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Rehabilitation Measures

Pittsburgh Rehabilitation Participation Scale

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Purpose

The PRPS is a clinician-rated instrument designed to assess a patient's participation in therapy.

Link to Instrument

Instrument Details

Acronym PRPS

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury
  • Stroke Recovery

Key Descriptions

  • Participation in the RPS is assessed on a 6-point Likert-type scale reflecting the therapists observations of patient participation:
    1) None: patient refused entire session, or did not participate in any exercises in session.
    2) Poor: patient refused or did not participate in at least half of session.
    3) Fair: patient participated in most or all of exercises*, but did not show maximal effort or finish most exercises*, or required much encouragement to finish exercises*.
    4) Good: patient participated in all exercises* with good effort and finished most but not all exercises* and passively followed directions (rather than actively taking interest in exercises* and future therapy).
    5) Very good: patient participated in all exercises* with maximal effort and finished all exercises, but passively followed directions (rather than actively taking interest in exercises* and future therapy).
    6) Excellent: patient participated in all exercises* with maximal effort, finished all exercises*, and actively took interest in exercises* and/or future therapy sessions.
  • This version is specifically for PT. For the OT form "exercises" should be replaced with "activities".

Number of Items

1

Time to Administer

5 minutes

Per session

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated by Anna de Joya PT, MS, NCS and the TBI EDGE task force of the Neurology section of the APTA in 2012.

ICF Domain

Body Function
Participation

Measurement Domain

Motor

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: 

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 PRPS does not assess different elements of participation and thus only provide a summary evaluation of each therapy session.

  • Assessments made by therapists between diagnostic groups may demonstrate some degree of differential validity.  For example in one study evaluations made for stroke patients were more predictive our outcomes than for elective joint replacement (Lenze, 2004).

  • Only baseline disability (standardized β=.35, P=.02) and executive functions (standardized β=-40, P=.005) were significant predictors of rehabilitation participation, (F4,32=9.35; R2=.54, P=.001)(Skidmore et al., 2010)

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Mixed Populations

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Cut-Off Scores

Acute In-Patient: (Lenze et al, 2004; n=242; diagnoses: elderly with neurologic, (eg, stroke), orthopedic (eg, fracture, joint replacement), or debility)

  • Good participators=<5%
  • Occasional Poor participators=5%-25%
  • Frequently poor participators=>25%

These cut offs were based on visual examination of the distribution and natural breaks in the data.

Normative Data

Acute Inpatients: (Lenze et al, 2004, n = 242; various diagnosis admitted for inpatient rehabilitation)

  • Mean PRPS scores = 4.73 (0.76)

Acute Rehabilitation patients: ( Paolucci et al, 1012: n=348; mean age 59.41± 12.85, diagnoses: CVA, orthopedic , lower limb amputation.)

PRPS mean score

 


Mean early score

Mean late score

CVA patients

3.77±1.02

4.17±0.98

Orthopedic patients

4.17±0.86

4.30±0.89

P value

Z=3.92

P=0.000

Z=4.68

P=0.000

Interrater/Intrarater Reliability

Acute Inpatients: (Lenze et al, 2004; Three occupational therapists and five physical therapists participated, 2 therapists independently rated each patient’s therapy session)

  • Excellent among occupational therapists (ICC = 0.91)
  • Excellent among physical therapists (ICC = 0.96)

Criterion Validity (Predictive/Concurrent)

Acute Inpatients: (Lenze et al, 2004)

  • Mean PRPS scores predicted changes in motor FIM scores (r = 0.32, p <.0001)

Construct Validity

Acute Inpatients: (Lenze et al, 2004)

PRPS Scores and Motor FIM Change in the 3 Impairment Subgroups

 

 

 

 

Group

n

PRPS Mean (SD)

Motor FIM Change Mean (SD)

Bivariate Correlation

Debility

73

4.55 (0.70)

20.3 (8.5)

.34*

CVA

38

4.62 (0.93)

23.0 (10.4)

.51?

Elective hip/knee

56

4.96 (0.60)

25.0 (6.4)

.11

Entire group

242

4.73 (0.76)

22.0 (8.8)

.32?

*p = .01
?p = .001

 

 

 

 

 

Stroke in Acute in-patient rehab: (Skidmore et al, 2010; n=44; mean age=73.6 (7.9); stroke onset, days=9.1(7.3))

Measure

PRPS (r)

Digit Span

-.12

HVLT

.11

Executive Interview

-.55*

Hamilton Rating Scale for Depression

-.39*

Apathy Evaluation Scale

-.27

FIM, baseline

.56*

Time (days since stroke)

-.30

*p <.01

  • Age (r=-17, P=.28), race (r=-.19, P_.23), education (r=.27, P=.08), and stroke location (Cramer’s V=.70, P=.98) were not reliably correlated with rehabilitation participation.

Content Validity

To ensure the measure demonstrated adequate psychometric properties, developers conducted interviews with therapists as well as observed therapy sessions to better quantify different levels of participation

Older Adults and Geriatric Care

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Normative Data

Community Dwelling Adults: (Talkowski et al, 2009; n = 18, participants all >60 years old; Longitudinal with three and  six month follow-ups)

Characteristics of Participants by Facility Type:

 

 

 

IRFs

(n = 16)

SNFs

(n = 2)

Age in years (mean)

78.0

86.0

Minutes in therapy (mean)

150.0

75.5

Activity counts per minute (median)

36.8

48.2

PRPS scores (mean)

5.0

5.2

Baseline HFRS (mean)

95.6

93.5

IRF = Inpatient Rehabilitation Facilities
SNF = Skilled Nursing Facilities
HFRS = Hip Fracture Functional Recovery Scale
PRPS = Pittsburgh Participation Rating Scale

 

 

Joint Pain and Fractures

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Criterion Validity (Predictive/Concurrent)

Hip Fracture: (Munin, 2005, n = 42 inpatient rehabilitation facilities, 34 = skilled nursing facilities; hip fracture patients undergoing rehabilitation, patients > 60 years old, had surgical stabilization of the fracture, and were living in the community when the fracture sustained)

Baseline Demographics and Clinical Measures:

 

 

 

 

 

 

 

Inpatient rehabilitation facilities

 

 

Skilled nursing facilities

 

 

Demographics

n

mean (SD)

min / max

n

mean (SD)

min / max

Age (years)

42

80.2 (8.4)

61 / 94

34

83.9 (9.4)

63 / 105

Female (%)

35

83.3

 

27

79.4

 

White (%)

40

95.2

 

30

88.2

 

Social support

41

18.5 (9.9)

2 / 37

32

13.5 (6.9)

1 / 31

Cognitive measures

 

 

 

 

 

 

MMSE

41

25.2 (3.8)

16 / 30

34

23.0 (5.3)

9 / 30

HAMD

41

9.5 (5.2)

2 / 24

33

11.6 (5.9)

4 / 26

Delirium Rating Scale

41

5.8 (5.7)

2 / 24

33

8.3 (6.6)

2 / 26

Clinical measures

 

 

 

 

 

 

CIRS

38

9.2 (3.1)

3 / 18

31

10.2 (2.9)

5 / 16

Rehabilitation participation

37

4.6 (0.8)

2.1 / 6

22

4.3 (1.1)

2.4 / 6

Hospital LOS

40

5.0 (1.9)

2 / 12

31

6.4 (3.7)

3 / 21

Rehabilitation LOS

36

12.8 (6.9)

4 / 38

24

36.2 (20.5)

15 / 90

min / max = minimum and maximum scores
MMSE = The Mini-Mental Status Examination
HAMD = The Hamilton Depression Rating Scale
CIRS = Cumulative Illness Rating Scale
LOS = Length of Stay

 

 

 

 

 

 

 

Bibliography

Lenze, E. J., Munin, M. C., et al. (2004). "The Pittsburgh Rehabilitation Participation Scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation." Archives of physical medicine and rehabilitation 85(3): 380-384.

Munin, M. C., Seligman, K., et al. (2005). "Effect of rehabilitation site on functional recovery after hip fracture." Archives of physical medicine and rehabilitation 86(3): 367-372.

Paolucci, S., Di Vita, A., et al. (2012). "Impact of participation on rehabilitation results: a multivariate study." Eur J Phys Rehabil Med 48(3): 455-466.

Talkowski, J. B., Lenze, E. J., et al. (2009). "Patient participation and physical activity during rehabilitation and future functional outcomes in patients after hip fracture." Archives of physical medicine and rehabilitation 90(4): 618-622.