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Rehabilitation Measures

Physical Activity Scale for the Elderly

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Purpose

The PASE measures the level of self-reported physical activity in individuals aged 65 years or older and is comprised of items regarding occupational, household, and leisure activities during the previous 7-day period.

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Instrument Details

Acronym PASE

Area of Assessment

Activities of Daily Living
Life Participation
Occupational Performance

Assessment Type

Patient Reported Outcomes

Cost

Free

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Stroke Recovery

Key Descriptions

  • It consists of 12 questions regarding the frequency and duration of leisure activity (e.g., sports, jogging, swimming, strengthening and endurance exercise), household activity, and work-related activity during the previous 7-day period.
  • Can be administered by telephone, mail or in-person. The questions are scored differently.
  • Participation in leisure-time and strengthening activities are scored as :
    1) never
    2) seldom (1-2 days per week)
    3) sometimes (3-4 days per week)
    4) often (5-7 days per week)
  • Duration of these activities is scored as:
    A) less than 1 hour
    B) 1-2 hours
    C) 2-4 hours
    D) more than 4 hours
  • Household and work related activities are scored as yes or no. In work related activities, paid or unpaid work is scored in hours/week.
  • The total PASE score is computed by multiplying either the time spent in each activity (hours per week) or participation (i.e., yes/no) in an activity, by empirically derived item weights and then summing overall activities.
  • The overall PASE score ranges from 0 to 400 or more.
  • The instructions for use and scoring are provided in the PASE Administration and Scoring Manual which can be purchased at http://www.neriscience.com.

Number of Items

12

Time to Administer

Les than 5 minutes

Required Training

No Training

Instrument Reviewers

Initially reviewed by Madawi Alotaibi PT, MHS in 10/2012. Updated 2/2016 by Alexander Yant, OTS; Kate Ibara, OTS; Emily Swiderski, OTS.

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
General Health

Considerations

  • PASE identifies the level of physical activity in elderly.
  • Easy to administer scale.
  • PASE can be used for a younger age group.
  • The highest score of PASE is in the age group 50-64 for younger people and above 65 for elderly.
  • Translated and validated in a variety of languages such as Japanese and Chinese.
  • Lack of information about MCID, cut-off scores, interrater/intrarater reliability, face validity, and responsiveness.
  • Construct validity is primarily poor-adequate among different diagnoses.
  • Evidence suggests that the PASE overestimates gender-specific tasks in regards to weighing task values. Specifically, the study mentioned women’s physical activity as compared to men, due to an incorrect weighing of heavy housework and caring for others (Hagiwara, 2008).

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Osteoarthritis

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Standard Error of Measurement (SEM)

Hip Osteoarthritis: (Svege, 2012; n = 33; mean age = 61.3 (10.0) years; mean pain duration= 49.8 (55.4) months)

  • SEM for total PASE score (n = 33): 31
  • SEM for Household/Work activities (n = 33): 32
  • SEM for Leisure time physical activity(PA) (n = 33): 15
  • SEM for Light PA intensity (n = 33): 13
  • SEM for Moderate PA intensity (n = 33): 10
  • SEM for Vigorous PA intensity (n = 33): 4

Minimal Detectable Change (MDC)

Hip Osteoarthritis: (Svege, 2012)

  • MDC for total PASE score (n = 33): 87
  • MDC for Household/Work activities (n = 33): 89
  • MDC for Leisure time PA (n = 33): 40
  • MDC for Light PA intensity (n = 33): 35
  • MDC for Moderate PA intensity (n = 33): 28
  • MDC for Vigorous PA intensity (n = 33): 10

Test/Retest Reliability

Hip Osteoarthritis: (Svege, 2012)

  • Excellent test-retest reliability (ICC = 0.77)

Construct Validity

Hip Osteoarthritis: (Svege, 2012)

  • Poor correlations between the total PASE score and the Actigraph GT1M accelerometer (r = 0.30)
  • Excellent correlations between the total PASE score and the International Physical Activity Questionnaire (IPAQ) total MET-minutes per week (r = 0.61)

Cancer

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Standard Error of Measurement (SEM)

Cancer: (Liu, 2011; n=50; mean age= 50 (12))

  • SEM for total PASE score (n = 50): 84

Minimally Clinically Important Difference (MCID)

 

Lung Cancer: (Granger, 2015; n=69; mean age = 68 years (age range= 61-74); time after diagnosis= 2, 4, and 6 months) 

  • (MCID): between 17 and 25 points

Test/Retest Reliability

Cancer: (Liu, 2011)

  • Adequate to Excellent test-retest reliability (ICC = 0.67 to 0.90).

Criterion Validity (Predictive/Concurrent)

Lung cancer: (Granger, 2015; n=69; mean age = 68 years (age range= 61-74); time after diagnosis= 2, 4, and 6 months)

  • Adequate predictive validity with the EORTC-QLQ-C30 global quality of life scores at 6 month follow-up (PASE: B coef=.35, p=.023)
  • Adequate predictive validity with the EORTC-QLQ-C30 physical function domain scores at 6 mos os sPASE:coef=.35, p=.008).

Construct Validity

Cancer: (Liu, 2011)

  • Poor correlations between the ActiGraph and the PASE (r = 0.16)

 

Lung Cancer: (Granger, 2015; n=69; mean age = 68 years (age range= 61-74); time after diagnosis= 2, 4, and 6 months)

  • Moderate convergent validity with movement sensors, counting steps per day (95%CI .29-.66)
  • Adequate to excellent correlation between the PASE and European Organization for the Research and Treatment of Cancer questionnaire and lung caencer module [EORTC-QLQ-C30] physical function domain (95%CI .46-.66)
  • Fair strength between PASE and ECOG-PS (95%CI .23-.49)
  • Poor to adequate correlation between the PASE and functional exercise capacity, 6 minute walking distance [MWD] (95%CI .23-.55)
  • Poor to adequate correlation between the PASE and handheld dynamometry for quadriceps muscle strength (95%CI .18-.54)

Floor/Ceiling Effects

Lung Cancer: (Granger, 2015; n=69; mean age = 68 years (age range= 61-74); time after diagnosis= 2, 4, and 6 months)

  • Floor Effect: Adequate floor effect with 3% (n=6/176)
  • Ceiling Effect: Excellent, no ceiling effect (highest score was 303, 400 was highest possible)

Joint Pain and Fractures

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Standard Error of Measurement (SEM)

Total Hip Arthroplasty: (Casartelli, 2015; n=50; mean age = 68.3 (5.9) years; mean time post-THA 7.4 (3.3) months)

  • SEM for total PASE score = 23.0%

Test/Retest Reliability

Total Knee Arthroplasty: (Bolszak, 2014; n=50; mean age = 70 (±6) years; time after TKA = 3-12 months)

  • Adequate test-retest reliability for men (ICC=0.77)
  • Poor test-retest reliability for women (ICC=0.58)

 

Total Hip Arthroplasty: (Casartelli, 2015; n = 50; mean age = 68.3 (5.9) years; mean time post-THA 7.4 (3.3) months)

  • Excellent test re-test reliability over a mean of 7.1 (0.5) days (ICC = 0.77)

Construct Validity

Total Knee Arthroplasty: (Bolszak, 2014; n=50; age range = 70 (±6) years; time after TKA = 3-12 months)

  • Adequate correlation between PASE and accelerometry for walking) in men (r=0.45)
  • Poor correlation between PASE and accelerometry for walking) in women (r=0.06)

 

Knee Pain: (Martin, 1999; n = 56; age = 471; mean age = 71.36; epidemiological study)

  • Adequate correlation between PASE and both the 6-min walk(r=0.35) and knee strength (r=0.41).

 

Total Hip Arthroplasty: (Casartelli, 2015; n = 50; mean age = 68.3 (5.9) years; mean time post-THA 7.4 (3.3) months)

  • Adequate correlation between PASE total score and Actigraph accelerometers (time spent in light-intensity physical activities) (r = 0.38)

Older Adults and Geriatric Care

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Normative Data

Community-dwelling Elderly: (Washburn et al, 1999; n = 20; mean age for women=72.4± 4.2 yrs / median range for men age=69-80 yrs; community-dwelling elderly people)

Mean PASE scores for the total sample and by age group

 

 

 

 

Age

Leisure exercise

Household

Occupation

Total PASE score

Total sample

31.5 ± 22.7

76.0 ± 42.7

17.7 ± 42.7

125.2 ± 79.9

Age ≤ 70 yrs

29.6 ± 22.9

78.8 ± 41.5

34.5 ± 60.9

142.9 ± 98.5

Age > 70 yrs

33.1 ± 23.7

73.6 ± 45.6

4.1 ± 6.3

110.8 ± 62.2

Test/Retest Reliability

Elderly: (Washburn et al, 1993)

  • Excellent test-retest reliability over a 3-7 week interval (ICC = 0.75)
  • Reliability for mail administration (r = 0.84) was higher than for telephone administration (r = 0.68)

 

Japanese Elderly: (Hagiwara, 2008; n=325, mean age = 72 years (age range = 67-77); population had no cognitive disorder or ADL deficiency.

  • Adequate test-retest reliability (ICC=0.65). (Men: Adequate (ICC=0.68). Women: Adequate (ICC=0.62))

 

Norwegian Elderly: (Loland, 2002; n = 327; women’s mean age = 74.8 (6.6) years; men’s mean age = 74.5 (6.3) years)

  • Excellent test-retest reliability over a 3-day interval (r=0.997)
  • Excellent test-retest reliability over a 3-week interval (r=0.993)

Internal Consistency

Elderly: (Washburn et al, 1993; n=396; mean age = 73.2)

  • Poor internal consistency (α = 0.69)

 

Norwegian Elderly: (Loland, 2002; n = 343; women’s mean age = 74.8 (6.6) years; men’s mean age = 74.5 (6.3) years)

  • Adequate internal consistency (α = 0.73)

Criterion Validity (Predictive/Concurrent)

Japanese Elderly: (Hagiwara, 2008; n=325, mean age = 72 years (age range = 67-77); population had no cognitive disorder or ADL deficiency

  • Significant concurrent validity with walking steps (p=.17), energy expenditure (p=.16), JALSPAQ (p=.48), MTMA (p=.15) and static balance (p=.19).
    • For men, additional concurrent validity with walking steps (p=.38), energy expenditure (.35), JALSPAQ (p=.48) and static balance (p=.2).
    • For women, additional concurrent validity with JALSPAQ (p=.47), grip strength (p=.16), MTMA (p=.23) and static balance (p=.17).

Construct Validity

Elderly: (Dinger, 2004; n = 56; age = 75.7+/-7.9 years; experimental design)

  • Excellent correlations between the 1st and 2nd interview total PASE scores (r = 0.91).
  • Adequate correlations between Actigraph mean counts x minute (-1) and 1st interview total PASE scores. (r = 0.43).

 

Elderly: (Ewald, 2010; n = 669; age = 63.3 (7.7) years; cross-sectional analysis)

  • Adequate correlations between PASE score and step count (r=0.37 in women, r=0.30 in men).

 

Elderly: (Washburn, 1993)

  • Adequate correlations between PASE scores and grip strength (r = 0.37), static balance (r = +0.33), age (r = -0.34) and perceived health status (r = -0.34); and overall Sickness Impact Profile score (r = -0.42).
  • Poor correlations between PASE scores and resting heart rate (r = -0.13) and leg strength (r = 0.25).

 

Sedentary Elderly: (Washburn, 1999; n=190; mean age=66.5 (age range= 61.2-71.9)

  • Construct validity established by correlating PASE scores and physiologic and performance characteristics—Significant association (P less than 0.5) with peak oxygen uptake (r=.2), systolic blood pressure (r=-.18), and balance score (r=.2).

 

Elderly: (Harada, 2001; n = 87; mean age = 75(age range=69-81)

  • Excellent correlation between PASE total score and 6-minute walk (r = 0.68)
  • Adequate correlation between PASE total score and Mini-Logger ankle (r = 0.59)
  • Adequate correlation between PASE total score and Mini-Logger waist (r = 0.52)
  • Adequate correlation between PASE total score and EPESE lower body functioning (r = 0.57)
  • Poor correlation between PASE total score and SF-36 Health Survey (self-reported functioning and well-being), Physical Functioning domain (r = 0.30)
  • Poor correlation between PASE total score and SF-36 Health Survey, General Health perceptions domain (r = 0.26)
  • Poor correlation between PASE total score and SF-36 Health Survey, Mental Health domain (r = 0.23)
  • Poor correlation between PASE total score and SF-36 Health Survey, Pain domain (r = 0.17)
  • Excellent correlation between PASE and Yale Physical Activity Survey (YPAS) (r = 0.61)
  • Excellent correlation between PASE and Community Healthy Activities Model Program for Seniors Questionnaire (CHAMPS “moderate” activities) (r = 0.64)
  • Adequate correlation between PASE and Community Healthy Activities Model Program for Seniors Questionnaire (CHAMPS “all” activities) (r = 0.58)

Non-Specific Patient Population

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Internal Consistency

Acute Coronary Event & Participation In Cardiac Rehabilitation: (Allison, 1998; n=32; mean age = 72 (4.24) years (age range = 67-83); mean time after cardiac event and rehabilitation not listed)

  • Adequate internal consistency (Cronbach’s alpha=0.71 for standardized variables (scores improved to 0.73 when researchers removed one item (number of hours worked)

Content Validity

The three-Step Test Interview (TSTI) method showed that participants perceived several problems when answering the PASE regarding the type, intensity and duration of activities.

 

Acute Coronary Event & Participation In Cardiac Rehabilitation: (Allison, 1998; n=32; mean age = 72 (4.24) years (age range = 67-83); mean time after cardiac event and rehabilitation not listed)

 

  • 83% agreement by the experts that the 12 activities from the PASE were relevant and appropriate for evaluating the physical activities of elderly people living in a rural community

Stroke

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Construct Validity

Ischemic Stroke: (Lindahl, 2008; n = 49; age ≥ 40 years of age; 3-12 months post stroke)

  • Adequate correlations between PASE and each of the five items in the Senior Fitness Test (SFT) that required strength, aerobic endurance and dynamic balance (correlation between 0.43 and 0.50) for the total group. The correlation between PASE and the two items testing flexibility were low and did not reach significance.

Bibliography

Allison, M. J., Keller, C., & Hutchinson, P. L. (1998) Selection of an instrument to measure the physical activity of elderly people in rural areas. Rehabilitation Nursing, 23 (6), 309-314.Find it on PubMed

Casartelli, N.C., Bolszak, S., Impellizzeri, F.M., & Maffiuletti, N.A. (2015). Reproducibility and Validity of the Physical Activity Scale for the Elderly (PASE) Questionnaire in Patients After Total Hip Arthroplasty. Physical Therapy, 95(1), 86-94. Find it on PubMed

Cavanaugh, J. T., & Crawford, K. (2014). Life-space assessment and physical activity scale for the elderly: Validity of proxy informant responses. Archives of Physical Medicine and Rehabilitation, 95(8), 1527–1532. Find it on PubMed

Dibble, L. E., Cavanaugh, J. T., et al. (2010). "Charting the progression of disability in Parkinson disease: study protocol for a prospective longitudinal cohort study." BMC Neurol 10: 110. Find it on PubMed

Dinger, M. K., Oman, R. F., et al. (2004). "Stability and convergent validity of the Physical Activity Scale for the Elderly (PASE)." J Sports Med Phys Fitness 44(2): 186-192. Find it on PubMed =

Ewald, B., McEvoy, M., et al. (2010). "Pedometer counts superior to physical activity scale for identifying health markers in older adults." Br J Sports Med 44(10): 756-761. Find it on PubMed

Granger, C. L., Parry, S. M., & Denehy, L. (2015). The self-reported physical activity scale for the elderly (PASE) is valid and clinically applicability measure in lung cancer. Support Care Cancer 23, 3211–3218. Find it on PubMed

Hagiwara, A., Ito, N., et al. (2008). "Validity and reliability of the Physical Activity Scale for the Elderly (PASE) in Japanese elderly people." Geriatr Gerontol Int 8(3): 143-151. Find it on PubMed

Harada, N. D., Chiu, V., King, A. C., & Stewart, A. L. (2001). An evaluation of three self-report physical activity instruments for older adults. Med. Sci. Sports Exerc, 33(6), 962–970.Find it on PubMed

Lindahl, M., Hansen, L., et al. (2008). "Self-reported physical activity after ischemic stroke correlates with physical capacity." Advances in Physiotherapy 10(4): 188-194.

Liu, R. D., Buffart, L. M., et al. (2011). "Psychometric properties of two physical activity questionnaires, the AQuAA and the PASE, in cancer patients." BMC Med Res Methodol 11: 30. Find it on PubMed

Loland, N. (2002). Reliability of the Physical Activity Scale for the Elderly (PASE). Eur J Sport Sci, 2(5), 1–12.

Martin, K. A., Rejeski, W. J., et al. (1999). "Validation of the PASE in older adults with knee pain and physical disability." Med Sci Sports Exerc 31(5): 627-633. Find it on PubMed

Ngai, S. P., Cheung, R. T., et al. (2012). "Validation and reliability of the Physical Activity Scale for the Elderly in Chinese population." J Rehabil Med 44(5): 462-465. Find it on PubMed

Schuit, A. J., Schonten, E. G., Westerterp, K. R., & Saris, W. H. M. (1997). Validity of the Physical Activity Scale for the Elderly (PASE): According to energy expenditure assessed by the doubly labeled water method. Journal of Clinical Epidemiology, 50(5), 541–546. Find it on PubMed

Siordia, C. (2012). Alternative scoring for Physical Activity Scale for the Elderly (PASE). Maturitas, 72(4), 379–382.Find it on PubMed

Svege, I., Kolle, E., et al. (2012). "Reliability and validity of the Physical Activity Scale for the Elderly (PASE) in patients with hip osteoarthritis." BMC Musculoskelet Disord 13: 26. Find it on PubMed

Washburn, R. A. and Ficker, J. L. (1999). "Physical Activity Scale for the Elderly (PASE): the relationship with activity measured by a portable accelerometer." J Sports Med Phys Fitness 39(4): 336-340. Find it on PubMed

Washburn, R. A., Smith, K. W., et al. (1993). "The Physical Activity Scale for the Elderly (PASE): development and evaluation." J Clin Epidemiol 46(2): 153-162. Find it on PubMed

Washburn, R. A., McAuley, E., Katula, J., Mihalko, S. L., & Boileau, R. A. (1999). The Physical Activity Scale for the Elderly (PASE): Evidence for validity. Journal of Clinical Epidemiology, 52(7), 643–651. Find it on PubMed

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