Measurement properties of the USER-Participation Restriction subscale and PROMIS® Ability to Participate in Social roles and Activities in in- and outpatient rehabilitation populations

PURPOSE: Participation is a key rehabilitation outcome. However, there is limited evidence on the measurement properties of patient-reported outcome measures (PROMs) that assess participation in rehabilitation settings. Therefore, this study evaluated the test-retest reliability and responsiveness of two widely used PROMs: the Utrecht Scale for Evaluation of Rehabilitation - Participation (USER-P) Restriction subscale and the Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities 4-item short form (PROMIS-APS-SF) in inpatient and outpatient settings.

METHODS: In this multicentre prospective cohort study, inpatients and outpatients completed PROMs at the start of rehabilitation (T0), after six months (T1), and two weeks thereafter (T2). Test-retest reliability (T1-T2) was evaluated using intraclass correlation coefficients (ICCs), Bland-Altman plots, and the smallest detectable change (SDC). Responsiveness (T0-T1) was examined using effect sizes, area under the curve (AUC), and the minimal important change (MIC) based on the Global Rating of Change scale.

RESULTS: A total of 553 patients completed PROMs at T0-T1, of whom 168 also completed them at T2. Scores on both PROMs demonstrated sufficient test-retest reliability (ICC > 0.70) across both rehabilitation settings. Moderate to large effect sizes were found, except for the PROMIS-APS-SF scores in inpatients, which showed a small effect size. The USER-P Restriction scores achieved sufficient AUC values for inpatients (0.71) and outpatients (0.72). At group level, MIC values exceeded the SDC for both PROMs, but only few did at individual level.

CONCLUSION: Scores on both PROMs appeared appropriate for evaluating participation outcomes at group level within rehabilitation settings, with the USER-P Restriction scores showing better responsiveness among inpatients. However, the use of these scores for evaluating individual participation goals seems limited.