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RehabMeasures Instrument

Participation measure for post-acute care

Last Updated

Purpose

Assesses participation outcomes in outpatient or home care settings based on the ICF classification scheme.

Link to Instrument

Acronym PM-PAC

Area of Assessment

Communication
Coordination
Functional Mobility
Occupational Performance
Quality of Life
Social Relationships
Social Support

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Brain Injury Recovery
  • Parkinson's Disease & Movement Disorders
  • Pediatric + Adolescent Rehabilitation
  • Spinal Cord Injury

Key Descriptions

  • The short form asks patients to rate their participation restrictions across 7 domains:

    Mobility
    Community, social and civic life
    Role functioning Self-care/domestic life
    Home management and finances
    Social relationships
    Communication

    Scoring:
    7 domain scores and 2 overall scores (Social and home participation and Community participation)
    Scoring algorithm not published

Number of Items

51

Time to Administer

15 minutes

A computerized adaptive test version of the participation measure for post-acute care (PMPAC- CAT) requires an average completion time of 6 minutes.

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

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 Anna de Joya, PT, DSc, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 5/2012.

ICF Domain

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 (VEDGE) 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:  

 

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

NR

NR

 

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

  • The PARTS/M is long and complex
  • Scoring is complex (although an adaptive version is available)
  • One quarter of PARTS/M items are related to self-care 
  • Combines objective and subjective ratings as a single construct and has uneven content coverage across domains 
  • May be inappropriate for people with cognitive impairments 
  • No scoring algorithm is publicly available 
  • Copyright fees 

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

Spinal Injuries

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Standard Error of Measurement (SEM)

Spinal Injury: (Noonan et al 2010; n = 545; age's ranged from 21 to 90 years; mean time from discharge to follow-up = 4 years)

PM-PAC Standard Error of Measurement (SEM)

 

 

 

Domain

Cronbach’s alpha

ICC (95% CI)

SEM

Communication

0.91

0.59 (0.47, 0.69)

0.29

Mobility

0.93

0.91 (0.87, 0.93)

0.26

Domestic Life

0.85

0.81 (0.74, 0.86)

0.34

Interpersonal Relationships

0.85

0.76 (0.68, 0.82)

0.42

Role Functioning

0.92

0.74 (0.65, 0.81)

0.58

Work & Employment

0.90

0.78 (0.66, 0.86)

0.42

Education

0.84

0.88 (0.65, 0.96)

0.19

Economic Life

0.84

0.77 (0.69, 0.83)

0.30

Community, Social & Civic Life

0.90

0.83 (0.77, 0.88)

0.34

Minimal Detectable Change (MDC)

Spinal Injury: (Noonan et al 2010)

 

 

 

 

 

 

PM-PAC MDC's*

 

 

Domain

MDC

MDC %

Communication

0.80

20.0

Mobility

0.73

18.3

Domestic Life

0.94

23.5

Interpersonal Relationships

1.17

29.3

 

Role Functioning

1.61

40.3

Work & Employment

1.16

29.0

Education

0.54

13.5

Economic Life

0.84

21.0

Community, Social & Civic Life

0.93

23.3

 

 

 

*MDC: minimal detectable change

 

 

Normative Data

Spinal Injury: (Noonan et al 2010)

 

PM-PCA Floor and Ceiling Effects:

 

 

PM-PCA Domain

Overall mean (SD)

Overall range

Communication

4.63 (0.66)

1.00–5.00

Mobility

4.26 (0.93)

1.00–5.00

Domestic Life

4.32 (0.87)

1.00–5.00

Interpersonal Relationships

4.08 (0.94)

1.00–5.00

Role Functioning

3.54 (1.19)

1.00–5.00

Work & Employment

4.19 (0.97)

1.00–5.00

Education

4.43 (0.78)

2.00–5.00

Economic Life

4.59 (0.76)

1.00–5.00

Community, Social & Civic Life

4.03 (0.90)

1.17–5.00

Floor/Ceiling Effects

Spinal Injury: (Noonan et al 2010)

 

PM-PCA Floor and Ceiling Effects:

 

 

PM-PCA Domain

% Worst possible score

% Best possible score

Communication

0.4

58.2

Mobility

0.2

43.3

Domestic Life

0.6

44.8

Interpersonal Relationships

0.4

30.8

Role Functioning

4.0

16.7

Work & Employment

1.0

39.1

Education

0.0

43.8

Economic Life

0.6

66.6

Community, Social & Civic Life

0.0

15.0

Mixed Populations

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Test/Retest Reliability

 

Musculoskeletal, Neurologic and medically complex disorders (Gandek et al, 2007; n = 36; mean age = 60 (range = 18 to 100) years; assessed 1–15 days (mean = 4 days) of the initial interview)

PM-PAC Test-retest Reliability

 

 

Domain

Strength

ICC

Mobility

Adequate

0.85

Role Functioning

Poor

0.61

Community, Social, and Civic Life

Adequate

 

0.86

Domestic Life

Poor

0.74

Economic Life

Poor

0.62

Interpersonal Relationships

Adequate

0.75

Communication

Adequate

0.85

PM-PAC Test-retest Reliability

 

 

Internal Consistency

Musculoskeletal, Neurologic and medically complex disorders (Gandek et al, 2007)

PM-PAC Internal Consistency

 

 

Domain

Strength

alpha*

Mobility

Excellent

0.85

Role Functioning

Excellent

0.83

Community, Social, and Civic Life

Excellent

0.89

Domestic Life

Adequate

0.76

Economic Life

Excellent

0.82

Interpersonal Relationships

Adequate

0.72

Communication

Adequate

0.79

 

 

 

*Cronbach’s alpha

 

 

Construct Validity

Literature Review: (Magasi & Post, 2010)

  • Confirmatory Factor Analysis (CFA) suggested a 7-factor model (however, some factors were highly correlated)
  • Principle Component Analysis (PCA) resulted in a 2 factor solution

 

Musculoskeletal, Neurologic and medically complex disorders (Gandek et al, 2007)

  • Participant with different diagnosis differed significantly (P < 0.001) on all scales (except domestic life)
  • Participants with higher Rankin scores tended to score lower in the mobility, role functioning, and community, social, and civic life domains.

 

Multiple Diagnoses: (Keysor et al, 2006 (n=342; diagnoses: complex medical (eg, COPD, MI, heart surgery, post-surgical debility), orthopedic (eg, fractures or amputations), neurologic (eg, stroke, Guillain-Barré syndrome, Parkinson’s disease, multiple sclerosis, traumatic brain injury) from acute care and inpatient rehabilitation; mean age=68 (14); 49% female) 

Pearson Correlation Coefficients of Home and Community Environment with Community Participation and Social and Home Participation 

 

1 Month (n=342)

 

6 Months (n=270)

 

Home and Community Environment

Social and Home Participation

Community Participation

Social and Home Participation

Community Participation

Home mobility barriers

NS

NS

NS

NS

Community Mobility barriers

.116*

-.127*

NS

NS

Mobility technology barriers

.170***

-.330***

NS

-.283***

Communication technology barriers

NS

NS

NS

.148**

Transportation facilitators

NS

.279***

NS

.134*

Social support

.408***

.137**

.344***

.154**

 

NS: Not significant; *P<.05, **P<.01, ***P<.001 

  • After adjusting for covariates, 1 month after discharge, a greater presence of 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 
  • At 6 months, social support was the only environmental factor associated with participation after adjusting for covariates. 

 

Multiple Diagnoses: (Jette et al, 2005; n=435; diagnoses: complex medical (eg,COPD, MI, heart surgery, post surgical debility) , orthopedic (eg, fractures or amputations), neurologic (eg, stroke, Guillain-Barré syndrome, Parkinson’s disease, multiple sclerosis, traumatic brain injury) from acute care and inpatient rehabilitation; mean age=67.4; 50.8% female) 

  • Activity limitations (Movement/physical, Personal care & instrumental, Applied cognitive) were the dominant factors that explained much of the variance in the extent of community participation achieved by patients. 
  • Personal (psychological, persistence, age, gender, race)and social environmental factors (social support) played a major role in predicting levels of social and home participation.

Content Validity

  • The development of the PM-PAC was guided by the ICIDH-2 and then reconciled with the ICF. 
  • Qualitative item review was based on focus groups with rehabilitation patients. 
  • Pilot tested with a sample of 8 people with disabilities; feedback also obtained from 8 rehabilitation researchers

Floor/Ceiling Effects

Literature Review: (Magasi & Post, 2010)

  • Many items are intended for lower functioning patients.  The most informative items tend to vary by the severity of disability experienced by the patient

Responsiveness

Literature Review: (Magasi & Post, 2010)

  • The PM-PAC-CAT (Computer Adaptive Test) was highly correlated with the traditional PM-PAC
    (ICC = .71 to .81).  Only minor decrements in sensitivity and responsiveness were observed.

Bibliography

Gandek, B., Sinclair, S. J., et al. (2007). "Development and initial psychometric evaluation of the participation measure for post-acute care (PM-PAC)." Am J Phys Med Rehabil 86(1): 57-71.

Jette, A. M. and Haley, S. M. (2005). "Contemporary measurement techniques for rehabilitation outcomes assessment." J Rehabil Med 37(6): 339-345.

Jette, A. M., Keysor, J., et al. (2005). "Beyond function: predicting participation in a rehabilitation cohort." Arch Phys Med Rehabil 86(11): 2087-2094.

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.

Magasi, S. and Post, M. W. (2010). "A comparative review of contemporary participation measures' psychometric properties and content coverage." Arch Phys Med Rehabil 91(9 Suppl): S17-28.

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.