Current Journal of Neurology

The psychometric properties of the Persian version of the participation measure-3 domains, 4 dimensions in Iranian patients with multiple sclerosis

Document Type : Original Article

Authors

Marzeih Heidari 1
Malahat Akbarfahimi 2
Ghorban Taghizadeh 3
Seyed Massood Nabavi 4
Laleh Lajevardi 1

1 Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran

2 Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran

3 Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran Geriatric Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran

4 Department of Regenerative Medicine, Neurology and Multiple Sclerosis Group, Royan Institute for Stem Cell Biology and Technology, Academic Center for Education, Culture and Research, Tehran, Iran

https://doi.org/10.18502/cjn.v24i4.22676
Abstract
Background: Multiple sclerosis (MS) profoundly influences individuals' participation across various life domains. This study evaluated the psychometric properties of the Persian version of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D) in people with MS (PwMS).
Methods: In a cross-sectional design with a nested test-retest sub-study, 230 PwMS were assessed. Construct validity was examined through intercorrelations among PM-3D4D dimensions and associations with the Community Integration Questionnaire (CIQ), Participation Measure for Post-Acute Care (PM-PAC), Satisfaction with Life Scale (SWLS), and Purpose in Life Test-Short Form (PIL-SF). The instrument's discriminative capacity across subgroups with different levels of disability and fatigue was also analyzed.
Results: The PM-3D4D demonstrated excellent test-retest reliability [intraclass correlation coefficient (ICC)(2,1) = 0.81-0.90] and good internal consistency (Cronbach’s alpha = 0.79-0.89). Strong correlations emerged between the diversity and frequency dimensions (rs = 0.70-0.88), alongside moderate to strong correlations with the difficulty dimension (rs = 0.37-0.82). As hypothesized, PM-3D4D scores correlated strongly with CIQ (rs = 0.71-0.83), and the difficulty dimension was negatively correlated with PM-PAC subscales
(rs = -0.75 to -0.85). Desire for change showed weak negative correlations with SWLS (rs = -0.16 to -0.29) and moderate negative correlations with PIL-SF (rs = -0.33 to -0.51). The instrument significantly differentiated participants based on disability and fatigue levels (P < 0.001).
Conclusion: The Persian version of the PM-3D4D is a valid and reliable measure for evaluating participation among PwMS in both clinical and research settings.

Keywords

Multiple Sclerosis
Participation
Reliability
Validity
Subjects
  1. Karhula ME, Tolvanen A, Hämäläinen PI, Ruutiainen J, Salminen AL, Era P. Predictors of Participation and Autonomy in People With Multiple Sclerosis. Am J Occup Ther 2019; 73(4): 7304205070p1-p8.
  2. Johansson S, Ytterberg C, Gottberg K, Holmqvist LW, Von Koch L, Conradsson D. Participation in social/lifestyle activities in people with multiple sclerosis: Changes across 10 years and predictors of sustained participation. Mult Scler 2020; 26(13): 1775-84.
  3. Karhula ME, Salminen AL, Hämäläinen PI, Ruutiainen J, Era P, Tolvanen A. Psychometric evaluation of the Finnish version of the impact on participation and autonomy questionnaire in persons with multiple sclerosis. Scand J Occup Ther 2017; 24(6): 410-20.
  4. Ben Ari Shevil E, Johansson S, Ytterberg C, Bergström J, von Koch L. How are cognitive impairment, fatigue and signs of depression related to participation in daily life among persons with multiple sclerosis? Disabil Rehabil 2014; 36(23): 2012-8.
  5. Chang FH, Chang KH, Liou TH, Whiteneck GG. Validation of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D). Arch Phys Med Rehabil 2017; 98(12): 2498-506.
  6. Abdullah EJ, Badr HE, Manee F. MS People's Performance and Satisfaction With Daily Occupations: Implications for Occupational Therapy. OTJR (Thorofare N J) 2018; 38(1): 28-37.
  7. Allataifeh E, Khalil H, Almhdawi K, Al-Shorman A, Hawamdeh Z, El-Salem K, et al. The clinical correlates of participation levels in people with multiple sclerosis. NeuroRehabilitation 2020; 47(2): 153-60.
  8. Chang FH, Ni P. Responsiveness and Predictive Validity of the Participation Measure-3 Domains, 4 Dimensions in Survivors of Stroke. Arch Phys Med Rehabil 2019; 100(12): 2283-92.
  9. Chang FH, Ni P, Coster WJ, Whiteneck GG, Jette AM. Measurement properties of a modified measure of participation for persons with spinal cord injury. J Spinal Cord Med 2016; 39(4): 476-83.
  10. Chang FH, Liou TH, Ni P, Chang KH, Lai CH. Development of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D): A New Outcome Measure for Rehabilitation. Arch Phys Med Rehabil 2017; 98(2): 286-94.
  11. Chang FH. Measuring Participation of Rehabilitation Patients: Test-Retest Reliability and Mode of Administration Concordance of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D). Arch Phys Med Rehabil 2017; 98(8): 1622-7.
  12. Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth 2017; 11(Suppl 1): S80-s9.
  13. Oervik MS, Sejbaek T, Penner IK, Roar M, Blaabjerg M. Validation of the fatigue scale for motor and cognitive functions in a danish multiple sclerosis cohort. Mult Scler Relat Disord 2017; 17: 130-4.
  14. Pashandi S, Khaghanizade M, Ebadi A. Review of translation and cultural adaptation process of questionnaires. Bimon Educ Strateg Med Sci 2009; 2(3): 117-20. [In Persian].
  15. Simon SD. Statistical evidence in medical trials: What do the data really tell us? Proc (Bayl Univ Med Cent) 2006; 19(4): 419.
  16. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17(2): 162-73.
  17. Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain 2014; 155(12): 2545-50.
  18. Beck AT, Steer RA, Brown GK-II (BDI-II). In: Gellman MD, Turner JR, editors. Encyclopedia of Behavioral Medicine. New York, NY: Springer; 2013.
  19. Feinstein A. Mood disorders in multiple sclerosis and the effects on cognition. J Neurol Sci 2006; 245(1-2): 63-6.
  20. Heitmann H, Andlauer TFM, Korn T, Mühlau M, Henningsen P, Hemmer B, et al. Fatigue, depression, and pain in multiple sclerosis: How neuroinflammation translates into dysfunctional reward processing and anhedonic symptoms. Mult Scler 2022; 28(7): 1020-7.
  21. Goldstein FC, Ashley AV, Miller E, Alexeeva O, Zanders L, King V. Validity of the montreal cognitive assessment as a screen for mild cognitive impairment and dementia in African Americans. J Geriatr Psychiatry Neurol 2014; 27(3): 199-203.
  22. Sharifi D, Lajevardi L, Taghizadeh G, Azad A. The Persian Version of the "Participation Measure-3 Domains, 4 Dimensions": Translation, Cultural Adaptation, Face and Content Validity. Func Disabil J 2025; 8(1).
  23. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) 2000; 25(24): 3186-91.
  24. Mokkink L, Prinsen CAC, Patrick DL, Alonso J, Bouter LM, de Vet HCW, et al. COSMIN Study Design checklist for Patient-reported outcome measurement instruments 2019. [Accessed June 2024]. Available from: URL: https://www.cosmin.nl/wp-content/uploads/COSMIN-study-designing-checklist_final.pdf
  25. Luhmann M, Hennecke M. The motivational consequences of life satisfaction. Motiv Sci 2017; 3(1): 51-75.
  26. Cattaneo D, Lamers I, Bertoni R, Feys P, Jonsdottir J. Participation Restriction in People With Multiple Sclerosis: Prevalence and Correlations With Cognitive, Walking, Balance, and Upper Limb Impairments. Arch Phys Med Rehabil 2017; 98(7): 1308-15.
  27. Valko PO, Bassetti CL, Bloch KE, Held U, Baumann CR. Validation of the fatigue severity scale in a Swiss cohort. Sleep 2008; 31(11): 1601-7.
  28. Willer B, Ottenbacher KJ, Coad ML. The community integration questionnaire. A comparative examination. Am J Phys Med Rehabil 1994; 73(2): 103-11.
  29. Negahban H, Fattahizadeh P, Ghasemzadeh R, Salehi R, Majdinasab N, Mazaheri M. The Persian version of Community Integration Questionnaire in persons with multiple sclerosis: translation, reliability, validity, and factor analysis. Disabil Rehabil 2013; 35(17): 1453-9.
  30. Gandek B, Sinclair SJ, Jette AM, Ware JE, Jr. Development and initial psychometric evaluation of the participation measure for post-acute care (PM-PAC). Am J Phys Med Rehabil 2007; 86(1): 57-71.
  31. Javanmard A, Abdi K, Ebadi A, Hosseinzadeh S. Participation instruments in persons with spinal cord injury: A narrative review. Med J Islam Repub Iran 2020; 34: 66.
  32. Diener E, Emmons RA, Larsen RJ, Griffin S. The Satisfaction With Life Scale. J Pers Assess 1985; 49(1): 71-5.
  33. Tagharrobi Z, Sharifi K, Sooky Z, Tagharrobi L. Psychometric evaluation of the satisfaction with life scale (SWLS) in the students of Kashan Nursing & Midwifery Faculty, Kashan, Iran. Qom Univ Med Sci J 2012; 6(1): 90-99. [In Persian].
  34. Schulenberg SE, Schnetzer LW, Buchanan EM. The purpose in life test-short form: Development and psychometric support. J Happiness Stud 2011; 12(5): 861-76.
  35. Cheraghi M, Oreyzi SSHR, Faraahani H. Reliability, validity, factor analysis and normalization of the Crumbaugh and Maholick’s questionnaire of purpose-in-life. J Psychol 2009; 12(1): 396-413.
  36. Armutlu K, Korkmaz NC, Keser I, Sumbuloglu V, Akbiyik DI, Guney Z, et al. The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients. Int J Rehabil Res 2007; 30(1): 81-5.
  37. Azimian M, Farahani AS, Dadkhah A, Fallahpour M, Karimlu M. Fatigue severity scale: the psychometric properties of the persian-version in patients with multiple sclerosis. Res J Biol Sci 2009; 4(9): 974-7.
  38. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety 2005; 21(4): 185-92.
  39. Hamilton DF, Giesinger JM, MacDonald DJ, Simpson AH, Howie CR, Giesinger K. Responsiveness and ceiling effects of the Forgotten Joint Score-12 following total hip arthroplasty. Bone Joint Res 2016; 5(3): 87-91.
  40. Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 2005; 19(1): 231-40.
  41. Souza DC, Wegner F, Costa LCM, Chiavegato LD, Lunardi AC. Measurement properties of the Human Activity Profile questionnaire in hospitalized patients. Braz J Phys Ther 2017; 21(3): 153-8.
  42. Wilson FR, Pan W, Schumsky DA. Recalculation of the critical values for Lawshe’s content validity ratio. Meas Eval Couns Dev 2012; 45(3): 197-210.
  43. Lawshe CH. A quantitative approach to content validity. Pers Psychol 1975; 28(4): 563-75.
  44. Carle AC, Riley W, Hays RD, Cella D. Confirmatory Factor Analysis of the Patient Reported Outcomes Measurement Information System (PROMIS) Adult Domain Framework Using Item Response Theory Scores. Med Care 2015; 53(10): 894-900.
  45. Sherer M, Poritz JMP, Tulsky D, Kisala P, Leon-Novelo L, Ngan E. Conceptual Structure of Health-Related Quality of Life for Persons With Traumatic Brain Injury: Confirmatory Factor Analysis of the TBI-QOL. Arch Phys Med Rehabil 2020; 101(1): 62-71.
  46. Brown M, Dijkers MP, Gordon WA, Ashman T, Charatz H, Cheng Z. Participation objective, participation subjective: a measure of participation combining outsider and insider perspectives. J Head Trauma Rehabil 2004; 19(6): 459-81.
  47. Minnes P, Carlson P, McColl MA, Nolte ML, Johnston J, Buell K. Community integration: a useful construct, but what does it really mean? Brain Inj 2003; 17(2): 149-59.
  48. Thompson NJ, Coker J, Krause JS, Henry E. Purpose in life as a mediator of adjustment after spinal cord injury. Rehabil Psychol 2003; 48(2): 100-8.
  49. Kwiatkowski A, Marissal JP, Pouyfaucon M, Vermersch P, Hautecoeur P, Dervaux B. Social participation in patients with multiple sclerosis: correlations between disability and economic burden. BMC Neurol 2014; 14: 115.
  50. Van der Hiele K, Middelkoop HA, Ruimschotel R, Kamminga NG, Visser LH. A pilot study on factors involved with work participation in the early stages of multiple sclerosis. PLoS One 2014; 9(8): e105673.
Current Journal of Neurology
Volume 24, Issue 4
Autumn 2025
Pages 257-269

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us