The study, published in the Scandinavian Journal of Occupational Therapy by Anna Ullenhag, Berit Gjessing and Per Enok Baksjøberget, set out to answer two fundamental questions that determine whether any measurement instrument can be trusted: is it stable over time, and do its items hang together coherently? In the language of psychometrics, these are known as test-retest reliability and internal consistency. Test-retest reliability asks whether the same person, in the same circumstances, will produce roughly the same answers when asked twice within a short window, long enough to forget their previous responses but short enough that nothing has genuinely changed. Internal consistency, typically quantified with Cronbach’s alpha, asks whether the items within a scale are measuring a unified underlying construct rather than a jumble of unrelated things. Without evidence on both fronts, clinicians and researchers cannot know whether a change in scores reflects a real change in a person’s life or mere measurement noise.

ActiveYou II is grounded in the Family of Participation-Related Constructs framework, a contemporary theoretical model that defines participation along two dimensions: attendance, meaning simply being there, captured through frequency and diversity of activity, and involvement, meaning the lived experience of participation, including motivation, engagement, persistence and social connection. The framework also highlights intrinsic factors such as activity preferences, perceived skill competency and sense of self, alongside extrinsic environmental factors, all of which influence participation in a bidirectional, reciprocal way. ActiveYou II operationalises these ideas through sixteen common Norwegian physical activities, ranging from pool activity, cycling and climbing to horseback riding, cross-country skiing, gaming for training and outdoor play. Each activity is illustrated with a slideshow of three photographs showing different performance modes, with and without assistive devices, and respondents answer questions about how often they do the activity, with whom, whether it is organised or informal, how good they think they are at it, how fun it is, and what facilitates or hinders their participation.

The web-based format is not a cosmetic choice. Delivering the questionnaire digitally means it can be sent to participants to complete at home before a rehabilitation stay, administered on any device with a standard browser, and updated easily, since photographs of activities can be swapped or adapted to specific contexts without reprinting anything. Each participant logs in with a unique account and password. This matters for a field in which previous attempts to validate Norwegian versions of established instruments such as the Children’s Assessment of Participation and Enjoyment ran into problems with fit and administration, particularly for children with intellectual disabilities, and where publishers declined to produce Norwegian versions at all because the market was too small. ActiveYou I and II were developed specifically to fill that gap, with group interviews involving children, parents and professionals identifying the facilitators and barriers that needed to be built into the instrument from the start.

To test the instrument’s reliability, the researchers recruited participants planning to attend a three-week intensive rehabilitation period at Beitostølen Health Sports Centre in Norway. In total, 105 adults and 72 children were invited, and the final analysis included 41 children with a mean age of 10.5 years and 41 adults with a mean age of 49.2 years, all living with various disabilities and with no, mild or moderate cognitive impairments. Participants completed ActiveYou II digitally two weeks before arriving at the centre and then again within a 14-day interval. The researchers followed the COSMIN guidelines, an internationally recognised consensus standard for evaluating health-related patient-reported outcome measures, and analysed the data using Stata statistical software. Notably, most children did not answer alone: at the first administration, only two children completed the questionnaire independently, while 24 received support and 15 were answered solely by proxy, a detail with important implications for how the instrument is deployed.

The headline results are encouraging. Test-retest reliability for the participation frequency scores was good, with intraclass correlation coefficients ranging from 0.66 for gaming for training to 0.95 for horseback riding, and most items landing in the good or excellent range. Quadratic Kappa statistics, appropriate for the ordinal scale data the instrument produces, showed all frequency items above the substantial agreement threshold, with ten items achieving almost perfect agreement above 0.81. Reliability was moderate for the skill-competency and involvement scores, with ICCs ranging from 0.43 to 0.89, a pattern the authors interpret not as a flaw but as a window into the nature of the constructs themselves. Enjoyment, engagement and perceived competence are transient states that vary with experiences, well-being, mood and social support; a person’s sense of how fun an activity is two weeks after the first rating may genuinely have shifted. Internal consistency was acceptable for the combined sample across all three domains, with alpha values of 0.749 for frequency, 0.833 for skill competency and 0.795 for involvement, and 89.1 percent of individual responses remained unchanged between test occasions.

The correlational analyses add theoretical depth. Moderate to strong positive correlations emerged between participation frequency and perceived skill competence, particularly in structured activities: among children, group activities, individual activities, walking and horseback riding showed the strongest associations, while adults showed strong correlations in cycling, cross-country skiing and outdoor activities. Even stronger links appeared between perceived skill competence and involvement, especially among children, where downhill skiing reached a correlation of 0.95 and group activities 0.87. These findings support the central prediction of the participation framework: that people who engage more frequently tend to feel more competent, and those who feel more competent report deeper, more emotionally invested participation. Interestingly, some episodic activities such as skating and downhill skiing showed weak or non-significant frequency-competence correlations, possibly reflecting seasonal rarity or accessibility barriers, and the authors note that for several adult activities fewer than ten respondents participated, which limits the precision of those specific correlations.

The study is candid about its limitations. The sample of 82 completers is small, and intraindividual variability was large, both of which can depress reliability estimates. The kappa statistic is also known to behave paradoxically when a characteristic is very common or very rare, and the percentage of absolute agreement, while intuitive, does not control for chance agreement. Reassuringly, the different statistical approaches produced similar results, which strengthens confidence in the overall picture. The modest alpha values in the age-separated analyses, some falling below the conventional 0.70 threshold, may reflect the deliberate diversity of the sixteen activities, which span indoor and outdoor, organised and spontaneous pursuits; adding redundant items could raise alpha but would risk participant fatigue and measurement error. The authors also raise the concept of response shift, the phenomenon whereby rehabilitation patients re-evaluate their internal standards and sense of competence over time, meaning changes in self-reported scores may reflect evolving self-understanding as well as behavioural change.

What makes this work resonate beyond the clinic is its vision of measurement as a route to inclusion. Because ActiveYou II maps both individual and environmental facilitators and barriers, it does not merely count how active a person is; it illuminates the interaction between the person and the world around them. Therapists can use it to plan and evaluate participation-focused interventions, treating children and adults with disabilities as the experts on their own lives, something proxy reports have repeatedly failed to capture. Community planners can use it to identify and dismantle barriers to recreational participation. The authors caution that the instrument may require further adaptation, given how many children needed assistance to complete it, and that future research should examine its responsiveness, or sensitivity to change, at both individual and group levels. But the core message stands: a theoretically grounded, web-based, self-report instrument for physical participation now has demonstrated reliability and internal consistency, and with it comes a practical tool for building rehabilitation and health-promotion strategies around what people with disabilities actually want to do, and what stands in their way.

Subject of Research: Psychometric evaluation of a web-based self-report instrument for physical activity participation in people with disabilities

Article Title: Psychometric evaluation of the web-based physical participation instrument ActiveYou II in children and adults with disabilities

Article References: Psychometric evaluation of the web-based physical participation instrument ActiveYou II in children and adults with disabilities. (n.d.). https://doi.org/10.1080/11038128.2025.2576669

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2576669

Keywords: ActiveYou II, psychometrics, participation, disability, physical activity, test-retest reliability, internal consistency, rehabilitation, self-report, involvement, skill competency, occupational therapy