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Objective: To avoid restraints and involuntary care caregivers should be aware if and how a patient resists care. This article focuses on behavioural expressions of people with severe dementia in nursing homes that are interpreted by their formal and informal caregivers as possible expressions of their experience of involuntary care. Method: Concept mapping was used, following five steps: (1) brainstorming, (2) rating, (3) sorting, (4) statistical analysis & visual representation and (5) interpretation. Specialists (n = 12), nurses (n = 23) and relatives (n = 13) participated in separate groups. Results: The views generated are grouped into clusters of behaviour, presented in graphic charts for each of the respondent groups. The large variety of behavioural symptoms includes, in all groups, not only the more obvious and direct behavioural expressions like aggression, resistance and agitation, but also more subtle behaviour such as sorrow, general discomfort or discontent. Conclusion(s): In the interpretation of behavioural symptoms of people with severe dementia it is important to take into account the possibility of that person experiencing involuntary care. Increased awareness and understanding of the meaning and consequences of the behavioural expressions is an important step in improving dementia care by avoiding restraints and involuntary care to its maximum. [ABSTRACT FROM AUTHOR]

Purpose: There is still a need for a generic participation instrument that measures both objective and subjective participation in adults living in the community and that is feasible for use in rehabilitation practice. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was developed to satisfy this need, comprising 31 items in three scales: Frequency, Restrictions and Satisfaction. The aim of this study was to examine the validity of this measure. Methods: Cross-sectional study involving former rehabilitation outpatients from five rehabilitation facilities in the Netherlands (n = 395). The Frenchay Activities Index (FAI), the participation subtotal score of the ICF Measure of Participation and Activities Screener (IMPACT-SP) and the Participation Scale were included as reference measures. Results: Internal consistency of the USER-Participation scales was satisfactory (α 0.70-0.91). Spearman correlations between these scales were between 0.36 and 0.52. Concurrent validity was shown by strong correlations between the Frequency scale and the FAI (0.59), the Restrictions scale and the IMPACT-SP (0.75) and the Satisfaction scale and the Participation Scale (−0.73). Discriminant validity was shown by significant differences in USER-Participation scores between participants with different levels of independence and between participants with different health conditions. Conclusion: The USER-Participation appears to be a valid measure to rate objective and subjective participation in persons with physical disabilities. [ABSTRACT FROM AUTHOR]

Objective: To assess the responsiveness of 4 participation measures., Design: Longitudinal study with repeated measurements at the start (t1) and at the end (t2) of a multidisciplinary out-patient rehabilitation programme, and at 4 months follow-up (t3)., Subjects: Outpatients with different diagnoses (n=395) from 5 rehabilitation centres in The Netherlands., Methods: Measures were the Frenchay Activities Index (FAI), the Participation subscale of the ICF Measure of Participation and Activities Screener (IMPACT-SP), the Participation Scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation). Responsiveness was analysed using the effect size and the standardized response mean., Results: Comparing scores at t1 and t2, the standardized response mean was 0.54 for the USER-Participation Restriction scale, 0.41 for the FAI, 0.40 for the IMPACT-SP, 0.39 for the USER-Participation Satisfaction scale, -0.36 for the Participation Scale, and 0.21 for the USER-Participation Frequency scale. Effect size values were generally somewhat smaller than standardized response mean values. Effect size and standardized response mean values were negligible between t2 and t3. Responsiveness parameters varied between diagnostic groups, with participants with acquired brain injury showing the largest change and participants with neuro-muscular disease or chronic pain showing least change., Conclusion: Overall and across the different diagnostic groups, the USER-Participation Restriction scale showed the best responsiveness.

Objective: To assess the reproducibility of 3 participation measures., Design: Repeated administration of a postal questionnaire with a 2-week interval., Participants: Outpatients (n = 47) from 2 rehabilitation centres and a university hospital in The Netherlands., Methods: Measures were the ICF Measure of Participation and Activities Screener (IMPACT-S), the Participation Scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). Test-retest reliability was analysed using Cohen's weighted kappa and the intraclass correlation coefficient (ICC). Agreement was expressed as the standard error of measurement and the smallest detectable change (SDC), substantiated as the ratio between the SDC and the standard deviation (SDC/SD)., Results: ICC values of the IMPACT-S were 0.54-0.90 for the scale scores, 0.92 and 0.74 for sub-total scores Activities and Participation, and 0.88 for the total score. The ICC of the Participation Scale was 0.82. The ICC of the USER-P was 0.65 for the Frequency scale, 0.85 for the Restrictions scale, and 0.84 for the Satisfaction scale. The SDC/SD ratios for all measures were small (0.11-0.28) at the group level, but large (0.78-1.91) at the individual level. Most participants found all measures relevant and easy to complete., Conclusion: All 3 measures showed generally satisfying reproducibility and were acceptable to the participants.