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RehabMeasures

Keele Assessment of Participation

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Purpose

The KAP is intended to measure an individuals level of participation in various activities including work, education, social activities, and activities of daily living.

Acronym KAP

Area of Assessment

Activities of Daily Living
Cognition
Functional Mobility
Life Participation
Quality of Life
Social Relationships

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Pain Management
  • Spinal Cord Injury

Key Descriptions

  • 15 items total, including four conditional screening questions (eg. “if yes, proceed to the next question”).
  • Minimum score= 0 (“no participation restrictions”); Maximum score= 11 (score of 1-11 indicates “participation restriction in at least one activity”).
  • Each item has the following options:
    -All of the time
    -Most of the time
    -Some of the time
    -A little of the time
    -None of the time
  • Participation that occurs “some of the time” or less is considered restricted participation and would be scored as a “1” for that item.

Number of Items

15

Equipment Required

  • Paper
  • Pen/Pencil

Time to Administer

4 minutes

Approximately 2-4 Minutes

Required Training

No Training

Instrument Reviewers

Initially reviewed by Chelsie Christophe, Shannon Vogel, and Rebecca Sax

ICF Domain

Participation

Measurement Domain

Activities of Daily Living
General Health
Motor

Considerations

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Non-Specific Patient Population

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Test/Retest Reliability

General population of adults over 50 (Wilkie et. al, 2005)

  • For the four filter questions, the mean observed agreement was 87.5% (range: 84–92%) and chance-corrected agreement ranged from moderate (k = 0.54; 95% CI: 0.41, 0.67) to substantial (k = 0.70; 95% CI: 0.57, 0.83)

  • The mean observed agreement for the five response options to each participation item was 75.1% (range: 68–83%) and chance-corrected agreement ranged from slight (k w = 0.34; 95% CI: 0.09, 0.59) to moderate (kw = 0.64; 95% CI: 0.54, 0.74).

  • For the dichotomised response (mean agreement=90.4%; range: 85.3– 94.4%) with chance-corrected agreement ranging from slight (k= 0.20, 95% CI: 0.04, 0.44) to substantial (k = 0.71; 95% CI: 0.57, 0.85).

  • The actual agreement for the categories of ‘None’ and ‘Any’ restriction was 71.6% and chance corrected agreement gave a kappa of 0.42 (95% CI: 0.27, 0.57).

  • There was a systematic difference in the prevalence of ‘Any’ participation restriction between the first and second administrations with the prevalence for the first mailing higher than for the second (46.7% cf 37.3%; % difference: -9.4; 95% confidence interval: -1.4%, -17.3%)

  • The mean observed agreement for the 5 answer options per questions was 75.1%. Kappa value when chance-corrected ranged from .34 to .64.

Criterion Validity (Predictive/Concurrent)

Predictive Validity

Older Adults (age 50+ years) with knee pain

  • Trend of increasing mobility restriction outside the home (one KAP question) with increasing levels of knee pain and stiffness measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Adjusting for age, sex, and socioeconomic status, the strongest association was with the highest category of pain severity (adjusted odds ratio [OR] 19.8, 95% confidence interval [95% CI] 13.6–28.9) (Wilkie, et al., 2007)
  • Restricted mobility outside the home is associated with three environmental factors developed by the study:

    • requirement of aids/assistance [OR 3.1, 95% CI 2.2–4.4]

    • poor access to public transportation [OR 2.3, 95% CI 1.4–3.9]

    • poor access to a car [OR 1.6, 95% CI 1.1–2.4])

  • Mobility restriction outside the home (one KAP question) is associated with a number of health conditions measured by the Health Survey questionnaire:

    • Having 2–3 health conditions: OR 2.0, 95% CI 1.2–3.2)

    • depression (possible case: OR 2.3, 95% CI 1.5–3.5, and probable case: OR 3.0, 95% CI 1.7–5.3)

    • cognitive impairment (low level: OR 1.6, 95% CI 1.1–2.4, and high level: OR 1.5, 95% CI 1.0–2.2)

    • Being underweight (OR 3.0, 95% CI 1.5–8.4)

    • NOT associated with bilaterality of knee pain, number of other lower limb joint pains, and anxiety

Construct Validity

Construct validity not applicable because the assessment does not have an official score (Magasi & Post, 2010)

Convergent validity

  • Moderate to strong convergent validity correlations (r>0.50) with the IPA, PM-PAC, POPS-OBJ, POPS-SUBJ, WHODAS-II (Noonan, et al., 2010) in the following domains:

    • Mobility (6 out of 10 correlations strong or moderate)

    • Self-care (2 out of 2 correlations strong or moderate)

    • Domestic life (10 out of 18 correlations strong or moderate)

    • Interpersonal interactions/relationships (3 out of 5 correlations strong or moderate)

    • Work/Education (8 out of 14 correlations strong or moderate)

    • Economic life (0 out of 1 correlations strong or moderate)

    • Community, social, and civic life (3 out of 5 correlations strong or moderate)

 

Ankylosing spondylitis (AS)

  • Excellent convergent validity with the Social Role Participation Questionnaire (SRPQ) constructs of satisfaction with time spent and role performance ( r=0.72 and r=0.68, respectively) (Davis, et al., 2011)

 

Psoriatic arthritis (PsA)

  • Excellent convergent validity with the Social Role Participation Questionnaire (SRPQ) constructs of satisfaction with time spent and role performance ( r=0.68 and r=0.65, respectively) (Davis, et al., 2011)

 

Variety of Diagnoses/practice settings

  • Excellent convergent validity with the Reintegration to Normal Living Index (RNL) (r=0.72--0.84) (Magasi &Post, 2010; Wood-Dauphinee, et al., 1988)

  • Poor divergent validity for items that are non-corresponding on the RNL (r=0.57-0.89) (Magasi & Post, 2010)

 

Various (mostly traumatic hand and neuromuscular diagnoses)

  • Excellent convergent validity with Impact on Participant and Autonomy Scale (IPA) (r= 0.74--0.97) (Magasi & Post, 2010; Cardol, et al., 1999)

  • Poor divergent validity for items that are non-corresponding on the IPA (r=0.66--0.97) (Magasi & Post, 2010)

 

General population of adults over 50:

  • In terms of convergent validity, the mean percentage agreement for the 10 pairs of corresponding items between KAP and RNL was 79.3% (range: 72–84%) Mean percentage agreement for 23 pairs of corresponding items between KAP and IPA was 87.7% (range: 74–97%). (Wilkie et al., 2005)

  • In terms of discriminant validity, the mean agreement for 60 pairs of non-corresponding items between the KAP and the RNL was 76.0% (range: 57–89%). The mean agreement for 160 pairs of non-corresponding items between the KAP and the IPA was 82.8% (range: 66–97%). (Wilkie et al., 2005)

  • Also, in terms of discriminant validity the mean percentage agreement, where responders indicated participation or participation restriction in both matched items for 23 matched pairs, was 47.6% (range: 24–87%) (Wilkie et al., 2005)

Face Validity

General population of adults over 50:

The proportion of responders who indicated ‘no’ in a filter question and also indicated that they did not participate in the corresponding task ranged from 64% to 98% (Wilkie et al., 2005)

Floor/Ceiling Effects

General population of adults over 50: (Wilkie et al., 2005)

  • Poor ceiling effect (53%)

Mixed Populations

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Standard Error of Measurement (SEM)

Adults with joint pain and comorbidity: (Hermsen et al., 2013)

  • KAPd1: SEM= 1.75
  • KAPd2: SEM= 2.02

Minimal Detectable Change (MDC)

Adults with joint pain and comorbidity (Hermsen et al., 2013)

  • KAPd1: MDC= 4.8
  • KAPd2: MDC= 5.6

Test/Retest Reliability

Adults with joint pain and comorbidity (Hermsen et al., 2013)

  • KAPd1: Adequate test-retest reliability (ICC=0.63)

  • KAPd2: Adequate test-retest reliability (ICC=0.57)

Internal Consistency

Adults with joint pain and comorbidity: (Hermsen et al., 2013)

  • KAPd1: Adequate internal consistency (Cronbach’s alpha= 0.74)
  • KAPd2: Poor internal consistency (Cronbach’s alpha= 0.57)

Floor/Ceiling Effects

Adults with joint pain and comorbidity: (Hermsen et al., 2013)

  • KAPd1: Poor ceiling effect (28%)
  • KAPd2: Poor ceiling effect (33%)

Bibliography

Davis, A.M., Palaganas, M.P., Badley, E.M., Gladman, D.D., Inman, R.D., & Gignac, M.A. (2011). Measuring participation in people with spondyloarthritis using the social role participation questionnaire. Annals of the Rheumatic Diseases, 70(10), 1765-1769. doi:10.1136/ard.2010.149211

Hermsen, L. A., Terwee, C. B., Leone, S. S., van der Zwaard, B., Smalbrugge, M., Dekker, J., ... & Wilkie, R. (2013). Social participation in older adults with joint pain and comorbidity; testing the measurement properties of the Dutch Keele Assessment of Participation. BMJ open3 (8), e003181. doi: 10.1136/bmjopen-2013-003181

Magasi, S. & Post, M.W. (2010). A comparative review of contemporary participation measures’ psychometric properties and content coverage. Archives of Physical Medicine and Rehabilitation, 91 (9 Suppl 1), S17-28. doi.org/10.1016/j.apmr.2010.07.011

Noonan, V.K., Kopec, J.A., Norceau, L., Singer, J., Masse, L.C., Zhang, H.,& Dvorak, M.F. (2010). Comparing the validity of five participation instruments in persons with spinal conditions. Journal of Rehabilitation Medicine, 42, 724-734.

Wilkie R, Peat G, Thomas E, & Croft P. (2007). Factors associated with restricted mobility outside the home in community-dwelling adults aged 50 years and older with knee pain: an example of use of the International

Classification of Functioning to investigate participation restriction. Arthritis Care and Research, 57,1381–9. doi: 10.1002/art.23083

Wilkie, R., Peat, G., Thomas, E., Hooper, H., & Croft, P. R. (2005). The Keele Assessment of Participation: a new instrument to measure participation restriction in population studies. Combined qualitative and quantitative examination of its psychometric properties. Quality of Research, 14, 1889-1899. doi: 10.1007/s11136-005-4325-2

Wood-Dauphinee, S.L., Opzoomer, M.A., Williams, J.I., Marchand, B., & Sptizer, W.O. (1988). Assessment of global function: The reintegration to normal living index. Archives of Physical Medicine and Rehabilitation, 69(8), 583-590.

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