, rheumatoid arthritis and general practice; median age = 54) 

  • Excellent Internal Consistency (Cronbach’s Alpha): 
    • Indoor autonomy: 0.94 
    • Family role: 0.90 
    • Outdoor autonomy: 0.91 
    • Social life and relationships: 0.86 
    • Work and education: 0.90

Construct Validity

Combined 5 diagnostic groups (neuromuscular disease, stroke, SCI, rheumatoid arthritis, fibromyalgia): 

Convergent Validity

(Cardol et al, 2001)

  • Poor correlation between the IPA domain of autonomy outdoors and the Sickness Impact Profile's physical dimension (r = 0.29)
  • Adequate correlation between the IPA domains of autonomy indoors, autonomy outdoors, and family role and the SF-36's physical domains (r = -0.43, -0.51, 0.49, respectively)
  • Adequate correlation between the IPA and the London Handicap Scale domains of mobility, physical independence, occupation, and integration (r = -0.42 to -0.57)

 

Discriminant Validity

(Cardol et al, 2001)

  • Poor correlation between the IPA Scale domains and the London Handicap Scale domains (r = -0.29 to 0.01)
  • Poor correlation between IPA domain of social relationships and the SF-36 physical domain (r = -0.36)
  • Poor correlation between IPA domain of social relationships and the SIP physical domain (r = -0.16)

 

Multiple Diagnoses:

(Sibley et al, 2006; n = 213; multiple sclerosis, spinal cord injury, rheumatoid arthritis and general practice; median age = 54) 

Construct Validity

  • Normal Fit Index = 0.98, Comparative Fit Index = 0.99 indicating a good fit to the model
  • Convergent and discriminant validity were confirmed by the predicted associations, or lack thereof, with the exception of a poor association between the ‘social life/relationships’ IPA subscale and Functional Limitations Profile-Emotion

Content Validity

Consecutive outpatients with a variety of diagnoses:

(Cardol, et al, 1999, = 100; 3 SCI, mean age 47.9(14.6))

  • The IPA is based on the participation definition contained in the ICIDH-2, clinical experience of the multi-disciplinary research group, and a small qualitative study with rehabilitation patients.
  • Established based on input from a multidisciplinary clinical research group, external experts, and a qualitative study with rehabilitation patients

Responsiveness

Consecutive individuals referred for OP rehabilitation of various diagnoses:

(Cardol et al, 2002, = 17)

Responsiveness by IPA Domain

 

 

 

 

Domain

Change score for improvement (SD)

AUC (%)

Degree of responsiveness

Autonomy indoors

1.4 (3.3)

62

Poor

Autonomy outdoors

2.7 (2.2)

89

Adequate

Family role

3.9 (4.9)

80

Adequate

Social life and relationships

0.2 (2.8)

50

Poor

Work and education= 5

2.0 (1.5)

92

Excellent

 

Responsiveness by IPA 'Problem Experience' Item Category

 

 

 

 

Item category

n

AUC (%)

Degree of responsiveness

Mobility

16

56

Poor

Self-care

13

69

Poor

Family role

12

61

Poor

Financial situation

6

58

Poor

Leisure

11

74

Adequate

Social relations

5

71

Adequate

Work

4

71

Adequate

Education and training

0

-

-

 

Spinal Injuries

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Standard Error of Measurement (SEM)

Traumatic or non-traumatic SCI; spinal column fracture without neurological involvement; spinal degenerative disease:

(Noonan et al, 2010, = 545; 79 SCI)

SEM by IPA Domain

 

 


Domain

SEM

Autonomy indoors

0.25

Autonomy outdoors

0.42

Family role

0.30

Social life and relationships

0.28

Work and education

0.35

Minimal Detectable Change (MDC)

Traumatic or non-traumatic SCI; spinal column fracture without neurological involvement; spinal degenerative disease:

(Noonan et al, 2010)

MDC by IPA Domain

 

 

Domain

MDC

Autonomy indoors

0.70

Autonomy outdoors

1.18

Family role

0.83

Social life and relationships

0.76

Work and education

0.96

 

*Due to high ceiling effects of IPA, study reports it is impossible to detect improvements beyond measurement error for majority of domains. MDC are based on one individual level changes.
 

Test/Retest Reliability

Traumatic or non-traumatic SCI; spinal column fracture without neuro involvement; spinal degenerative disease:

(Noonan et al, 2010, = 139)

Test-retest Reliability by IPA Domain

 

 

 

Domain

ICC (95% CI)

Degree of reliability

Autonomy indoors

0.84

Excellent

Autonomy outdoors

0.85

Excellent

Family role

0.88

Excellent

Social life and relationships

0.83

Excellent

Work and education

0.86

Excellent

Internal Consistency

Traumatic or non-traumatic SCI; spinal column fracture without neuro involvement; spinal degenerative disease:

(Noonan et al, 2010, = 545, 79 SCI)

Internal Consistency by IPA Domain

 

 

 

Domain

Cronbach's α

Degree of consistency

Autonomy indoors

0.94

Excellent

Autonomy outdoors

0.95

Excellent

Family role

0.95

Excellent

Social life and relationships

0.90

Excellent

Work and Education

0.96

Excellent

Face Validity


 

Floor/Ceiling Effects

SCI:

(Lund et al, 2007, = 161, mean age 52(18.2), Swedish rehab unit)

 

  • Adequate Ceiling/Floor Effect: Rasch analysis showed that 20% of people were either above or below the range of item calibration values - indication of floor and ceiling effects

 

Traumatic or non-traumatic SCI; spinal column fracture without neuro involvement; spinal degenerative disease:

(Noonan et al, 2010)

Floor/Ceiling Effect by IPA Domain

 

 

 

Domain

% worst possible score

% best possible score

Autonomy indoors

0.0 Excellent

49.5 Poor

Autonomy outdoors

1.5 Adequate

31 Poor

Family role

0.2 Adequate

29.4 Poor

Social life and relationships

0.0 Excellent

41.1 Poor

Parkinson's Disease

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Standard Error of Measurement (SEM)

Parkinson's Disease:

(Franchignoni at al, 2007; n = 100 patients with Parkinson's Disease, 41 male, 59 female; mean age = 72(7) years; HY 2.5(1.5-4))

  • SEM = 0.53

Construct Validity

Parkinson's Disease:

(Franchignoni at al, 2007)

  • Excellent correlation between IPA-I and PDQ-39 (r = 0.72)
  • Excellent correlation between IPA-II and PDQ-39 (r = 0.74)
  • Poor correlation between IPA-I and UPDRS-ME (r = 0.26)
  • Poor correlation between IPA-I and UPDRS-ADL (r = 0.37)
  • Poor correlation between IPA-II and HY (r = 0.21)
  • Poor correlation between IPA-II and UPDRS-ADL (r = -0.26)

Bibliography

Cardol, M., Beelen, A., et al. (2002). "Responsiveness of the Impact on Participation and Autonomy questionnaire." Archives of Physical Medicine and Rehabilitation 83(11): 1524-1529. Find it on PubMed

Cardol, M., de Haan, R. J., et al. (2001). "Psychometric properties of the Impact on Participation and Autonomy Questionnaire." Archives of Physical Medicine and Rehabilitation 82(2): 210-216. Find it on PubMed

Cardol, M., de Haan, R. J., et al. (1999). "The development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA)." Clinical Rehabilitation 13(5): 411-419. Find it on PubMed

Franchignoni, F., Ferriero, G., et al. (2007). "Rasch psychometric validation of the Impact on Participation and Autonomy questionnaire in people with Parkinson's disease." Eura Medicophys 43(4): 451-461. Find it on PubMed

Lund, M. L., Fisher, A. G., et al. (2007). "Impact on participation and autonomy questionnaire: internal scale validity of the Swedish version for use in people with spinal cord injury." J Rehabil Med 39(2): 156-162. Find it on PubMed

Noonan, V. K., Kopec, J. A., et al. (2010). "Comparing the reliability of five participation instruments in persons with spinal conditions." J Rehabil Med 42(8): 735-743. Find it on PubMed

Sibley, A., Kersten, P., et al. (2006). "Measuring autonomy in disabled people: Validation of a new scale in a UK population." Clin Rehabil 20(9): 793-803. Find it on PubMed

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