Cross-Cultural Adaptation and Psychometric Evaluation of the Persian Version of the ADL Taxonomy Questionnaire in Persons With Stroke: A Rasch Analysis.
Esmail Sadeghi, Narges Shafaroodi, Mandana Fallahpour and 2 others
The Persian ADL Taxonomy is a valid, reliable tool for assessing daily living participation in stroke survivors, with strong agreement with the MBI and stable scores over time, though a few items around communication, reading, and travel need cautious interpretation.
Key findings
1The Persian ADL Taxonomy showed a strong positive correlation with the Modified Barthel Index (r = 0.89, p < 0.001), supporting convergent validity.
2Test-retest reliability was excellent, with an ICC of 0.98 (95% CI: 0.96–0.99), indicating stable scores when the assessment is repeated 10–15 days later.
3Rasch analysis showed most of the 46 items fit the model, but five items (making contact, taking part in a conversation, reading ability, car travel, and long-distance travel) showed misfit, and two items (reading ability and cycling/motorcycle) had insufficient discrimination.
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What it does not show
Participants were recruited by convenience sampling from only two centres in Tehran, so the findings may not generalise to rural areas or other cultural contexts. Individuals with severe cognitive or speech impairments were excluded, so the validation mainly reflects mild-to-moderate post-stroke impairment and may underrepresent the lower end of the ability range. The design is cross-sectional (single time point); the test-retest component checks stability but does not assess responsiveness to change over a rehabilitation course. No confirmatory factor analysis or differential item functioning analysis was performed, partly due to sample size, so the dimensional structure and potential item bias across subgroups are not fully characterised. Five items (communication, reading, transportation) showed Rasch misfit and two showed low discrimination, likely reflecting cultural or contextual factors rather than a problem with the underlying construct.
Declared interests
No funding was received. The authors declare no conflicts of interest.
The easy way to misread this
Do not read the overall validation as meaning every item is equally reliable. Five items (making contact, conversation, reading, car travel, long-distance travel) showed misfit and two (reading, cycling/motorcycle) had poor discrimination in the Rasch analysis, so scores on those specific actions should not be used to make clinical decisions without further assessment. Additionally, the tool was validated only in Persian-speaking, urban, mild-to-moderate stroke survivors in Tehran; it has not been tested in more severely affected patients, rural populations, or non-Persian-speaking groups.
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