• Sachi O'Hoski, Ayse Kuspinar, Julie Richardson, Joshua Wald, Dina Brooks, Roger Goldstein, and Marla K Beauchamp.
• School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.
• Chest. 2021 Jan 1; 159 (1): 138146138-146.

BackgroundParticipation in life roles is a critical patient-centered health outcome associated with morbidity and mortality in older adults, but it is not measured routinely in people with COPD. We aimed to validate a participation measure, the Late Life Disability Instrument (LLDI), in people with COPD.Research QuestionTo what extent does the LLDI demonstrate test-retest measurement error and reliability, internal consistency, construct and face validity, and floor or ceiling effects when applied to people with COPD?Study Design And MethodsIn this cross-sectional study, LLDI scores were compared with scores on measures of theoretically related constructs and between groups based on symptom severity, prognosis, and frailty. A subsample (n = 36) completed the LLDI a second time over the phone within one week. Participants and health-care professionals were asked about the relevance, comprehensiveness, and comprehensibility of the LLDI. Floor and ceiling effects were explored, and the internal consistency (Cronbach's α) of the LLDI was calculated.ResultsNinety-six older adults with COPD participated. The frequency and limitation domains of the LLDI showed excellent test-retest reliability (two-way random effect intraclass correlation coefficient, 0.90 [standard error of measurement, 1.74 points] and 0.90 [standard error of measurement, 3.16 points], respectively). Both domains showed fair correlations with physical function, depression, and quality of life (r = 0.38-0.59). The relationship with anxiety was poor for the LLDI frequency domain (r = -0.21) and fair for LLDI limitation domain (r = -0.45). Both domains discriminated between people with different symptom severity, prognosis, and frailty (P ≤ .026). Neither domain showed floor or ceiling effects, and Cronbach's α was 0.69 and 0.91 for the LLDI frequency and limitation domains, respectively. All healthcare professionals and most participants agreed that the LLDI measures participation (79%) and that the items were relevant (81%).InterpretationThe LLDI shows test-retest reliability, internal consistency, and construct and face validity in people with COPD. The LLDI can be used to assess participation in this population.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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