The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) was designed to measure how often and how pleasurable someone with SCI finds their activities and participation in their daily lives, as well as any restrictions experienced.

The three scales of the USER-P are:

  • The Frequency scale consists of two parts:
    • Part A – Vocational activities (e.g., the number of hours the respondent has spent on paid/unpaid work in a typical week).
    • Part B – Leisure and social activities (e.g., going out, indoor recreation, or visiting family/friends) in the past 4 weeks.
  • The Restrictions scale asks about experienced participation barriers in vocational, leisure and social activities as a result of the person’s health or disability.
  • The Satisfaction scale asks about person’s satisfaction level with vocational, leisure and social relationships.

Clinical Considerations

The USER-P scale scores are assessed individually; that is, a clinician works with their client to improve their frequency of, and satisfaction with, participation, while attempting to reduce any restrictions.

ICF Domain

Activities and Participation

Administration

Self-reported.

Number of Items

32 items:

  • Frequency scale:
    • Part A: 4 items.
    • Part B: 8 items.
  • Restrictions scale: 10 items.
  • Satisfaction scale: 9 items.

Equipment

N/A

Scoring

  • Frequency scale:
    • Part A: Each item is scored from 0 (not at all) up to 5 (36 hours or more).
    • Part B: Each item is scored from 0 (not at all) to 5 (19 times or more).
  • Restrictions scale:
    Each item score ranges from 0 (not possible at all) to 3 (independent without difficulty). “Not applicable” is an optional response.
  • Satisfaction scale:
    Items are rated on a scale of 0 (very dissatisfied) to 4 (very satisfied). Not applicable is an optional response.

Each scale scores are converted to a 0–100 scale.

There is no USER-P total score.

Training Required

None.

Availability

The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) worksheet can be found here.

Measurement Property Summary

# of studies reporting psychometric properties: 3

Interpretability

Higher scores indicate higher levels of participation.

MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI

Typical Values

Mean (SD) Scores:

  • Frequency: 34.2 (12.2)
  • Restrictions: 70.0 (21.7)
  • Satisfaction: 69.3 (18.0)

(Mader et al. 2016; n=1549; 1107 males, 442 females; injury level: 474 tetraplegia, 1063 paraplegia; 646 complete, 894 incomplete injury; mean (SD) time post-SCI = 16.9 (12.7) years)

Reliability – Moderate to High

Internal consistency is Moderate to High:

  • USER-P Frequency: α = 0.51 – 0.70
  • USER-P Restrictions: α = 0.89 – 0.91
  • USER-P Satisfaction: α = 0.78 – 0.90

(Mader et al. 2016; n=1549; 1107 males, 442 females; injury level: 474 tetraplegia, 1063 paraplegia; 646 complete, 894 incomplete injury; mean (SD) time post-SCI = 16.9 (12.7) years)
(van der Zee et al. 2014; n=157; 104 males, 53 females; 69.4% complete injury; mean (SD) time post-SCI = 25.3 (26.8) years)
(Post et al. 2012; n=395; 211 males, 184 females; participants with MSK disease, TBI, stroke, neuromuscular disease (such as SCI), chronic pain, and heart failure)

Validity – Moderate to High

  • Moderate to High correlation with ICF Measure of Participation and Activities Screener (IMPACT-S) total:
    • USER-P Frequency: rs = 0.32
    • USER-P Restrictions: rs = 0.73
    • USER-P Satisfaction: rs = 0.38
  • Moderate to High correlation with World Health Organization Disability Assessment Schedule II (WHODAS II) – total disability index:
    • USER-P Frequency: rs = -0.37
    • USER-P Restrictions: rs = -0.76
    • USER-P Satisfaction: rs = -0.52

 (van der Zee et al. 2014; n=157; 104 males, 53 females; 69.4% complete injury; mean (SD) time post-SCI = 25.3 (26.8) years)

  •  Moderate to High correlation with Frenchay Activities Index (FAI):
    • USER-P Frequency: rs = 0.59
    • USER-P Restrictions: rs = 0.51
    • USER-P Satisfaction: rs = 0.42
  • Moderate to High correlation with Participation Scale (P-Scale):
    • USER-P Frequency: rs = -0.40
    • USER-P Restrictions: rs = -0.71
    • USER-P Satisfaction: rs = -0.73

(Post et al. 2012; n=395; 211 males, 184 females; participants with MSK disease, TBI, stroke, neuromuscular disease (such as SCI), chronic pain, and heart failure)

Responsiveness

No values were reported for the responsiveness of the USER-P for the SCI population.

Floor/Ceiling Effect

  • Floor effects:
    • USER-P Frequency: 0.0%
    • USER-P Restrictions: 0.3%
    • USER-P Satisfaction: 0.3%
  • Ceiling effects:
    • USER-P Frequency: 0.0%
    • USER-P Restrictions: 9.5%
    • USER-P Satisfaction: 3.0%

(Mader et al. 2016; n=1549; 1107 males, 442 females; injury level: 474 tetraplegia, 1063 paraplegia; 646 complete, 894 incomplete injury; mean (SD) time post-SCI = 16.9 (12.7) years)

Reviewers

Dr. Carlos Leonardo Cano-Herrera, Matthew Querée

Date Last Updated

31 December 2024

Mader L, Post MW, Ballert CS, Michel G, Stucki G, Brinkhof MW. Metric properties of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) in persons with spinal cord injury living in Switzerland. J Rehabil Med. 2016 Feb;48(2):165-74. doi: 10.2340/16501977-2010.
https://pubmed.ncbi.nlm.nih.gov/26926920/

Post MW, van der Zee CH, Hennink J, Schafrat CG, Visser-Meily JM, van Berlekom SB. Validity of the utrecht scale for evaluation of rehabilitation-participation. Disabil Rehabil. 2012;34(6):478-85. doi: 10.3109/09638288.2011.608148.
https://pubmed.ncbi.nlm.nih.gov/21978031/

van der Zee CH, Post MW, Brinkhof MW, Wagenaar RC. Comparison of the Utrecht Scale for Evaluation of Rehabilitation-Participation with the ICF Measure of Participation and Activities Screener and the WHO Disability Assessment Schedule II in persons with spinal cord injury. Arch Phys Med Rehabil. 2014 Jan;95(1):87-93. doi: 10.1016/j.apmr.2013.08.236.
https://pubmed.ncbi.nlm.nih.gov/24008052/

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