ICF - Measure of Participation and Activities Screener

Acronym:

IMPACT-S

Purpose:

The ICF-Measure of Participation and Activities Screener (IMPACT-S) is a self-report measurement instrument to assess experienced limitations in activities and participation. The questions concern aspects of daily life in which a person could possibly experience limitations as a consequence of their health or disability. The score is used to indicate low or high levels of participation.

The 32 questions are distributed across 9-scales, reflecting the 9 activity and participation domains of the International Classification of Functioning, Disability and Health (ICF). The IMPACT-S is the screener portion of the ICF Measure of Participation & Activities (IMPACT) questionnaire (Post et al., 2008). The measure was designed to describe functioning and disability independent of health conditions.

Description:

IMPACT-S is a 32-item questionnaire. Each item contains a question about experiences in one's life, examples how the limitation might be experienced, and a 4-point limitation rating scale (No, no limitations whatsoever; Yes, some limitations; Yes, considerable limitations; Yes, I cannot do that at all).

In addition to a total score, 9 scale scores (one per ICF domain), and 2 subtotal scores for activities and participation can be computed. All summary scores are converted to a score on a 0 to 100 scale, with higher scores indicating higher levels of participation and lower scores indicating greater limitations to participation.

Area of Assessment: Life Participation

Body Part: Not Applicable

ICF Domain: Activity, Participation

Domain: ADL, Cognition, Emotion, General Health, Motor, Sensory

Assessment Type: Patient Reported Outcomes

Length of Test: 05 Minutes or Less, 06 to 30 Minutes

Time to Administer:

No published data on administration time (Magasi & Post, 2010).

Number of Items: 32

Equipment Required:

None

Training Required:

No Training

Type of training required: No Training

Cost: Free

Actual Cost:

Free

Age Range: Adolescent: 13-17 years, Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Acquired Brain Injury, Arthritis, Cardiac Conditions, Cerebral Palsy, Chronic Obstructive Pulmonary Disease, Concussion, Fibromyalgia, Geriatrics, Hip Fracture, Knee Dysfunction, Lower Limb Amputation, Movement Disorders, Multiple Sclerosis, Neck Injury, Parkinson's Disease, Peripheral Neuropathy, Pulmonary Disease, Spinal Cord Injury, Stroke, Traumatic Brain Injury, Vestibular Disorders

Populations Tested:

• Spinal cord injury (SCI) (Van der Zee et al, 2014)
• Physical disabilities: musculoskeletal disease, traumatic brain injury, stroke, neuromuscular diseases, chronic pain, and heart failure (Van der Zee et al, 2010)
• Road accidents: fractures, traumatic brain injury, spinal cord injury, whiplash, other (Post et al, 2008)

Standard Error of Measurement (SEM):

Physical Disabilities: (Van der Zee et al, 2010; n = 47; mean age = 50.6 (11.8) years; mean time post diagnosis = 1.7 years; Dutch, Physical Disabilities)

• SEM= 4.4

Minimal Detectable Change (MDC):

Physical Disabilities: (Van der Zee et al, 2010, Physical Disabilities)

• MDC for entire group (n = 47)= 1.8 (SD= 0.14)
• MDC for individuals= 12.1 (SD= 0.96)

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not Established

Normative Data:

Not Established

Test-retest Reliability:

Physical Disabilities: (Van der Zee et al, 2010, Physical Disabilities)

• Adequate test-retest reliability for most scale scores and sub-total score Participation: (ICC = 0.74)
• Fair to excellent reliability: Weighted kappa values for individual items varied from 0.22-0.82
  • Fair for three items, Moderate for seven, and almost perfect for three
• The mean percentage of exact agreement between individual items on a test-retest with two week latency period was 73.1% (range 56.6-89.1%)

Road Accidents: (Post et al, 2008; n = 197; mean age = 40.4 (15.8) years; mean time post injury = 2.2 (0.9) years; with residual disability at discharge; Dutch, Road Accidents)

• Adequate test-retest reliability between most domain scale scores (Kappa = 0.48-0.59) and excellent test-retest reliability between Knowledge & Mobility (Kappa = 0.63, 0.66).
• Adequate test-retest reliability between Activities & Participation sub-total scores (Kappa = 0.59, 0.56)
• Adequate test-retest reliability for IMPACT-S total scores (Kappa = 0.58).
• Excellent test-retest reliability for all domain scale scores (ICC = 0.75-0.92) except General tasks scale (ICC = 0.72).
• Excellent test-retest reliability for Activities & Participation sub-total scores (ICC = 0.93, 0.90).
• Excellent test-retest reliability for IMPACT-S total scores (ICC = 0.94).

Interrater/Intrarater Reliability:

Not Established

Internal Consistency:

SCI: (Van der Zee et al, 2014; n = 157; mean age = 50.6 (10.5); mean time post SCI = 25.3 (26.8) years; wheelchair dependent; Dutch, Spinal Cord Injury)

• Excellent internal consistency for IMPACT-S total score (Cronbach's alpha = 0.92)
• Excellent internal consistency for Activities subtotal score (Cronbach's alpha = 0.84)
• Excellent internal consistency for Participation subtotal score (Cronbach's alpha = 0.88)

Road Accidents: (Post et al, 2008, Road Accidents)

• Adequate internal consistency for Knowledge, General tasks, Communications, Interpersonal, Major life areas, Community life domain scale scores (Cronbach's alpha = 0.74-0.78) and excellent internal consistency for Mobility, Self-care, Domestic life domain scales scores (Cronbach's alpha = 0.81-0.89).
• Excellent internal consistency for Activities & Participation sub-total scores (Cronbach's alpha = 0.92, 0.92).
• Excellent internal consistency for IMPACT-S total score (Cronbach's alpha = 0.96).

Criterion Validity (Predictive/Concurrent):

Concurrent Validity:

SCI: (Van der Zee et al, 2014, Spinal Cord Injury)

• Adequate to excellent concurrent validity predicting Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) frequency, restrictions, and satisfaction scores (Spearman coefficient = 0.32-0.73)
• Excellent concurrent validity predicting World Health Organization Disability Assessment Schedule II (WHODAS II) total disability index scores (Spearman coefficient = 0.70-0.78)

Road Accidents: (Post et al, 2008, Road Accidents)

• Excellent concurrent validity predicting World Health Organization Disability Assessment Schedule II (WHODAS II) scores between corresponding & non-corresponding scales (Spearman coefficient = 0.64-0.78)

Construct Validity (Convergent/Discriminant):

Discriminant validity:

SCI: (Van der Zee et al, 2014, Spinal Cord Injury)

• Excellent discriminant validity correlation with paraplegia IMPACT-S total score (U = 73.8) and
• Excellent discriminant validity correlation with tetraplegia IMPACT-S total score (U = 63.3)

Convergent validity:

Road Accidents: (Post et al, 2008, Road Accidents)

• Adequate to excellent convergent validity for all domain scale scores (Spearman's coefficient = 0.34-0.75).
• Adequate to excellent convergent validity for Activities & Participation sub-total scores (Spearman's coefficient = 0.56-0.89).
• Adequate to excellent convergent validity for IMPACT-S total score (Spearman's coefficient = 0.63-0.97).

Content Validity:

Content validity was established based on correspondence to the ICF and pilot testing with a heterogeneous sample of motor vehicle collision survivors (n=11) and rehabilitation professionals (n=18). Validity and reliability statistics are based on postal surveys with a Dutch sample of 275 survivors of motor vehicle collisions. Validity and reliability statistics are reported for 9 domain scales, 2 subtotal scores for activities and participation, and a total score. (Magasi & Post, 2010)

Face Validity:

Physical Disabilities: (Van der Zee et al, 2010, Physical Disabilities)

• Not statistically assessed; however, majority of respondents consider this questionnaire to be a relevant measure to assess their participation.

SCI: (Van der Zee et al, 2014, Spinal Cord Injury)

• Not statistically assessed, however, 44.8% of all respondents considered the IMPACT-S, USER-Participation and WHODAS II instruments equally suitable to assess their participation, and 12.6% judged the IMPACT-S as best suitable.

Floor/Ceiling Effects:

Physical Disabilities: (Van der Zee et al, 2010, Physical Disabilities)

• Excellent: The total score did not show floor or ceiling effects

Outpatient Rehab Program : (Van der Zee et al, 2011, Outpatient Rehab Program)

• Excellent: No floor or ceiling effects.

SCI: (Van der Zee et al, 2014, Spinal Cord Injury)

Excellent: No floor and ceiling effects (0.0% and 0.0% respectively)

Responsiveness:

Not Established

Considerations:

• Empirical testing failed to support the hypothesized distinction between activities and participation, and there was limited patient involvement in the instrument's development (Magasi & Post, 2010).
• Even though an English version of the IMPACT-S is available, it has not yet been validated in English (Van der Zee et al, 2014). 
• IMPACT was designed as a 2-level instrument. Level 1 is the screener part (IMPACT-S) that covers all ICF activity and participation chapters and can be used as an independent measure. Level 2 is a series of modules but is still in the developmental phase (Post et al, 2008).
• Some patients reported that completing the questionnaire was confronting because it showed the many different disabilities that one may experience after trauma, but did not judge this negatively (Post et al, 2008).

Bibliography:

Magasi & Post. (2010). A comparative review of contemporary participation measures' psychometric properties and content coverage. Archives of Physical Medicine and Rehabilitation, 91(9), S17-28. doi: 10.1016/j.apmr.2010.07.011

Post, M., De Witte, L. P., Reichrath, E., Verdonschot, M. M., Wijlhuizen, G. J., & Perenboom, R. J. (2008). Development and Validation of IMPACT-S, an ICF-Based Questionnaire to Measure Activities and Participation. Journal of Rehabilitation Medicine, 40, 620-627. doi:10.2340/16501977-0223

Van der Zee, C. H., Post, M. W., Brinkhof, M. W., & Wagenaar, R. C. (2014). Comparison of the Utrecht Scale for Evaluation of Rehabilitation-Participation With the ICF Measure of Participation and Activities Screener and the WHO Disability Assessment Schedule II in Persons With Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, 95, 87-93. doi: 10.1016/j.apmr.2013.08.236

Van der Zee, C. H., Priesterbach, A. R., van der Dussen, L., Kap, A., Schepers, V. P., Visser-Meily, J., & Post, M. W. (2010). Reproducibility of three self-report participation measures: The ICF Measure of Participation and Activities Screener, the Participation Scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation. Journal of Rehabilitation Medicine, 42(8), 752-757.

Year published: 2008

Instrument in PDF Format: Yes

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