Validity of the Utrecht scale for evaluation of rehabilitation-participation restrictions scale in a hospital-based stroke population 3 months after stroke

Figures & data

Table 1. Patient characteristics (n = 359).

Demographic factors (3 months after stroke)
Sex (% male)	60.2
Age in years (at time of stroke)	70.0 (17.0)^a
Marital status (% living together)	72.1
Residency (% living at home)	96.9
Stroke-related factors
Ischemic stroke (%)	93.0
Left hemisphere (%)	46.2
Severity of stroke (NIHSS) at hospital admission (n = 242)	3.0 (4.0)^a
No or minor stroke symptoms (% NIHSS ≤ 4)	68.0
Moderate to severe stroke symptoms (% NIHSS > 4)	32.0
ADL dependency (BI) 4 days after stroke (n = 275)	19.0 (4.0)^a
% ADL-dependent (BI ≤17)	37.2
ADL dependency (BI) at discharge (n = 264)	20.0 (2.0)^a
% ADL-dependent (BI ≤17)	23.6

Abbreviations: ADL, activities of daily living; BI, Barthel Index; NIHSS, National Institutes of Health Stroke Scale.

^aMedian (IQR, interquartile range)

Figure 1. Distribution of the USER-Participation Restrictions scale across mRS scores (dark blue) and across different levels of patient-reported decrease in health (light blue) and in daily activities (white) 3 months after stroke.

Abbreviations: mRS, Modified Rankin Scale; USER-P-R, Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions scale.Note: The bold horizontal bars in the boxes represent the median for the USER-P-R. The ends of the boxes represent the first and third quartiles. The vertical line represents the minimum and maximum scores (inside 1.5 IQR). The open dots represent outliers (outside 1.5 IQR). Higher USER-P-R scores indicate better participation outcome, higher mRS scores indicate worse disability.

Figure 2. Percentage of participants experiencing restrictions regarding the items of the USER-Participation Restrictions scale across the different mRS levels.

Abbreviations: mRS, Modified Rankin Scale; USER-P-R, Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions scale.Note: Item on work/education: only participants aged <66 years were included, as the retirement age in the Netherlands during inclusion (2018) was 66 years.

Table 2. Frequencies and descriptive statistics of the USER-participation restrictions scale.

	n	Mean	± SD	Median	IQR	% maximum
USER-P-R total score	359	77.6	± 21.4	81.8	63.3–96.7	21.4
EQ-5D-5 L total score	359	78.0	± 19.6	80.8	69.4–91.7	21.2
PROMIS-10 total score	359	54.3	± 18.5	55.0	42.5–65.0	1.9
USER-P-R total score across the different mRS levels
mRS 0	47	94.8	± 12.6	100	96.3–100	70.2
mRS 1	135	89.3	± 11.6	92.6	83.3–100	28.1
mRS 2	134	70.3	± 16.8	71.8	58.1–81.8	4.5
mRS 3–5	43	45.1	± 19.5	46.7	33.3–60.0	0
USER-P-R total score across the different levels of patient-reported decrease in health and in activities
No decrease in health	131	88.7	± 16.4	96.7	84.8–100	42.7
Little decrease in health	164	77.3	± 18.9	80.5	66.7–93.1	12.2
Strong decrease in health	64	55.7	± 19.4	53.9	44.7–68.9	1.6
No decrease in activities	118	91.1	± 13.7	96.8	87.6–100	48.7
Little decrease in activities	155	78.4	± 19.4	81.5	66.7–93.3	12.3
Strong decrease in activities	86	57.7	± 18.3	58.3	46.7–70.0	0

Abbreviations: IQR, interquartile range; mRS, Modified Rankin Scale; SD, standard deviation; USER-P-R, Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions scale.

Note: higher USER-P-R total scores indicate better participation outcome.

Table 3. Spearman correlations (rho) between the USER-Participation Restrictions scale, the modified Rankin Scale, EQ-5D-5 L (including daily activities item score) and PROMIS-10 (including social participation item score).

	mRS	EQ-5D-5 L total score	EQ-5D-5 L item (daily activities)	PROMIS-10 total score	PROMIS-10 item (social participation)
USER-P-R	−.71*	.67*	−.73*	.66*	.55*
mRS		−.62*	.64*	−.61*	−.50*
EQ-5D-5 L total score			−.72*	.75*	.54*
EQ-5D-5 L item (daily activities)				−.63*	−.55*
PROMIS-10 total score					.78*

Abbreviations: EQ-5D-5 L, EuroQol 5-dimensional 5-level value score; mRS, Modified Rankin Scale; PROMIS-10, Patient Reported Outcomes Measurement Information System 10-Question Short Form; USER-P-R, Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions scale.

* p ≤ 0.001

Table 4. Ability of the USER-Participation Restrictions scale to discriminate between adjacent mRS levels (mRS 0 vs. mRS 1, mRS 1 vs. mRS 2, mRS 2 vs. mRS 3–5) and different levels of patient-reported decrease in health and in activities post-stroke.

		Mean ∆	SE ∆	P-value	95% CI ∆	Hedges’ g
USER-P-R	mRS 0 vs. mRS 1	5.52	2.53	0.130	−1.01–12.05	0.46
	mRS 1 vs. mRS 2	18.99*	1.82	<0.001*	14.29–23.69	1.31
	mRS 2 vs. mRS 3–5	25.16*	2.62	<0.001*	18.40–31.92	1.44
	No vs. little decrease in health	11.38	2.13	<0.001*	6.38–16.39	0.64
	Little vs. strong decrease in health	21.64	2.67	<0.001*	15.35–27.93	1.20
	No vs. little decrease in activities	12.76	2.13	<0.001*	7.75–17.78	0.80
	Little vs. strong decrease in activities	20.65	2.35	<0.001*	15.13–26.17	1.22

Abbreviations: ∆, difference; CI, confidence interval; mRS, Modified Rankin Scale; SE, standard error; USER-P-R, Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions scale.

Note: Higher mRS scores indicate worse disability.

* p < 0.05

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request ([email protected]).