Participation Objective, Participation Subjective

Last Updated

December 14, 2012

Purpose

The POPS assesses perspectives of the respondent regarding his/her participation in home and community activities, and the societal/normative (��outsider��) valuations.

Link to Instrument

Instrument Details

Acronym POPS

Cost

Not Free

Cost Description

Cost not known

Diagnosis/Conditions

Brain Injury Recovery

Brain Injury

The 26 items are sorted into 5 categories:
1) Domestic Life
2) Major Life Activities
3) Transportation
4) Interpersonal Interactions and Relationships
5) Community, Recreational and Civic Life
In the Participation Objective (PO) portion of the POPS, the stem question varies with the category of activity.
1) Domestic Life activities - the question is coached in terms of the proportion of the activity for which the interviewee is responsible. For example, do you do all, most, some or none of the cleaning that occurs in the household?
2) Major Life Areas and Transportation - the stem question is coached in terms of the number of hours per day, week, or month the person engages in the activity.
3) Remaining activity areas - stem questions inquire about frequency of occurrence of the activity in a day, week, or month.
The Participation Subjective (PS) portion of the POPS consists of a second set of questions asked with respect to each participation indicator. Two stem questions are asked about each of the 26 items:
1) ��What is the importance of this activity to your well-being?��
2) "Would you like to change your current level of engagement?"
For each item, 2 types of questions are asked:
1) Participation Objective Question - "How often in a typical month do you go to the movies?"
2) Subjective Participation Question - "How important is this to your well-being? Are you satisfied with your current level of participation, or would you like to be doing more or be doing less?"
Scoring:
1) Participation Objective (PO) - all hour and frequency items are converted to a single base, which, depending on the item, is frequency or duration per day, week or month. Standardized z scores are then calculated.
2) Scoring of the Participation Subjective (PS) - multiply the individual��s importance score by his/her satisfaction score, where a person��s wanting less or more is scored as �C1, and their being satisfied with current level (��same��) is scored as +1.
The z-score is then weighted by a factor that is the average of the mean importance rating of all persons in the TBI sample and the mean importance rating of ND individuals in the standardization sample for each item in question.
Total PO score is calculated as the average of the weighted z-scores for the 26 individual items. Similarly, subtotal scores are calculated as the average weighted z-score for the items included in each subscale.

Number of Items

10-20 minutes

Required Training

No Training

Instrument Reviewers

Initially reviewed by Anna de Joya, PT, MS, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 5/2012

ICF Domain

Participation

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association��s Multiple Sclerosis Taskforce (MSEDGE), Parkinson��s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:

*Abbreviations:*
HR	Highly Recommend
R	Recommend
*LS / UR*	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	N/A	N/A	N/A	N/A

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
TBI EDGE	No	No	No	Not reported

Considerations

A Portuguese version of the POPS is available (Brown, 2006)

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Test/Retest Reliability

Traumatic Brain Injury: (Brown et al, 2004; community dwelling individuals with TBI; n=454)

Poor to excellent test-retest reliability for PO and PS subscale scores and total scores:

PO Scores	ICC
Domestic Life	0.89
Interpersonal Interactions and Relationships	0.69
Major Life Areas	0.66
Transportation	0.28
Community, Recreational, and Civic Life	0.37
PO Total	0.75

PS Scores	ICC
Domestic Life	0.58
Interpersonal Interactions and Relationships	0.68
Major Life Areas	0.42
Transportation	0.56
Community, Recreational, and Civic Life	0.49
PS Total	0.80

Construct Validity

Traumatic Brain Injury: (Brown et al, 2004; community dwelling individuals with TBI; n=454)

Poor correlation of the PO and the PS Total scores (0.23 for the group with mild TBI, 0.21 for the group with moderate-severe TBI)
Poor correlations were also found with respect to PO total score correlations with PS subscale scores, and the PS total score with PO subscale scores
Stronger correlations in both groups (mild TBI and moderate to severe TBI) , was found of ��subjective�� measures (ie, BISQ, BDI II, Flanagan QOLS, Life 3) with the PS than with the PO total scores
Current age, injury severity, and years post-TBI onset were not related to PO or to PS total scores

	Mild TBI		Moderate to Severe TBI
PO Scores	PO Total	PS Total	PO Total	PS Total
Domestic Life	0.60	0.10	0.63	0.14
Interpersonal Interactions and Relationships	0.46	0.20	0.56	0.17
Major Life Areas	0.58	0.20	0.56	0.08
Transportation	0.35	-0.04	0.48	0.03
Community, Recreational, and Civic Life	0.42	0.10	0.40	0.12
PO Total	---	0.23	---	0.21
PO Scores
Domestic Life	0.21	0.70	0.23	0.72
Interpersonal Interactions and Relationships	0.22	0.72	0.23	0.72
Major Life Areas	0.07	0.60	0.17	0.70
Transportation	0.18	0.71	0.09	0.73
Community, Recreational, and Civic Life	0.11	0.732	0.02	0.64
PS Total	0.23	---	0.21	---
Other Measures
BISQ Physical	0.00	-0.30	-0.11	-0.27
BISQ Cognitive	-0.08	-0.27	0.02	-0.23
BISQ Emotional	-0.03	-0.27	-0.02	-0.22
BISQ Total	-0.06	-0.30	-0.02	-0.26
BDI Cognitive	-0.16	-0.38	-0.25	-0.38
BDI Somatic	-0.24	-0.44	-0.07	-0.33
BDI Self-esteem	-0.13	-0.32	-0.25	-0.32
BDI Total	-0.21	-0.43	-0.19	-0.39
Life 3	0.17	0.32	0.23	0.31
Flanagan Unmet Needs	-0.23	-0.37	-0.10	-0.33
Flanagan Unmet Important Needs	-0.14	-0.41	-0.17	-0.35
Injury Severity	0.01	0.01	-0.12	-0.03
Age at Onset	-0.09	0.04	-0.07	0.4
Years Post-TBI Onset	0.03	0.05	0.12	0.11
Current Age	-0.06	0.03	-0.04	0.10
?POPS indicates Participation Objective, Participation Subjective; TBI, traumatic brain injury; BISQ, Brain Injury Screening Questionnaire; and BDI, Beck Depression Inventory

Traumatic Brain Injury: (Cantor et al, 2008; n=223 community-dwelling individuals with mild to severe TBI and 85 non-injured controls)

None of the index scores, including the POPS total scores, were significantly correlated with Global Fatigue Index (GFI) for either group
5 of 26 individual POPS objective participation items were correlated with GFI scores (cleaning house, paying bills, visiting friends, engaging in sex, and speaking to neighbors), with poor correlation coefficients from �C0.141 (P = .041) to �C0.163 (P = .020)
Partial correlations controlling for gender in the TBI group and gender and income in the control group:
- 13 individual items on the GFI pertaining to the impact of fatigue on participation with responses to POPS items (shopping for groceries, cleaning house, cooking, working, attending school, socializing with friends and relatives in per-son and by phone, engaging in sex, participating in recreational activities such as movies, dining out, shopping, and sporting events)
- TBI group: significant negative correlation between frequency of sexual activity and the extent to which participants thought fatigue interfered with their sex lives (r=�C0.169, P=.036). However, none of the other correlations were significant for either group.

Traumatic Brain Injury: (Curtin et al, 2010; n=131 individuals with TBI from rural brain injury facilities; mean age=40.83 (11.77); male=69.7% and female=32.1%; time post-TBI=8.35 (6.29) years)

*Changes to the POPS items based on feedback: the original item about travelling in a car was split into two questions (one on driving a car and one on being a passenger in a car), increasing the number of items to 27; and a question about frequency of sexual intercourse changed to ask instead about intimacy with another person.

The relationships between the PO scores were generally fairly low
Higher correlations for PS observed
Positive relationship between the objective and subjective rating for each area other than for transport, suggesting that the higher the level of activity, the greater the satisfaction
The relationships tend to be relatively small and there is no relationship between the objective total scores and the subjective total scores
No relationship was found between the POPS scores and gender and there was no relationship with time since TBI

Participation Objective (PO)
PO	Domestic	Major Life Areas	Transport	Interpersonal	Community	Total
Major Life Areas	0.23**	---	---	---	---	---
Transportation	0.11	0.34**	---	---	---	---
Interpersonal	0.16	0.22*	0.32**	---	---	---
Community	0.03	-0.09	0.29**	0.36**	---	---
Objective Total	0.52**	0.55**	0.62**	0.69**	0.50**	---
p<0.05, *0.01

Participation Objective (PO)
PS	Domestic	Major Life Areas	Transport	Interpersonal	Community	PO Total
Domestic	0.23*	0.04	0.01	0.11	0.10	0.14
Major Life Areas	0.02	0.35**	0.12	0.01	-0.03	0.14
Transport	-0.02	-0.01	0.10	-0.06	-0.05	-0.03
Interpersonal	-0.03	-0.09	0.03	0.21*	0.09	0.05
Community	0.09	0.08	0.09	0.08	0.24**	0.15
Subjective Total	0.09	0.13	0.11	0.08	0.07	0.13

Participation Subjective (PS)
PS	Domestic	Major Life Areas	Transport	Interpersonal	Community	Total
Domestic
Major Life Areas	0.22*
Transport	0.49**	0.16
Interpersonal	0.54**	0.26**	0.41**
Community	0.52**	0.18	0.41**	0.55**
Subjective Total	0.76**	0.58**	0.70**	0.75**	0.71**
p<0.05, *0.01

Bibliography

Brown, M., Dijkers, M. P., et al. (2004). "Participation objective, participation subjective: a measure of participation combining outsider and insider perspectives." J Head Trauma Rehabil 19(6): 459-481.

Cantor, J. B., Ashman, T., et al. (2008). "Fatigue after traumatic brain injury and its impact on participation and quality of life." J Head Trauma Rehabil 23(1): 41-51.

Curtin, M., Jones, J., et al. (2011). "Outcomes of participation objective, participation subjective (POPS) measure following traumatic brain injury." Brain Inj 25(3): 266-273.

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