Abstract
BackgroundIn clinical settings, it is important for health care providers to measure different aspects of functioning in older adults with joint pain and comorbidity. Besides the use of distinct measures, it could also be attractive to have one general measure of functioning that incorporates several distinct measures, but provides one summary score to quantify overall level of functioning, for example for the identification of older adults at risk of poor functional outcome. Therefore, we selected four measures of functioning: Physical Functioning (PF), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and participation, and tested the possibility to aggregate these measures into one general measure of functioning.MethodsA prospective cohort study of older adults (≥65 years) with joint pain and comorbidity provided baseline data (n = 407) consisting of PF (PF subscale, RAND-36; 10 items), ADL (KATZ index; 6 items), IADL (Lawton index; 7 items) and participation (KAP; 6 items). We tested two models with confirmatory factor analysis: first, a bifactor model with all four measures and second, a bifactor model with PF, ADL and IADL and a correlated but distinct subgroup factor for participation. Several model fit indexes and reliability coefficients, such as explained common variance (ECV) and omegas were computed for both models.ResultsThe first model fitted the data well, but the reliability analysis indicated multidimensionality and unique information in the subgroup factor participation. The second model showed similar model fits, but better reliability; ECV = 0.67, omega-t = 0.94, low omega-s = 0.18-0.22 on the subgroup factors and high omega of 0.82 on participation, which all were in favour of the second model.ConclusionsThe results indicate that PF, ADL and IADL could be aggregated into one general measure of functioning, whereas participation should be considered as a distinct measure.
Highlights
In clinical settings, it is important for health care providers to measure different aspects of functioning in older adults with joint pain and comorbidity
The domains activities and participation capture levels of functioning at an individual and societal level, respectively. It is important for health care providers to measure aspects of functioning that are incorporated in these two International Classification of Functioning (ICF) domains, as this contributes to optimal management and treatment of joint pain and comorbidity [8]
For the development of prediction models for the early identification of older adults at risk of poor functional outcome, it may be more attractive to use one general measure for functioning. Such a general measure would include various aspects of functioning, but provides one summary score quantifying the overall level of functioning, which subsequently would enable the development of a general prediction model for poor functional outcome, instead of distinct models for each measure
Summary
It is important for health care providers to measure different aspects of functioning in older adults with joint pain and comorbidity. The domains activities and participation capture levels of functioning at an individual and societal level, respectively In clinical settings, it is important for health care providers to measure aspects of functioning that are incorporated in these two ICF domains, as this contributes to optimal management and treatment of joint pain and comorbidity [8]. Such a general measure would include various aspects of functioning, but provides one summary score quantifying the overall level of functioning, which subsequently would enable the development of a general prediction model for poor functional outcome, instead of distinct models for each measure This may facilitate the creation of a more common language in the identification of older adults at risk of poor functional outcome and subsequent follow-up strategies in primary care
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