The conceptual foundation of the questionnaire rests on a distinction that has become central to gerontological research: the difference between objective and subjective participation. Objective participation refers to what a person actually does, how often they engage in particular activities, and how frequently those activities appear in their weekly routine. Subjective participation, by contrast, captures the inner experience of doing, how satisfied a person feels with their level of engagement, how important those activities are to their sense of identity, and how competent they believe themselves to be while performing them. Two people may attend a weekly chess club with identical regularity, yet one may feel deeply fulfilled while the other feels merely present. The EDLQ-old was built to capture both sides of that divide, and the validation study was designed to determine whether its structure and scores hold up under statistical scrutiny.

The instrument itself asks respondents about their engagement across seven categories of activity that prior research has linked to physical and mental health in later life. For each category, participants rate their experience on four separate scales: frequency, satisfaction, importance and competence. This design reflects a broader shift in the field, informed by frameworks such as the World Health Organization’s International Classification of Functioning, Disability and Health, which treats participation as a central outcome of health rather than a peripheral one. Existing instruments, including the Activity Card Sort, the Meaningful Activity Participation Assessment, the Engagement in Meaningful Activities Survey and the Do-Live-Well framework, have each contributed to this landscape, but the developers of the EDLQ-old sought a measure that would combine breadth of activity coverage with a systematic assessment of the subjective quality of engagement in a single questionnaire.

To test the tool, the researchers recruited 502 community-dwelling older adults in Israel between July 2021 and February 2023, using convenience sampling. The mean age of the sample was 75.07 years, with a standard deviation of 7.90, meaning the cohort spanned a wide swath of later life, from the newly retired to the oldest old. All participants lived in the community rather than in institutional settings, which is precisely the population that healthy-aging policy aims to support. The study received ethics approval from the Hebrew University’s committee for research involving human subjects and was conducted according to the Declaration of Helsinki, with written informed consent obtained from every participant. Funding came from the Israel National Institute for Health Policy Research and the Minerva Center on Intersectionality in Aging.

The first psychometric property the team examined was internal consistency, the degree to which items within each scale measure the same underlying construct. The results were strong across the board. Cronbach’s alpha and McDonald’s omega, two complementary statistical coefficients that estimate reliability from slightly different angles, ranged from 0.705 to 0.830 across the questionnaire’s scales. In the conventional language of psychometrics, values above 0.70 are considered acceptable and values approaching 0.90 are excellent, so the EDLQ-old landed squarely in the territory where researchers and clinicians can trust that the scores are not dominated by random measurement error. This matters because a questionnaire that produces unstable readings cannot detect meaningful change, whether that change reflects decline following an illness or improvement after a rehabilitation program.

Next came construct validity, tested through confirmatory factor analysis, a statistical technique that evaluates whether the pattern of correlations among items matches a theorized structure. The researchers hypothesized a four-factor structure corresponding to the four scales, with frequency representing the objective dimension of participation and satisfaction, importance and competence representing its subjective dimensions. The data supported this model with an acceptable goodness of fit. The chi-square statistic was 658.463 with 303 degrees of freedom, and the fit indices told a consistent story: the Comparative Fit Index reached 0.954 and the Tucker-Lewis Index 0.942, both above the 0.95 and 0.90 thresholds commonly used to indicate good fit, while the Standardized Root Mean Square Residual was 0.048 and the Root-Mean-Square Error of Approximation was 0.048, both comfortably below the 0.08 cutoff for acceptable error. In practical terms, the questionnaire measures four distinct but related dimensions of participation in the way its designers intended.

The study also examined known-groups validity, which asks whether a measure distinguishes between groups that theory says should differ. Here the EDLQ-old performed as expected: older adults without long-term health problems scored significantly higher on activity frequency, satisfaction and competence than their peers living with chronic conditions. This finding carries real clinical weight. It suggests that the questionnaire is sensitive to the ways in which long-term health problems reshape daily life, not merely in terms of what people stop doing, but in how capable and satisfied they feel while doing what remains. A screening or assessment tool that can flag this erosion of engagement early could give clinicians and policymakers a window for intervention before isolation and inactivity compound existing health burdens.

Convergent validity provided the final pillar of evidence. If the EDLQ-old truly measures participation, its scores should correlate with other established measures of related constructs. The researchers computed Pearson’s correlations between the EDLQ-old and the World Health Organization Quality of Life questionnaire, abbreviated WHOQoL, and between the EDLQ-old and the Engagement in Meaningful Activities Survey. The correlations with quality of life ranged from 0.342 to 0.665 across the scales, while the correlations with meaningful activity engagement ranged from 0.480 to 0.558. All were positive and statistically significant. The pattern is exactly what one would hope for: strong enough to confirm that the questionnaire is tapping a genuinely related construct, yet not so high as to suggest it is merely a redundant duplicate of existing instruments. The moderate overlap with quality of life in particular supports the idea that participation is a distinct contributor to well-being rather than a simple proxy for it.

The implications of this validation extend well beyond the laboratory. Occupational therapists, geriatricians, rehabilitation specialists and public health planners all need instruments that can quantify participation in a way that is both scientifically defensible and practically meaningful. Because the EDLQ-old captures objective and subjective dimensions simultaneously, it can support a more nuanced conversation between clinician and patient. A person whose activity frequency remains high but whose satisfaction is slipping may need a very different intervention from someone whose engagement has collapsed across the board. The questionnaire’s structure makes such distinctions visible, and its demonstrated reliability means that changes over time can be interpreted with confidence. For researchers, it opens the door to studies linking participation profiles to downstream outcomes such as cognitive decline, depression, hospitalization and mortality.

There are, of course, boundaries to what any single study can establish. The sample was recruited through convenience sampling in one country, and the cross-sectional design captures a single moment in each participant’s life rather than tracking change over years. The authors published their work as an open-access article, and it appeared as a peer-reviewed, accepted manuscript carrying a permanent digital object identifier, 10.1186/s12877-026-08389-4, with the final version of record to follow. Even with those caveats, the study delivers what validation research is meant to deliver: coherent evidence that the EDLQ-old is a reliable and valid measure of participation among community-dwelling older adults. As societies worldwide grapple with the demographic realities of aging populations, tools like this one transform an abstract ideal, living fully in later life, into something that can be measured, monitored and ultimately protected.

Subject of Research: Validation of a questionnaire measuring objective and subjective participation in daily activities among community-dwelling older adults

Article Title: Validation of the Experiencing Day-to-Day Life Questionnaire (EDLQ-old): assessing objective and subjective participation of community-dwelling older adults

Article References: Fogel-Grinvald, H., Maeir, A., & Golos, A. (2026). Validation of the Experiencing Day-to-Day Life Questionnaire (EDLQ-old): assessing objective and subjective participation of community-dwelling older adults. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08389-4

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08389-4

Keywords: healthy aging, participation, older adults, psychometrics, quality of life, questionnaire validation, geriatrics, confirmatory factor analysis, daily activities, reliability, construct validity, community-dwelling

The research, led by Tomoe Ebisu of Kobe University Graduate School of Health Sciences together with colleagues at Osaka Kawasaki Rehabilitation University and Lund University in Sweden, was published on 2 July 2025 as an open-access article. Its central question was deceptively simple: does the Japanese adaptation of this Swedish interview-based tool produce stable, meaningful measurements when used with Japanese people living with mental illness? To answer it, the team followed the Consensus-Based Standards for the Selection of Health Measurement Instruments, or COSMIN, a widely respected framework for evaluating how well health measurement instruments perform.

The SDO-OB itself is an interview conducted by occupational therapists and organized into three sections covering four domains of daily life: work and studies, leisure, household and maintenance, and self-care. The first section measures activity level by asking whether the respondent engages in thirteen specific activities, with the number of affirmative answers summed into a score. The second section asks the respondent to rate satisfaction with those same thirteen activities on a seven-point scale ranging from worst to best, regardless of whether the activities were actually performed in the previous two months. The third section probes perceived occupational balance with one question per domain plus a general question—’Overall, how much do you feel you are doing various daily activities?’—rated on a five-point scale from far too little to far too much.

That final section is what distinguishes the SDO-OB from its predecessor, the SDO, which included only the activity level and satisfaction components. The balance questions generate a profile classifying respondents as under-occupied, in-balance, or over-occupied in each domain, reflecting the time-allocation perspective of occupational balance. Earlier versions of the instrument had already proven psychometrically sound in Sweden among people with mental illness, and Spanish versions had been validated for people with mental disorders and stroke survivors. But no Japanese version existed, leaving Japanese clinicians without an efficient tool that links perceived balance to concrete daily activities.

To fill that gap, the researchers recruited fifty-three participants from four healthcare facilities in a Japanese prefecture that provide vocational training, community activity support centre services, and assisted group homes. Eligible participants were between eighteen and sixty-five years old, not hospitalized at the time of data collection, had a psychiatric diagnosis under Chapter 5 of the tenth revision of the International Statistical Classification of Diseases, could recall their daily lives over the previous two months, and were native Japanese speakers. Roughly sixty percent were men, about half lived with family, and around half carried schizophrenia-related diagnoses. The sample size of fifty or more was chosen because COSMIN guidance considers it adequate for test-retest reliability studies and hypothesis testing for construct validity.

Each participant was interviewed twice, two weeks apart, between July 2023 and January 2024, with the same interviewer conducting both sessions. At the first time point, participants also completed the Trail Making Test Part B, a measure of neurocognition requiring them to alternately connect numbers and Japanese characters in sequence, and the Japanese version of the MOS 8-Item Short-Form Health Survey, which yields physical and mental component summary scores for health-related quality of life. Global functioning was rated with the Japanese version of the modified Global Assessment of Functioning scale, determined jointly by the interviewer and facility staff. Crucially, neither functioning scores nor cognitive test times changed significantly between the two interviews, confirming that participants’ conditions were stable enough for reliability to be meaningfully assessed.

The reliability results were striking. Weighted kappa coefficients, which measure agreement between repeated ratings while correcting for chance, reached 0.75 for total activity level—a value classified as substantial—0.85 for total activity satisfaction, classified as almost perfect, and 0.54 for general occupational balance, classified as moderate. This was the first study to examine the test-retest reliability of the complete SDO-OB instrument in people with mental illness, and the findings align with earlier Swedish studies of the SDO and a Spanish study of the SDO-OB in stroke survivors. Notably, the general balance question performed better here than in the Spanish stroke study, though the authors suggest that perceptions of general balance may be influenced by more confounding factors than the more concrete activity scores.

Construct validity was tested through seven pre-formulated hypotheses derived from previous research. The activity level and satisfaction scores showed no significant correlation with global functioning, neurocognition, or mental-related quality of life, supporting the predicted discriminant validity—the idea that a measure of daily activity engagement should not simply mirror measures of cognition or clinical functioning. Physical-related quality of life, however, correlated significantly with activity satisfaction, supporting convergent validity and echoing earlier findings. One hypothesis was only partly supported: activity satisfaction did not correlate with mental-related quality of life, contrary to expectations, which the authors attribute to the fact that quality of life is not a uniform concept.

The general balance question revealed its own pattern. Participants were classified as under-occupied, in-balance, or over-occupied, with twenty-one, twenty-three, and nine individuals in those groups respectively. The in-balance group scored significantly higher on mental-related quality of life than the under-occupied group, with mean T-values of 46.9 versus 42.0, a statistically significant difference. No differences emerged in global functioning, cognitive performance, or physical quality of life across the groups. The authors suggest that Japan’s mental health system—marked by many psychiatric care beds, long-term inpatients, and community support that relies heavily on families—may shape how occupational balance relates to functioning, and that daily-activity concepts like balance are likely more tied to real-world functioning than to neurocognition, whose link to outcomes is known to be indirect.

The study’s limitations are acknowledged: participants were all users of healthcare facilities, the sample was modest given the diversity of psychiatric diagnoses, and comparisons with Swedish cohorts were constrained by differing healthcare systems and sociodemographic profiles. Still, the verdict is clear. The SDO-OB-J showed relatively good test-retest reliability and construct validity, and the authors conclude it can serve as a first step in clinical practice for evaluating occupational balance among people with mental illness in Japan. Future work will test additional psychometric properties nationwide with larger, more diverse samples, and the Japanese manual and interview form are available on request from the first author. For a country working to shift psychiatric care from long hospital stays toward community life, a validated tool that captures not just how much people do, but how balanced and satisfying their daily occupations feel, could prove an quietly powerful instrument in the rehabilitation toolkit.

Subject of Research: Psychometric validation of a Japanese occupational balance assessment tool for people with mental illness

Article Title: Test–retest reliability and construct validity of a Japanese version of the Satisfaction with Daily Occupations and Occupational Balance for people with mental illness

Article References: Ebisu, T., Masuzawa, T., Yotsumoto, K., Hashimoto, T., Argentzell, E., & Eklund, M. (2025). Test–retest reliability and construct validity of a Japanese version of the Satisfaction with Daily Occupations and Occupational Balance for people with mental illness. Scandinavian Journal of Occupational Therapy, 32(1), Article 2526427. https://doi.org/10.1080/11038128.2025.2526427

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2526427

Keywords: occupational balance, mental illness, psychometrics, test-retest reliability, construct validity, occupational therapy, quality of life, Japan, assessment tool, daily activities, rehabilitation, kappa coefficient