title: The psychometric properties of the Chinese version-reintegration to normal living index (C-RNLI) for identifying participation restriction among community-dwelling frail older people.
abstract: The Reintegration to Normal Living Index (RNLI) was developed to measure reintegration to normal living after major traumas/illnesses. Its psychometric properties remain unknown when used to measure participation restriction under the World Health Organization's International Classification of Functioning, Disability, and Health (WHO-ICF) framework. This study examines the psychometric properties of the Chinese version-RNLI to measure WHO-ICF participation restriction among community-dwelling pre-frail and frail older people.
  
  
  
  A cross-sectional study was conducted in community and day-care centres in Hong Kong between May 2015 and January 2016. Through face-to-face interviews, information was collected on the participants' demographic background, medical history, frailty status, depressive mood, functional performance in daily activities, and participation restriction. The internal consistency, test-retest reliability, and construct and convergent validity of the C-RNLI were assessed.
  
  
  
  Two hundred and ninety-nine pre-frail or frail community-dwelling older people with a mean age of 79.53 were recruited. A confirmatory factor analysis showed that the C-RNLI has a two-factor structure comprised of "participation in physical activities" and "participation in social events". The test-retest coefficient was 0.71. The Cronbach's alpha of the total C-RNLI score, and those of the factors "participation in physical activities" and "participation in social events" were 0.88, 0.82 and 0.84, respectively. Pre-frail older people had significantly higher scores for the factors "participation in physical activities" (z = -5.05, <0.01) and "participation in social events" (z = -6.04, p < 0.01) than frail older people. Older people from community centres had significantly higher scores for the factors "participation in physical activities" (z = -4.48, <0.01) and "participation in social events" (z = -4.03, p < 0.01) than older people from day-care centres. The factors "participation in physical activities" and "participation in social events" of the C-RNLI were significantly convergent with depressive mood (rs= -0.25 and rs= -0.39, respectively) and functional performance in daily activities (rs= 0.28 and rs= 0.45, respectively).
  
  
  
  The C-RNLI is a two-factor structured scale with acceptable level of reliability and validity to measure WHO-ICF participation restriction among community-dwelling pre-frail and frail older people.
authors.affiliation: Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. Justina.liu@polyu.edu.hk.
authors.forename: Justina Yat-Wa
authors.initials: JY
authors.lastname: Liu
authors.affiliation: Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
authors.forename: Ka Wai
authors.initials: KW
authors.lastname: Ma
mesh_terms: D000069537:Adult Day Care Centers / Q000639:trends*; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000523:psychology*; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology; D005163:Factor Analysis, Statistical; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D057187:Independent Living / Q000523:psychology* / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results
keywords: Frailty; Participation restriction; Psychometric properties; WHO-ICF