ACTIVLIM - Instructions

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  1. Downloading test packages
  2. Administering the questionnaire
  3. Analysing the patient's responses
  4. Interpreting the activity limitations measures


Downloading test packages

The test packages for administrating the ACTIVLIM questionnaire are available for download to registered users. Registration is FREE and will only take a few minutes to complete. The test packages are available in French, Dutch en English. Each package contains the instruction sheet and the testing forms in 10 random orders.


Administering the questionnaire

Figure 1: ACTIVLIM scoring sheet [+] Figure 1: ACTIVLIM scoring sheet

The ACTIVLIM questionnaire is administered on a self-reported basis. Patients do not perform the activities. The adult patients (16-80 years) and the parents of the affected children (6-15 years) are asked to estimate the difficulty of performing each activity when the activities are done:
- without help
- irrespective of the limb(s) they actually use
- whatever the strategies used to do the activity.

The activities are presented in a random order to avoid any systematic effect. Ten different random orders of presentation are used. The evaluator selects the next one of the 10 orders for each new assessment, no matter which patient is tested.

During the evaluation, a 3-level response scale is presented to the adult patient and to the parents of the affected child. Patient are asked to rate their perception on the response scale as 'Impossible', 'Difficult' or 'Easy'. Activities not attempted in the last 3 months are not scored and are entered as not applicable (check the question mark '?' on the scoring sheet). Activities not realised because they are too difficult must be scored as 'Impossible'.

Moreover, the child activities (activities C) are recorded as missing values in adult evaluation and similarly, the adult activities (activities A) are recorded as missing values in child evaluation.

The scores are entered as shown in the Figure 1.


Analysing the patient's responses

The responses to the questionnaire can be submitted for an online analysis on this web site.

The analysis uses the Rasch model to convert the raw scores into a linear measure. The linear measure can be determined even when some items have not been answered (missing responses will only reduce the precision of the measure).

The online form is available with the items ordered in the 10 random orders used on the paper scoring sheets. Select the language and the order (1 to 10) that were used during the evaluation. Then enter the patient's responses into the online form and submit the form to display the evaluation report.


Interpreting the activity limitations measures

Figure 2: ACTIVLIM evaluation report [+] Figure 2: ACTIVLIM evaluation report

The evaluation report is presented in Figure 2.

The patient's activity level (vertical red line) and its 95% confidence interval (dotted red lines) are located on the activity scale (abscissa) expressed in logits. The higher the activity level of a patient the more the measure will be located to the right.

The logit is a linear unit that expresses the odds of success of the patient on any given item. The activity scale is centred on the average item difficulty (0 logit).

The item map lists the items from top to bottom by decreasing difficulty order. The item map shows the most probable score (0 = "Impossible", 1 = "Difficult" or 2 = "Easy") to each item as a function of the activity level of the patient and the difficulty of the item. Note that "Hopping on one foot" is the most difficult item for children and "carrying a heavy load" the most difficult item for adults as it requires the highest activity level to be succeeded easily; "Washing one's face" is the easiest one. Note also that the most probable score for any given item increases with the patient's activity level. The item map can be used for treatment planning and follow-up as it shows the item(s) that should be recovered first during the rehabilitation process (obviously, the easier ones).

The sigmoid curve shown at the bottom relates the total score on the questionnaire to the activity measure (for a complete response set). Note that the score increases with activity level, although the increase is not linear given the shape of the curve. Therefore changes of activity level must be interpreted in linear logit units rather than in raw scores.

The patient's response to each item is circled (missing responses are not shown). For any particular item, the range overlapping the 95% confidence interval indicates the most probable score(s) given the overall activity level measure. Note that in the example, most scores fit with the overall activity level measure of the patient indicating the patient scores are coherent across items. The item "wiping one's upper body" is scored as "easy" while it is expected to be more difficult, given the overall activity level measure. These unexpected scores (circled in red in the report) may help you to diagnose an atypical behaviour of the patient or other comorbidities.

The evaluation report also indicates the patient's activity measure on the scale and the standard error of measurement (in logits). Keep those in your records in order to measure the patient recovery at a future occasion.