Levels of disability, classified as mild, moderate, severe, and extremely severe, were determined based on the Taiwan statutory LTC policies for older people. To further depict the personal characteristic data of the participants, the minimum data set (MDS) tool recommended on the interRAI country websites was used to record demographic data (such as education and religion) and the location and number of joint contractures (based on medical records and the MDS) [22].

The Mini-Mental Status Examination (MMSE) was used to evaluate the cognitive status of participants [23]. This instrument employs a simple quantitative assessment scale and is widely used in clinics and research studies to evaluate cognitive function and screen cognitive impairment. The MMSE has 13 items, with a total score of 33, and takes only 5 to 10 min to complete. A higher score indicates better cognitive function. The test-retest reliability of the MMSE is good, and the interrater reliability correlation coefficient is 0.8 [23]. An MMSE score of 25 or less is defined as cognitive impairment [24].

The Chinese version of the PaArticular Scales for joint contractures was generated from the English version through five stages: translation, review, back-translation, review by a panel of specialists, and a pretest (Supplementary File 4). The Chinese version of the PaArticular Scales contains 35 items; the Activity subscale has 24 items, and the Participation subscale has 11 items. The sum of the Activity and Participation domain scores ranges from 0 (fewest limitations) to 47 (maximum limitations) and from 0 (fewest restrictions) to 19 (maximum restrictions), respectively. A higher score indicates greater activity limitations and participation restrictions. Because the scale is an organized face-to-face contact scale to assess activity and participation, before the assessment, the assessor emphasized that the study participants must describe their present surroundings and not imaginary surroundings or their original home surroundings.

In terms of reliability, Cronbach’s α coefficients of the internal consistency of the Activity subscale and the Participation subscale are 0.96 and 0.92, respectively, in the English version. Additionally, McDonald’s ω totals are 0.98 and 0.95, respectively [15], indicating high internal consistency. The Pearson correlation coefficients of the Activity and Participation subscales determined using the criterion validity of the visual analogue scale of the EuroQol-5 dimensions (EQ-5D), which is one of the most frequently used generic health status measurement tools, demonstrated good validity and reliability, at − 0.40 (p > .001) and − 0.30 (p > .001), respectively [15]. The EQ-5D is a generic health-related QoL questionnaire [25]. The Activities and Participation subscales have negative Pearson correlations with the EQ-5D, indicating that higher QoL corresponds to lower activity limitations and participation restrictions.

The short version of the WHO’s Quality of Life Instrument (WHOQoL-BREF) is widely validated and popularly used to assess the subjective QoL of patients and the general public [26]. To evaluate the criterion validity of the Chinese version of the PaArticular Scales, we used the Chinese version of the WHOQoL-BREF developed from the WHO’s WHOQoL group, which contains 26 items (Supplementary File 5). When the amount of missing data is large (greater than 10 %), the results of subsequent statistical analyses may be biased [27]. Therefore, questionnaires with more than 20 % missing data were discarded. Multiple imputation methods were used to manage missing data. If more than two values were missing in a domain, the domain score was not calculated (except for domain 3; the score was calculated only if the missing value was < 1).

For the Chinese version of the WHOQOL-BREF, Cronbach’s α coefficient for the internal consistency of the overall questionnaire ranged from 0.73 to 0.83, and the test-retest reliability coefficients of each category ranged from 0.41 to 0.79 [28]. The Pearson correlation between each item and its category ranged from 0.45 to 0.82 (p < .01), and the correlation between different categories ranged from 0.48 to 0.63 (p < .01). For the confirmatory factor analysis (CFA) of the construct validity, the structural equation model of the four factors replicates the potential structure designed by the questionnaire, and the comparative fitness indices (CFIs) of these two analyses had values of 0.886, which is equivalent to that of the Hong Kong version of the questionnaire (CFI = 0.894) and similar to that of the questionnaire using global data (CFI = 0.903) [28].

To evaluate the criterion validity of the Chinese version of the PaArticular Scales, we used the Chinese version of the WHODAS 2.0–36 items. Participants used a 5-point Likert scale to answer questions related to difficulties in performing activities. The score ranged from 0 (least difficulty) to 100 (maximum difficulty) and was calculated as the sum of each domain score [29]. A higher score indicated a higher degree of disability and more severe restriction. Restriction severity refers to the difficulty level classification method of the ICF and WHODAS 2.0. The classification of impairment severity was as follows: below 4 %, none; 5–24 %, mild; 25–49 %, moderate; 50–95 %, severe; and more than 96 %, extremely severe [30]. Four items in the WHODAS 2.0 cover job domains (e.g., Have you ever had to accept a lower-level job because of health factors?); thus, only 32 items were calculated in the study because all participants were retired and unemployed.

Regarding the reliability indices of the Chinese version of the WHODAS 2.0, Cronbach’s α for internal consistency is between 0.70 and 0.99, and the intraclass correlation coefficient is between 0.80 and 0.89 [31, 32]. Among the validity indices, the content and the concurrent validity have some correlation, and based on exploratory factor analyses (EFAs), 5 to 7 factors have an explanatory power higher than 55 %. The factor loadings of the CFA are all higher than 0.56 [31]. Therefore, the Chinese version of the WHODAS 2.0 has excellent reliability and validity and is consistent with item response theory. In the current study, authorities have granted permission for the use of each Chinese version of the survey instrument .

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