Abstract
BackgroundGALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction. GALI is the measure underlying the European indicator Healthy Life Years (HLY). Gali has a substantial policy use within the EU and its Member States. The objective of current paper is to bring together what is known from published manuscripts on the validity and the reliability of GALI.MethodsFollowing the PRISMA guidelines, two search strategies (PUBMED, Google Scholar) were combined to identify manuscripts published in English with publication date 2000 or beyond. Articles were classified as reliability studies, concurrent or predictive validity studies, in national or international populations.ResultsFour cross-sectional studies (of which 2 international) studied how GALI relates to other health measures (concurrent validity). A dose-response effect by GALI severity level on the association with the other health status measures was observed in the national studies. The 2 international studies (SHARE, EHIS) concluded that the odds of reporting participation restriction was higher in subjects with self-reported or observed functional limitations. In SHARE, the size of the Odds Ratio’s (ORs) in the different countries was homogeneous, while in EHIS the size of the ORs varied more strongly. For the predictive validity, subjects were followed over time (4 studies of which one international). GALI proved, both in national and international data, to be a consistent predictor of future health outcomes both in terms of mortality and health care expenditure. As predictors of mortality, the two distinct health concepts, self-rated health and GALI, acted independently and complementary of each other. The one reliability study identified reported a sufficient reliability of GALI.ConclusionGALI as inclusive one question instrument fits all conceptual characteristics specified for a global measure on participation restriction. In none of the studies, included in the review, there was evidence of a failing validity. The review shows that GALI has a good and sufficient concurrent and predictive validity, and reliability.
Highlights
Ageing of populations defies health and social policies
Concurrent validity Concurrent validation studies are cross-sectional studies with the objective to measure how Global Activity Limitation Indicator (GALI) relates to other health measures
The multinomial odds ratios (MORs) of fair self-rated health (SRH) and very poor/poor SRH indicated a similar pattern but were more extreme in function of the functional comorbidity score while less extreme in function of the functional disability indicator. These results suggest that GALI was primarily a measure of functional status and secondarily a measure of physical and mental morbidity whereas for SRH, physical morbidity and to a lesser extend mental morbidity were the main correlates
Summary
Ageing of populations defies health and social policies. Population ill-health and especially disability are major challenges as there is currently no consistent evidence that the lengthening of life expectancy goes with aThe concept of disability is complex and multidimensional. Ageing of populations defies health and social policies. Population ill-health and especially disability are major challenges as there is currently no consistent evidence that the lengthening of life expectancy goes with a. More biophysical-social models introduce the person-environment perspective of the disablement process: disability as the outcome of the interaction of a person and his environment [6] and the dynamics of disability which is affected by how a person’s capacity fits the environmental demand and results in participation [3]. Because participation is influenced by environmental factors and social norms, any measure of participation restriction cannot differentiate the impact of the impairment and functional limitations from the impact of accommodations and enabling environments [8, 9]. GALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction.
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