Patient-reported measures of physical activity level for older adults in the home care setting: a systematic review and assessment of psychometric properties

Abstract

Introduction: Compared with conventional hospitalization, Comprehensive Geriatric Hospital at Home allows functional rehabilitation in a more realistic environment.Methodologically robust measurement tools are needed to monitor the functional recovery and quality of care of older adults in the home setting. To this end, PatientReported Outcome Measures (PROMs) provide a valid and efficient means to assessphysical activity in older adults. This systematic review aims to: (1) identify PROMs to monitor physical activity in older adults receiving home care and; (2) assess their psychometric properties.Methods: A systematic review was conducted in MEDLINE (PubMed), Scopus, and EMBASE databases, following PRISMA guidelines. The PROQOLID and BiblioPRO libraries were also checked. PROMs designed to assess physical activity levels were identified and screened against eligibility criteria and psychometric properties extracted. Psychometric properties were evaluated using the Evaluating the Measurement of Patient Reported Outcomes (EMPRO) tool, which scores range from 0 to 100, with higher scores indicating better psychometric properties.Results: A total of 435 articles met inclusion criteria, of which 59 described 21 PROMs assessing physical activity. Seven PROMs assessing physical activity level met criteria: Community Health Model Activities Program for Seniors Physical Activity Questionnaire (CHAMPS), International Physical Activity Questionnaire (IPAQ), Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire (LAPAQ), Physical Activity Scale forthe Elderly (PASE), Paffenbarger Physical Activity Questionnaire (PPAQ), Rapid Assessment of Physical Activity (RAPA), and Short Questionnaire to Assess Health Enhancing Physical Activity (SQUASH). Scores were highest for reproducibility and lowest for responsiveness and internal consistency. The CHAMPS achieved the best overall performance (71.21), followed by the PASE (58.17) and LAPAQ (50.16); scores of 50 or above are considered acceptable; whereas the PPAQ (21.51) and SQUASH (28.10) scores were the lowest. CHAMPS showed the lowest administration burden. CHAMPS, IPAQ, LAPAQ, PASE, and SQUASH were validated against accelerometry, yielding heterogeneous results that indicated low-to-moderate correlations.Conclusions: CHAMPS, PASE, and LAPAQ showed the most acceptable psychometric properties. Most PROMs had limited responsiveness and inconsistencies. Implementation