The Oxford Participation and Activities Questionnaire (Ox-PAQ)

The Oxford Participation and Activities Questionnaire is a short, 23-item, patient-reported outcome measure developed to assess participation and activity in patients experiencing a range of health conditions.

Background

There is growing interest in the management of long-term conditions and keeping people active and participating in daily life (1-4). Testing the effectiveness of interventions which aim to impact upon activities and participation, however, can be challenging without the availability of a well-developed, valid and reliable instrument.

The Oxford Participation and Activities Questionnaire is a patient-reported outcome measure that is grounded on the World Health Organization International Classification of Functioning, Disability, and Health (ICF) and is fully compliant with current best practice guidelines, such as those published by the FDA.

The Ox-PAQ was developed by researchers within the Health Services Research Unit, part of the Nuffield Department of Population Health at the University of Oxford.

The development of the OxPAQ was funded by the European Brain Council.

Using the Ox-PAQ

The primary use of the Ox-PAQ is intended to be in clinical trials and related forms of evaluation of interventions targeted at maintaining activity and participation.

Initial validation of the Ox-PAQ identified three domains; Routine Activities (14-items), Emotional Well-Being (5 items) and Social Engagement (4 items).

Validated Populations

Aneurysmal subarachnoid hemorrhage
Chronic obstructive pulmonary disease (COPD)
Motor neurone disease
Multiple sclerosis
Parkinson’s disease
Valvular heart disease

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Development

Development stages of Ox-PAQ:

Ox-PAQ items, which had previously been informed using the nine chapters of the ICF, 41 patient interviews, expert reviews and 13 cognitive interviews , were administered by postal survey to 386 people with three neurological conditions; Parkinson’s disease, amyotrophic lateral sclerosis, and multiple sclerosis. Participants also completed the MOS 36-Item Short Form Survey (SF-36) and EQ-5D-5L. Consenting participants were also sent the OxPAQ items to complete again after a period of two weeks.

162 men and 172 women completed the survey achieving a response rate of 86.5%. The mean age of the sample was 60.06 years (SD 12.10).

Ox-PAQ domains

Routine Activities (14 items), assesses individuals’ capacity to engage in regular activities that form the basis of daily life.
Emotional Well-Being (5 items), gives an indication of current mental health status.
Social Engagement (4 items), reflects how well, or otherwise, individuals are able to maintain relationships, both personal and from a wider community perspective.

Reliability

Internal reliability (n= 334) for the three domains was high (corrected item-total correlations 0.87-0.60, Cronbach’s α .81-.96). Good test-retest reliability was found among those who completed the Ox-PAQ again after a two week interval (n=127). Intra-class correlation coefficients ranged from 0.83 to 0.92.

Validity

Concurrent validity was demonstrated through highly significant relationships with relevant domains of the MOS SF-36 and the EQ-5D-5L. Known-groups validity was demonstrated through ANOVA results indicating statistically significant differences between the three conditions for all three domains; Routine Activities, F(2, 311) = 45.66, p < .01; Emotional Well-Being, F(2, 330) = 10.64, p < .01; Social Engagement, F(2, 326) = 14.16, p < .01.

Responsiveness

The responsiveness of the Ox-PAQ is currently being assessed in an online survey, the data from which will be published in due course.

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Versions

The Ox-PAQ also comes as an:

‘Acute’ version, with emphasis on the recall period being more recent; 1 week rather than 4 weeks.
Short-form, the Ox-PAQ can be summed to provide a summary index score. Furthermore, a subset of fourteen items can very closely replicate the results gained from the original parent form.
The Ox-PAQ domain of Routine Activities (Ox-PAQ-RA) can also used as a stand-alone measure without compromising its psychometric integrity.

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References

Macfarlane J. Other physical consequences of disability. Handb Clin Neurol. 2013;110:315–322.
Beer S, Khan F, Kesselring J. Rehabilitation interventions in multiple sclerosis: an overview. J Neurol. 2012;259(9):1994–2008.
Blickem C, Kennedy A, Vassilev I, et al. Linking people with long-term health conditions to healthy community activities: development of Patient-Led Assessment for Network Support (PLANS). Health Expect. 2013;16(3):3.
Provencher V, Bier N, Audet T, Gagnon L. [Long-term effect of a cognitive intervention on learning and participation in a significant leisure activity in early dementia of Alzheimer type: a case study]. Psychol Neuropsychiatr Vieil. 2009;7(2):131–140. French.

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