Validity and Reliability of the Korean Version of the Utrecht Scale for Evaluation of Rehabilitation and Participation

PURPOSE: This study investigated the reliability and validity of the Korean version of the Utrecht Scale for Evaluation of Rehabilitation–Participation (K–USER–P) in patients with stroke

BACKGROUND: Participation is an important outcome of rehabilitation treatment. Particularly in community-based settings and outpatient clinics, the final goal of rehabilitation is to improve the level of activities of daily life participation rather than the level of function. A participation measure is therefore needed as an outcome measure to evaluate the effects of rehabilitation interventions.

Since the introduction of the International Classification of Functioning in 2001, various participation measurements have been developed. However, there is a lack of measures that include both the subjective and the objective aspects of participation. The Utrecht Scale for the Evaluation of Rehabilitation–Participation (USER–P) was developed to measure both objective and subjective participation.

Construct, concurrent, and discriminative validity values of the USER–P were relatively good in people with various physical disabilities. These findings suggest that the USER–P is a valid and reliable measurement of participation in rehabilitation.

DESIGN: Reliability and validity design

PARTICIPANTS: Study participants were recruited through rehabilitation hospitals and centers in Wonju, Korea. Patients were eligible to participate in the study if (1) they were ≥18 yr old, (2) they had experienced stroke ≥6 mo before the study, (3) they were able to read Korean, and (4) they had participated in rehabilitation therapy for ≥4 wk. Exclusion criteria were (1) severe aphasia and cognitive impairments or (2) a fast-progressing medical condition after stroke. Informed consent was obtained from all participants

METHOD: This study was performed over a period of 3 mo from November 2013 to January 2014. In the 1st month, the USER–P was translated from English to Korean and compared with the original English USER–P questionnaire by two experienced occupational therapists. The USER–P Korean version was subsequently developed through review by a committee of experts. In the 2nd mo, a total of 120 questionnaires involving the USER–P Korean version were distributed to rehabilitation hospitals and centers by mail. In addition, to analyze test–retest reliability, we distributed another 30 questionnaires to patients 2 wk after distribution of the first

ANALYSIS: The psychometric properties of the K–USER–P were examined in two parts. First, we assessed test–retest reliability and internal consistency. Second, we compared the K–USER–P, SF-12, and London Handicap Scale (LHS). Analyses were performed with SPSS Version 21.0 (SPSS Inc., Chicago, IL). Internal consistency was assessed with the use of Cronbach’s α, which should be ≥.70. Test–retest reliability was assessed with the use of Spearman’s correlation coefficient, which was hypothesized to be ≥.60. Construct validity was tested by comparing the K–USER–P with the SF–12 and LHS using the Spearman’s rank correlation test as a nonparametric approach.

RESULTS: Internal consistency of the K–USER–P was determined using Cronbach’s α. The α values were .75 for the Frequency scale, .90 for the Restriction scale, and .88 for the Satisfaction scale, indicating very high internal consistency within the assessment. The internal consistency of the SF–12 and LHS were .77 and .82, respectively. The greatest correlation was found in the K–USER–P frequency scale (.76, p < .01), and the second highest agreement was found in the K–USER–P satisfaction scale (.68, p < .01). The K–USER–P restriction scale had the lowest correlation among the three areas (.55, p < .05). Intercorrelations between the subtests of SF–12 including PCS and MCS and the LHS with the K–USER–P scales are listed in Table 4. The majority of intercorrelations were in the range of –.223 to –.369 except for the K–USER–P frequency item. These results indicate that the K–USER–P is weakly correlated with the SF-12 and the LHS.

DISCUSSION: This study is significant because the K–USER–P presents intervention information related to the daily life participation level of stroke patients that can be used by occupational therapists in hospitals and local communities in Korea.

IMPACT STATEMENT: Participating individually in activities of daily living or community is important with stroke patients. The Utrecht Scale for Evaluation of Rehabilitation–Participation (USER–P) is useful tool as a rehabilitation outcome measure in the community living. Therefore, the Korean translation of the USER–P can be used to assess stroke patients in clinical practice and in the local community.