Reintegration to Normal Living Index (RNLI)

Purpose

The Reintegration to Normal Living Index (RNLI) was developed to assess, quantitatively, the degree to which individuals who have experienced traumatic or incapacitating illness achieve reintegration into normal social activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(e.g. recreation, movement in the community, and interaction in family or other relationships). Reintegration to normal living was defined by the scale authors as the “reorganization of physical, psychological, and social characteristics of an individual into a harmonious whole so that one can resume well-adjusted living after incapacitating illness or trauma” (Wood-Dauphinee & Williams, 1987).

The RNLI has been tested for use with individuals with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., malignant tumors, degenerative heart disease, central nervous system disorders, arthritis, fractures and amputations; spinal cord injury; traumatic brain injury; rheumatoid arthritis; subarachnoid hemorrhage; hip fracture; physical disability; and community-dwelling elderly.

In-Depth Review

Purpose of the measure

The Reintegration to Normal Living Index (RNLI) was developed to assess, quantitatively, the degree to which individuals who have experienced traumatic or incapacitating illness achieve reintegration into normal social activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(e.g. recreation, movement in the community, and interaction in family or other relationships). Reintegration to normal living was defined by the scale authors as the “reorganization of physical, psychological, and social characteristics of an individual into a harmonious whole so that one can resume well-adjusted living after incapacitating illness or trauma” (Wood-Dauphinee & Williams, 1987).

The RNLI has been tested for use with individuals with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., malignant tumors, degenerative heart disease, central nervous system disorders, arthritis, fractures and amputations; spinal cord injury; traumatic brain injury; rheumatoid arthritis; subarachnoid hemorrhage; hip fracture; physical disability; and community-dwelling elderly.

Available versions

The RNLI was developed by Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer in 1988.

Features of the measure

Items:

The RNLI index is made up of 11 declarative statements (e.g. I move around my living quarters as I feel necessary), including the following domains: indoor, community, and distance mobility; self-care; daily activity (work and school); recreational and social activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
;; family role(s); personal relationships; presentation of self to others and general coping skills. The first 8 items represent ‘daily functioning’ and the remaining 3 items represent ‘perception of self’.

Scoring:

Each domain is accompanied by a visual analogue scale (VAS) (0 to 10 cm). The VAS is anchored by the statements “does not describe my situation” (1 or minimal integration) and “fully describes my situation” (10 or complete integration). Individual item scores are summed to provide a total score out of 110 points that is proportionally converted to create a score out of 100.

Three- and 4-point categorical scoring systems were also developed (Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer, 1988), and the 3-point categorical system has been used in the evaluation of strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients (Mayo et al., 2000; Mayo et al., 2002). In the 3-point system, an additional category is inserted between the two anchor points (“partially describes my situation”) and the respondent selects the most applicable of the three categories. This option yields total scale scores from 22-0, with higher scores indicating poorer reintegration (Mayo et al., 2000, Mayo et al., 2002).

Time:

The time to administer depends on the mode of administration (e.g. self-administration, interviewer-administration, proxy, postal, etc.) and the participant’s abilities, but typically takes less than 10 minutes to complete.

Subscales:

There are two subscales to the RNLI: Daily Functioning (indoor, community, and distance mobility; self-care; daily activity (work and school); recreational and social activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
; general coping skills) and Perception of Self (family role(s); personal relationships; and presentation of self to others.).

Equipment:

Only the test and a pencil are required to complete the RNLI.

Training:

The RNLI requires no training to administer.

Alternative forms of the Reintegration to Normal Living Index

• Reintegration to Normal Living Index – Postal Version (RNLI-P) was developed by Daneski, Coshall, Tilling, and Wolfe in 2003.
  This measure modified the original RNLI in phrasing and scoring for use by post with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. patients. The RNLI – P uses an agree/disagree format (0=disagree, 1= agree).
• There are also versions created with minor modifications in wording to the original RNLI for: individuals who use adaptive devices motor aids or human assistance where the use of equipment and resources are clarified; use by health care professionals; and use by significant others (Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer,1988).

Client suitability

Can be used with:

• Patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Should not be used with:

• The use of a visual analogue scale may not be appropriate for the assessment of some strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. patients (i.e. those with attentional deficits or visual impairments or difficulty comprehending the meaning of a VAS). Instead, the use of the 3- or 4-point categorical scoring system is recommended.

In what languages is the measure available?

The RNLI is available in Canadian English and Canadian French (Wood-Dauphinee & Williams, 1987; Wood-Dauphinee, Opzoomer, Williams, Marchand, & Spitzer, 1988).

Please click here to access the french language version. A research version is also available.

Summary

What does the tool measure?	The degree to which individuals who have experienced traumatic or incapacitating illness achieve reintegration into normal social activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. .
What types of clients can the tool be used for?	The RNLI has been tested for use with individuals with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., malignant tumors, degenerative heart disease, central nervous system disorders, arthritis, fractures and amputations; spinal cord injury; traumatic brain injury; rheumatoid arthritis; subarachnoid hemorrhage; hip fracture; physical disability; and community-dwelling elderly.
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment
Time to administer	The amount of time it takes to administer the RNLI is dependent upon mode of administration and participant’s abilities but should take approximately 10 minutes.
Versions	Reintegration to Normal Living Index ( RNLI) Reintegration to Normal Living Index- Postal Version (RNLI-P). There are also versions created with minor modifications in wording to the original RNLI for: individuals who use adaptive devices motor aids or human assistance where the use of equipment and resources are clarified; use by health care professionals; and use by significant others. The original RNLI index is made up of 11 declarative statements Three- and 4-point categorical scoring systems are also available.
Other Languages	Canadian French (Please click here to access the french language version. A research version is also available.)
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.: Six studies have examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the RNLI. Four reported excellent Cronbach’s alphas. One reported excellent Cronbach alphas for the total RNLI patient and significant other score as well as for the patient score on the Perception of Self subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). , adequate Cronbach alphas for the Daily Functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). for both patient and significant other score, as well as on the significant other score on the Perception of Self subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). . One study reported adequate to excellent Cronbach alphas. Test-retest: Three studies have examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). of the RNLI and reported adequate test-retest agreement between items using kappa statistics, and excellent test-retest on the global score using correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. coefficients. Intra-rater: No studies have examined the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings. of the RNLI. Inter-rater: No studies have examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. of the RNLI.
ValidityThe degree to which an assessment measures what it is supposed to measure.	Construct: Convergent/Discriminant: – Excellent correlations between the total score of the RNLI-P and the Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. Index (FAI), the Short Form 36 Health Survey (SF-36) and with the Hospital Anxiety and DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. Scale-Depression subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). (HADS). Excellent correlations between the Daily Function subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). of the RNLI-P and the FAI and the SF-36. Poor correlations between the RNLI-P Daily Functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). and the HADS-Anxiety subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). as well as between the Perceptions of Self subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). and both the FAI and the Barthel Index. – Excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between the RNLI and the Quality of Life Index (QL) and with a measure of psychological wellbeing. Excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between Daily Functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). and with Quality of Life Index items Activity and Daily Living. Adequate correlations between Perceptions of Self subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). and Support and Outlook items from the Quality of Life Index. Strong correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between the RNLI and the ParticipationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. Survey/Mobility (PARTS/M). A positive relationship between the Health Options Scale and the RNLI for strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. survivors well as a positive relationship between the Herth Hope Index and the RNLI for both strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. survivors and their spouses. – Adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between the RNLI and items on the subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). related to physical performance of the Prosthetic Profile of the Amputee (PPA) with the exception of the item “active use of the prosthesis indoors” which was poor. No correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between items of the Perception of Self subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). of the RNLI with items on the subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). related to physical performance of the PPA with the exception of prosthetic wear which was adequate. Adequate to excellent correlations between items of the total RNLI with items in the subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). related to Physical performance of the PPA with the exception of items “Active use indoors” and “Active use outdoors” which had non-significant correlations. – Poor to adequate correlations between items of the total RNLI, and its two subscales with items on the PPA subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). related to acceptance of amputation and prosthesis. – Significant correlations between the RNLI and the Functional Independence Measure (FIM). – Adequate to excellent correlations between scores the total RNLI and the Daily Functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). with patient (with Rheumatoid arthritis) age, number of affected joints, the Functional Independence Measure (FIM), the Lee Index (pain, fatigue, and stiffness), and the American Rheumatism Association Classification. The total RNLI was also adequately correlated to disease duration.
Acceptability	The use of the 3 or 4 point categorical scoring system may be more appropriate for the assessment of some strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. patients than the visual analogue scale
Feasibility	The administration of the RNLI is quick and simple and requires no training to administer. The RNLI index is made up of 11 declarative statements representing the domains ‘daily functioning’ (indoor, community, and distance mobility; self-care; daily activity (work and school); recreational and social activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. ;; family role(s); personal relationships; and ‘perception of self'(presentation of self to others, general coping skills. Each domain is accompanied by a visual analogue scale (VAS) (0 to 10 cm). The VAS is anchored by the statements “does not describe my situation” (1 or minimal integration) and “fully describes my situation” (10 or complete integration). Individual item scores are summed to provide a total score out of 110 points that is proportionally converted to create a score out of 100.
How to obtain the tool?	The RNLI is available by clicking here.

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Reintegration to Normal Living Index (RNLI).

Floor/Ceiling Effects

Not yet examined.

Reliability

Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.:
Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer (1988) administered the RNLI to three samples of patients with varied diagnoses to determine internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.. The RNLI was completed by patients, significant others, and healthcare professionals. The Cronbach’s alphas were excellent for patients, significant others, and health care professionals (alpha = 0.90, 0.92, and 0.95, respectively). Corrected item to total correlations ranged from 0.39 (patient assessment of “comfort with self-care needs”) to 0.75 for patients, 0.61 to 0.87 for significant others, and 0.70 to 0.90 for health professionals.

Tooth, McKenna, Smith, and O’Rourke (2003) administered the RNLI to 57 pairs of patients and significant others six months after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. rehabilitation. Cronbach’s alphas were excellent for the total RNLI patient and significant other scores (alpha = 0.80 and 0.81, respectively). For the Daily Functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
, adequate Cronbach’s alphas were found for both patient and significant other scores (alpha = 0.71 and 0.73, respectively). For the Perception of Self subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
, Cronbach’s alpha was excellent for patient scores (alpha = 0.84) and adequate for significant other scores (alpha = 0.76).

Steiner et al. (1996) examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the RNLI in two samples of community-dwelling persons aged 75 and over (n=414, n=50). Cronbach’s alphas were adequate (0.76) to excellent (0.83).

Daneski, Coshall, Tilling, and Wolfe (2002) examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of a postal version of the RNLI (the RNLI-P) administered to 76 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (at one-year). The Cronbach’s alpha was excellent (0.84).

Stark, Edwards, Hollingsworth, and Gray (2005) administered the RNLI to 604 people between the ages of 18 and 80 years who had a mobility limitation (including patients with spinal cord injury, Multiple Sclerosis, strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., cerebral palsy, and polio), lived in the community, and had been discharged from rehabilitation for at least 1 year. The Cronbach’s alpha for this sample was excellent (0.91).

Bluvol and Ford-Gilboe (2004) administered the RNLI to both spouses in 40 families in which one of the partners had experienced a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. with moderate to severe functional impairments (6 months to 5 years post-stroke). The internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the measure was excellent for both the partners with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (alpha = 0.92) and their spouses (alpha = 0.85).

Test-retest:
Steiner et al. (1996) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the RNLI in 50 community-dwelling persons aged 75 and over interviewed twice, by the same interviewer, with 7 to 14 days between interviews. Test-retest for the total sample of community-dwelling elderly was excellent (r = 0.83). When examined by age group, correlations were excellent for the 75 to 79 age group (r = 0.82), 80 to 84 age group (r = 0.93), and for the 85+ age group (r = 0.76).

Daneski, Coshall, Tilling and Wolfe (2002) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of a postal version of the RNLI (the RNLI-P) in 26 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (3-12 months post-stroke) who completed the test twice within a 2-week interval. All 11 items demonstrated agreement between the two occasions above that expected by chance. Kappa values ranged from poor to excellent agreement (kappa = 0.38 for the item “embarrassed when with others”, to 0.92 for the item “getting around outside”).

Korner-Bitensky, Wood-Dauphinee, Siemiatycki, Shapiro, and Becker (1994) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the RNLI in 366 patients with a diagnosis of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. or orthopedic condition discharged from a rehabilitation hospital. The test was administered twice – once by face-to-face interview and once by a structured telephone interview to either a self or proxy respondent. The interclass coefficient (ICC) for the RNL Index was 0.80 indicating excellent agreement between the two modes of interview. However, for the self-respondents, poor community reintegration was reported more often during the home interview than the interview conducted over the telephone.

Type of rater:
Korner – Bitensky, Wood Dauphinee, Shapiro, and Becker (1994) analyzed the reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
of RNLI scores of 366 participants (with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. or an orthopedic condition post discharge from a rehabilitation hospital) who completed both a home interview (conducted by a health professional only) and a telephone interview (conducted by either a lay person or health professional). Results revealed that there were no significant differences on the comparison of kappa scores when patients were interviewed by lay interviewers or health professionals. When a dichotomized score of 40 was used (0-40 = no disability, scores of >40 equals disability), the group interviewed by phone by a layperson was significantly more likely to report difficulties in community reintegration compared to when interviewed face-to-face.

Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer (1988) analyzed the reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
of RNLI scores between patients and relatives and between patients and health professionals. Using Pearson’s correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient to measure reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
they reported adequate significant other to patient correlations of r = 0.62 and r = 0.65 in two different patient/significant other samples. They also reported poor to adequate health professional to patient correlations of r = 0.39 and r = 0.43. Based on these results, the authors stated that patients or significant others could complete the RNLI but that the use of health professionals as proxies should be avoided.

Trombly, Radomski, and Davis (1998) administered the RNLI to 16 adults with traumatic brain injury and their significant others. At admission to a treatment program, patients’ and proxies’ scores did not differ significantly, however at discharge and follow-up, they differed significantly

Tooth, McKenna, Smith, and O’Rourke (2003) examined patient proxy reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
of RNLI scores in 57 subacute patients paired with a significant other 6 months post strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. rehabilitation. Intra-class CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficients were poor for the total RNLI score (0.36) and the Daily Functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
(0.24). Adequate reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
was found for the Perception of Self subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
(0.55.).

Validity

Content:

The RNLI was developed based on literature reviews, incorporation of experiences of investigators, and open- and closed-ended questionnaires given to patients with myocardial infarction, cancer, and other chronic diseases, health professionals (physicians, social workers, physical and occupational therapists, psychologists), significant others of patients; and clergy and other lay people.

Construct:

Convergent/Discriminant:
Daneski, Coshall, Tilling and Wolfe (2003) examined the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of a postal version of the RNLI (RNLI-P) with other similar measures in 76 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Excellent correlations were found between the total score on the RNLI-P and the Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index (FAI – Holbrook & Skilbeck, 1983) (r = 0.69), the Short Form 36 Health Survey (SF-36 – Ware, Snow, Kosinski & Gandek, 1993) (r = 0.74), and with the Hospital Anxiety and DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale-Depression subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
(HADS – Zigmond & Snaith, 1983) (r = -0.61). Excellent correlations were reported between the Daily Function subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the RNLI-P and the FAI (r = 0.74) and the SF-36 (r = 0.73). The RNLI-P Daily Function subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
correlated poorly with the HADS-Anxiety subscale(r=-0.30). The Perceptions of Self subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
correlated poorly with the FAI (r = 0.26) and with the Barthel Index (Mahoney & Barthel, 1965), (r = 0.06).

Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer (1988) administered the RNLI to 70 patients with myocardial infarct or cancer and reported excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with scores on the Quality of Life (QL) Index (Spitzer, Dobson, Hall, Chesterman, Levi, Shepherd, Battista & Catchlove, 1981) (r = 0.68) and with a measure of psychological well-being (r = 0.32 for positive wellbeing, -0.41 for negative wellbeing, and 0.41 for overall). Daily Functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
scores showed excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with QL Index items Activity and Daily Living (r = 0.67) while Perceptions of Self scores correlated adequately with Support and Outlook from the QL Index (r = 0.36).Items on the QL Index that reflected dimensions not included on the RNLI, correlated less strongly (r < 0.20).

In a study describing the development and psychometric properties of the ParticipationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. Survey/Mobility (PARTS/M), Gray, Hollingsworth, Stark and Morgan (2006) administered the RNLI to 604 people with mobility limitations due to a diagnosis of spinal cord injury, Multiple Sclerosis, cerebral palsy, strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. or post poliomyelitis and reported a strong correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the two indices (canonical correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
=0.71).

Bluvol and Ford-Gilboe (2004) administered the Herth Hope Index (measure of hope – Herth, 1992), the Health Options Scale (measure of health work – Ford-Gilboe, 1997, 2002b) and the RNLI to both spouses in 40 families in which one of the partners had experienced a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. with moderate to severe functional impairments (6 months to 5 years post-stroke). They found a positive relationship between the Health Options Scale (health work) and the RNLI for strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. survivors (r = 0.50) but not for their spouses(r = 0.06) as well as a positive relationship between the Herth Hope Index (hope) and the RNLI (quality of life) for both strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. survivors (r = 0.59) and spouses (r = 0.32).
Note: Health work is defined as “an active process through which families learn ways of coping and developing that are conducive to healthy living over time” Ford-Gilboa 2002a.

Gauthier-Gagnon, and Grise (1994) administered the RNLI and the Prosthetic Profile of the Amputee (PPA) questionnaire (Grise, Gauthier-Gagnon, 1993) to 89 people with a lower limb amputation. Items on the Daily ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the RNLI correlated adequately (r = 0.36 to 0.56) with items on the subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
related to physical performance of the PPA with the exception of the item “active use of the prosthesis indoors” which was poor ( r = 0.28).

In this same study, items of the Perception of Self subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the RNLI failed to correlate with items on the subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
related to physical performance of the PPA with the exception of prosthetic wear which was adequate (r = 0.32).

Items of the total RNLI had adequate to excellent correlations (r = 0.36 to 0.53) with items in the subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
related to Physical performance of the PPA with the exception of items “Active use indoors” and “Active use outdoors” which had non-significant correlations.

Items of the total RNLI, and its two subscales revealed poor to adequate correlations (r = 0.53 to 0.30) with items on the subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
related to acceptance of amputation and prosthesis.

Daverat, Petit, Kemoun, Dartigues, and Barat (1995) conducted a longitudinal study of 149 individuals with long-standing spinal cord injury. The univariate analysis showed that the RNLI significantly correlated with the Functional Independence Measure (FIM) (Hamilton, Granger, & Sherwin, 1987) FIM. The multivariate analysis determined that the following significant seven independent variables contributed to 72% of the RNLI variance. They included the FIM, the Yale Scale Score (Chehrazi, Wagner, Collins, Freedman, 1981) the Centre for Epidemiological Studies DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale (CES-D – Radloff, 1977), living conditions, relationship, sexual life and age.

Calmels, Pereira, Domenach, Pallot-Prades, Alexandre, and Minaire (1994) administered the RNLI to 57 individuals with rheumatoid arthritis, with a mean disease duration of 15 years. In this study, scores on the total RNLI and the Daily Function subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
had adequate to excellent correlations with patient age, number of affected joints, the Functional Independence Measure (FIM), the Lee Index (pain, fatigue, and stiffness), and the American Rheumatism Association Classification (r = 0.38 to 0.84). The total RNLI was also adequately correlated to disease duration (r = 0.31).

McColl, Paterson, Davies, Doubt, and Law (2000) administered the RNLI to 61 community-dwelling individuals with a disability and found that RNLI scores were adequately correlated with the satisfaction subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Canadian Occupational Performance Measure (COPM – Law et al., 1991, 1994, 1998) (r = 0.38) but only poorly correlated with the Performance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
(r = 0.22). The RNLI had excellent correlations with the Life Satisfaction Scale (Michalos, 1980) (r = 0.71) and with the Satisfaction with Performance Scaled Questionnaire (Yerxa, Burnett-Beaulieu, Stocking & Azen, 1988) (r = 0.72).

Steiner et al. (1996) evaluated the performance of the RNLI in an elderly community-based population (n = 414). The RNLI demonstrated adequate positive correlations with instrumental activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living scale (Lawton, Moss, Fulcomer & Klegan, 1982) (r = 0.47) and perceived health (r = 0.45). Poor to adequate negative correlations were reported for living alone (r = -0.14) and number of both bed days (r = -0.16) and chronic conditions(r = -0.32). There was an unpredicted negative correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between age and RNLI (r = -0.11).

May and Warren (2002) examined the external and structural components of validityThe degree to which an assessment measures what it is supposed to measure.
of the spinal cord injury version of the Ferrans and Powers Quality of Life Index (Ferrans & Powers, 1992) in a sample of 98 individuals with spinal cord injury living in the community and reported an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the RNLI (r = -0.65).

Patrick, Perugini, and Leclerc (2002) reported that in a study of 48 consecutive referrals for neuropsychological evaluation following admission to a geriatric rehabilitation inpatient service (for various diagnosis including: orthopedic injury, strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., functional deconditioning, Parkinson’s disease and other various medical conditions) that the RNLI was significantly correlated to the number of falls sustained and functional status at 6 months. Results of the partial correlations coefficients revealed significant relationships between the RNL and the California Verbal Learning Test (CVLT) (measures memory functioning) and Hooper Visual Organization Test (HVOT – measures spatial skills).
Note: The authors did not report the actual r scores.

Known groups:
Clarke, Black, Badley, Lawrence & Williams, (1999) divided subjects at 3 months and 1 year post-stroke by level of impairment (mild-moderate-severe according to Adam’s Hemispheric StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Scale), by the presence or absence of depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
(Zung Self-Rating DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
scale), by levels of physical disability (independent-moderately dependent-dependent according to the Functional Independence Measure), RNLI scores for these known groups demonstrated expected gradients and were significantly different as analyzed by analysis of variance. The difference in mean RLNI scores between categories in these analyses ranged from 12% to 62%.

Responsiveness

Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer (1988) administered the RNLI to a sample 70 patients to determine the responsivenessThe ability of an instrument to detect clinically important change over time.
of the RNLI. They concluded that the scale is sensitive to change but the use of subscales provides a more accurate reflection as change (improvement or worsening) in specific domains could be hidden within the total score.

References

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See the measure

You can obtain the RNLI here.

Please click here to access the french language version. A research version is also available.