Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts.
Arch Phys Med Rehabil. 2019 Dec;100(12):2283-2292. doi: 10.1016/j.apmr.2019.06.018. Epub 2019 Aug 14.
To examine the responsiveness and predictive validity of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D) in people receiving outpatient rehabilitation following stroke.
Prospective cohort observational study.
Outpatient rehabilitation settings.
Volunteer patients (N=269) with stroke (mean age ± SD [y], 55.36±12.46; 70.26% male).
Not applicable.
The PM-3D4D was designed to measure 3 domains (Productivity, Social, and Community) and 4 dimensions (Diversity, Frequency, Desire for change, and Difficulty) of participation in individuals with rehabilitation needs. All participants completed the PM-3D4D, the Participation Assessment with Recombined Tools-Objective (PART-O), the Participation Measure for Post-Acute Care (PM-PAC), and the EuroQol-5-Dimension (EQ-5D) at the baseline assessment and again following 3 months of outpatient rehabilitation.
Significant mean changes in scores were observed for most of the PM-3D4D subscales, with the largest score change observed in the Difficulty subscale (standardized response mean=0.57∼0.88). The minimal detectable change and meaningful clinically important differences were calculated for each subscale. The Frequency and Difficulty dimensions of the PM-3D4D demonstrated significantly greater responsiveness than the PART-O and PM-PAC, respectively. The baseline PM-3D4D scores, except for Desire for change subscales, were significantly correlated with the PART-O, PM-PAC, and EQ-5D scores after 3 months of rehabilitation.
This study provides evidence supporting the responsiveness and predictive validity of the PM-3D4D in survivors of stroke. Among all subscales of the PM-3D4D, the Difficulty dimensional scale demonstrated the greatest responsiveness. The Desire for change dimension of the PM-3D4D showed less responsiveness, and we recommend that it be used as a goal-setting tool rather than an outcome measure. The PM-3D4D can potentially be used to predict participation outcomes and the health-related quality of life following rehabilitation interventions.
考察参与量表-3 领域 4 维度（PM-3D4D）在脑卒中后接受门诊康复治疗的人群中的反应性和预测效度。
前瞻性队列观察性研究。
门诊康复机构。
志愿者脑卒中患者（平均年龄 ± 标准差 [y]，55.36±12.46；70.26%为男性）。
不适用。
PM-3D4D 旨在测量有康复需求的个体的参与度的 3 个领域（生产力、社会和社区）和 4 个维度（多样性、频率、改变意愿和难度）。所有参与者在基线评估时完成 PM-3D4D、组合工具目标参与评估（PART-O）、康复后参与量表（PM-PAC）和欧洲五维健康量表（EQ-5D），并在 3 个月的门诊康复后再次完成。
大多数 PM-3D4D 分量表的评分均有显著的平均变化，难度分量表的评分变化最大（标准化反应均数=0.57∼0.88）。计算了每个分量表的最小可检测变化和有临床意义的差异。PM-3D4D 的频率和难度维度分别比 PART-O 和 PM-PAC 具有更高的反应性。在康复 3 个月后，除了改变意愿分量表外，PM-3D4D 的基线评分与 PART-O、PM-PAC 和 EQ-5D 评分均显著相关。
本研究为脑卒中幸存者 PM-3D4D 的反应性和预测效度提供了证据。在 PM-3D4D 的所有分量表中，难度维度的量表表现出最大的反应性。PM-3D4D 的改变意愿维度反应性较差，我们建议将其用作目标设定工具，而非结果测量工具。PM-3D4D 可能可用于预测康复干预后的参与度结果和健康相关的生活质量。
