Activities-specific balance confidence scale: a Rasch evaluation of the Arabic version in lower-limb prosthetic users

Abstract

Purpose

To evaluate the psychometric properties of the Arabic version of the Activities-Specific Balance Confidence Scale using the 5-option response categories for individuals with lower limb amputation (ABC-5/Ar).

Materials and methods

This was a methodological study on a convenience sample of individuals with unilateral lower-limb amputation attending outpatient rehabilitation centres in Saudi Arabia and Turkey (N = 155). Rasch analysis (WINSTEPS version 4.6.5) was used to examine the 5-categories rating scale structure, item fit, item difficulty hierarchy, person separation index, unidimensionality, local item dependency, and differential item functioning.

Results

The ABC-5/Ar 5-response option demonstrated an appropriate model fit. Most items fit the Rasch model, except for item #12 “walk in a crowded mall,” which showed an overfitting value of 0.63. The person separation indices 2.95 (Cronbach’s α = 0.96). Principal component analysis of residuals confirmed the unidimensionality of the scale; however, local dependency was detected between item #14 “Ride in escalator holding rail,” and item #15 “Ride in escalator not holding rail.”

Conclusions

The findings suggest that the ABC-5/Ar shows promise in assessing balance confidence in Arabic-speaking lower-limb prosthesis users. However, further studies with larger sample sizes and in diverse clinical contexts are needed to confirm its effectiveness in various clinical settings.

IMPLICATIONS FOR REHABILITATION

• Overall, our Rasch-based study provides additional evidence to support the psychometric appropriateness of using the Activity-specific Balance Confidence scale with the 5-category options (ABC-5) of the Arabic version among lower prosthesis users.

• Clinicians and researchers should be mindful of cultural and contextual differences that exist among Arabic-speaking population which may influence how participants responded to certain items in the scale.

• It is essential to conduct a comprehensive psychometric evaluation to guide the implementation and interpretation of scales, particularly in Arabic-speaking countries due to the scarcity of validated and standardised outcome measures to assess prosthesis users’ confidence

Keywords:

• Amputee
• amputation
• Rasch analysis
• prosthesis
• outcome measures
• psychometrics
• rehabilitation

Authors’ contributions

HB and GF were responsible for the conception, design, data analysis, and drafting of the manuscript, and HA and NK contributed to data collection and extraction. All the authors contributed to the interpretation of the findings, critical revision of the manuscript, and review of the document prior to submission.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research project was funded by the Deanship of Scientific Research and Libraries, Princess Nourah bint Abdulrahman University, through the Program of Research Project Funding After Publication, grant No (RPFAP-2- 1445).