Psychometric Properties of the Proxy-Reported Life-Space Assessment in Institutionalized Settings (LSA-IS-Proxy) for Older Persons with and without Cognitive Impairment

Abstract

(1) Background: Life-space mobility assessments for institutionalized settings are scarce and there is a lack of comprehensive validation and focus on persons with cognitive impairment (CI). This study aims to evaluate the psychometric properties of the Life-Space Assessment for Institutionalized Settings by proxy informants (LSA-IS-proxy) for institutionalized, older persons, with and without CI. (2) Methods: Concurrent validity against the self-reported version of the LSA-IS, construct validity with established construct variables, test-retest reliability, sensitivity to change during early multidisciplinary geriatric rehabilitation treatment, and feasibility (completion rate, floor/ceiling effects) of the LSA-IS-proxy, were assessed in 94 hospitalized geriatric patients (83.3 ± 6.1 years), with and without CI. (3) Results: The LSA-IS-proxy total score showed good-to-excellent agreement with the self-reported LSA-IS (Intraclass Correlations Coefficient, ICC3,1 = 0.77), predominantly expected small-to-high correlations with construct variables (r = 0.21–0.59), good test–retest reliability (ICC3,1 = 0.74), significant sensitivity to change over the treatment period (18.5 ± 7.9 days; p < 0.001, standardized response mean = 0.44), and excellent completion rates (100%) with no floor/ceiling effects. These results were predominantly confirmed for the sub-scores of the LSA-IS-proxy and were comparable between the sub-groups with different cognitive status. (4) Conclusions: The LSA-IS-proxy has proven to be feasible, valid, reliable, and sensitive to change in hospitalized, geriatric patients with and without CI.

Assessing life-space mobility

“…Most information was provided for the validity of the LSM questionnaires, more specifically for their construct validity showing predominantly hypothesisconfirming associations with physical, cognitive, psychosocial, financial, environmental, and/or sociodemographic variables. Given the overall complexity of real-life mobility [4], it was unexpected that only a few of the identified studies assessed the construct validity of the LSM questionnaires based on a conceptual framework of mobility including various potential determinants [21][22][23]48]. Summarizing the results on construct validity of the same questionnaire across several studies, the UAB-LSA, the NHLSD, the LSA-CI and the interview/proxy-based LSA-IS were identified as the most valid questionnaires for the LSM construct.…”

“…Completion times were provided even less frequently, averaging between 3 min and 9 min across 5 studies [16,21,22,27,48 . Four studies used a conceptual framework for mobility [4] to select constructvariables [21][22][23]48]. Overall, results on construct validity yielded expected directions and magnitudes of correlations with cut-offs of r > 0.5 for similar (e.g., physical variables) and r > 0.30-0.50 for related constructs (e.g., financial, psychosocial variables) for evaluation.…”

“…Higher scores consistently indicate higher mobility levels. Some questionnaires provide options to analyze only spatial mobility aspects [15,16,[21][22][23], rate specific sub-groups depending on frequency of being outdoors [12] or differentiate between low or high [25], or low, intermediate, and high LSM [18].…”

“…Studies calculating standardized response means reported small (< 0.5) [23,35], moderate (> 0.5) [21,47], and large (> 0.8) [22,48] sensitivity to intervention-induced changes.…”

“…The LSA-CI and both versions of the LSA-IS were comprehensively validated in the German language, with overall good results on feasibility, validity, reliability, and sensitivity to change [21][22][23]48]. A Ger-man version is also available for the UAB-LSA, whose construct validity has recently been documented in German communitydwelling older adults [33].…”