Construct validity, responsiveness, and interpretability of the Utrecht Scale for Evaluation of Rehabilitation (USER) in patients admitted to inpatient geriatric rehabilitation

Clinical Rehabilitation, vol. 38, pp. 98–108

Abstract

OBJECTIVE: The Utrecht Scale for Evaluation of Rehabilitation is a multi-domain measurement with good content validity, structural validity and reliability for measuring physical functioning (mobility, selfcare) and cognitive functioning in geriatric rehabilitation. We aimed to determine the construct validity of both Utrecht Scale for Evaluation of Rehabilitation scales and the responsiveness and interpretability of the scale for physical functioning in geriatric rehabilitation. DESIGN: Prospective follow-up study embedded in routine care. SETTING: Four care organisations in The Netherlands. SUBJECTS: Patients admitted for inpatient geriatric rehabilitation (2021-2022). MAIN MEASURES: Data collection included the Utrecht Scale for Evaluation of Rehabilitation, Mini-Mental State Examination, Barthel index, and a global rating scale anchor on recovery. Hypothesis testing was used to determine construct validity and responsiveness. For interpretability, minimal important change and floor and ceiling effects were determined. RESULTS: = 211) was 77 (SD 10.4). Their mean length of stay was 38.6 days (SD 26.3), and 81% returned home. The Utrecht Scale for Evaluation of Rehabilitation showed adequate construct validity, as all three hypotheses were confirmed for both scales. The Utrecht Scale for Evaluation of Rehabilitation-physical function scale showed adequate responsiveness, with all five hypotheses confirmed. The mean change for physical function (scale range 0-70) was 15.5 points (SD 17.1). The minimal important change for Utrecht Scale for Evaluation of Rehabilitation-physical function was 14.5 points difference for improvement. This scale showed no floor (2%) and ceiling effects (14%) at admission and discharge. CONCLUSIONS: The Utrecht Scale for Evaluation of Rehabilitation showed to be effective for evaluating physical functioning during geriatric rehabilitation as well as screening cognitive functioning. In total, 14.5 points difference has been established as a minimal important change for physical functioning.

Authors 6

1. Margot W. M. de Waal corresponding Aachen Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands

   University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands

2. Loes M Bakker

   Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

3. Arno J. Doornebosch Aachen Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands

   University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands

4. E. Wattel

   Amsterdam Public Health · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands

   Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

   de Zorgcirkel, Purmerend, the Netherlands

5. Dennis Visser

   Amsterdam Public Health · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands

   Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

   de Zorgcirkel, Purmerend, the Netherlands

6. Ewout B Smit

   Amsterdam Public Health · Amsterdam University Medical Centers · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands

   Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

   University Network of care for Older people of Amsterdam UMC (UNO Amsterdam), Amsterdam UMC, Amsterdam, the Netherlands

   Vivium Zorggroep, Naarden, the Netherlands