Introduction
Joint contractures are common complications of nervous system diseases, such as stroke and spinal cord injury,1 and more than one-fifth (22.0%) of elderly residents in long-term care (LTC) facilities suffer from joint contractures,2 resulting in functional restrictions and limitations of joint mobility and thus activity limitations and participation restrictions.2-4 Many studies have noted that activity limitations and participation restrictions, such as the inability to write or inability to visit friends, are most relevant to patients with joint contractures.5,6
Unfortunately, activity limitations and participation restrictions are closely related to the quality of life (QOL) of elderly residents in LTC facilities.7 Many experts even believe that QOL is an important outcome indicator for elderly residents in LTC facilities.8,9 Recent studies have examined the explanatory power of various factors on the QOL of elderly residents in LTC facilities and have found that activity and participation have the best explanatory power (52.1%) on the QOL of elderly residents in LTC facilities.10 This finding can help scholars and experts concerned about the QOL of elderly residents in LTC facilities to simplify the complex QOL connotation. Therefore, elderly individuals with joint contractures may have severely limited mobility, which could lead to participation restrictions and negatively affect their QOL.5-7,11
Currently, the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) is a widely used scale for the global assessment of activity and participation; however, the scale has several issues. First, the population is heterogeneous. Both the individuals who are frail but still able to walk and the individuals who are severely constrained by mobility are included. Second, affected individuals have different preferences in terms of participation. Third, individuals may already have one or more fully developed joint contractures or are at risk of developing joint contractures. Fourth, personal life situations are diverse, including different nursing care and assistance resources.12 However, the WHODAS 2.0 is deigned to be applicable to all health conditions, including diseases, illnesses, injuries, mental or emotional problems, and alcohol or drug abuse. It does not attempt to assign aetiology or apportion impairment or disability to any particular disorder.13 The evaluation of activity and participation is complex, and the complex personal experience of impaired individuals must be acknowledged.12 Therefore, an outcome questionnaire that quantifies the activity and participation of a particular population is particularly important. Thus far, no universally accepted scale can address the abovementioned key issues.12However, the International Classification of Functioning, Disability, and Health (ICF) is the common basis of the WHO’s patient-centred measures and intervention plan and comprehensively classifies all health and health-related fields.5 Therefore, the PaArticular Scales, developed using the ICF as a standard, can fill this gap. The purpose of this study was to examine the psychometric properties of the Chinese version of the PaArticular Scales in joint contractures population.