{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:37:50Z","timestamp":1778546270751,"version":"3.51.4"},"reference-count":43,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2014,5,2]],"date-time":"2014-05-02T00:00:00Z","timestamp":1398988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"National Institute of Aging of the National Institutes of Health","award":["AG032420-01A1"],"award-info":[{"award-number":["AG032420-01A1"]}]},{"name":"National Institute of Aging of the National Institutes of Health","award":["R01 AG 040105-01A1"],"award-info":[{"award-number":["R01 AG 040105-01A1"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Stages quantify severity like conventional measures but further specify the activities that people are still able to perform without difficulty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop Activity Limitation Stages for defining and monitoring groups of adult community\u2010dwelling Medicare beneficiaries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross\u2010sectional.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Community.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>There were 14,670 respondents to the 2006 Medicare Current Beneficiary Survey.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Stages were empirically derived for the Activities of Daily Living (ADLs) and the Instrumental Activities of Daily Living (IADLs) by profiling the distribution of performance difficulties as reported by beneficiaries or their proxies. Stage prevalence estimates were determined, and associations with demographic and health variables were examined for all community\u2010dwelling Medicare beneficiaries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measurements<\/jats:title><jats:p>ADL and IADL stage prevalence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Stages (0\u2010IV) define 5 groups across the separate ADL and IADL domains according to hierarchically organized profiles of retained abilities and difficulties. For example, at ADL\u2010I, people are guaranteed to be able to eat, toilet, dress, and bathe\/shower without difficulty, whereas they experience limitations getting in and out of bed or chairs and\/or difficulties walking. In 2006, an estimated 6.0, 2.9, 2.2, and 0.5 million beneficiaries had mild (ADL\u2010I), moderate (ADL\u2010II), severe (ADL\u2010III), and complete (ADL\u2010IV) difficulties, respectively, with estimates for IADL stages even higher. ADL and IADL stages showed expected associations with age and health\u2010related concepts, supporting construct validity. Stages showed the strongest associations with conditions that impair cognition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Stages as aggregate measures reveal the ADLs and IADLs that people are still able to do without difficulty, along with those activities in which they report having difficulty, consequently emphasizing how groups of people with difficulties can still participate in their own lives. Over the coming decades, stages applied to populations served by vertically integrated clinical practices could facilitate large\u2010scale planning, with the goal of maximizing personal autonomy among groups of community\u2010dwelling people with disabilities.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.pmrj.2014.05.001","type":"journal-article","created":{"date-parts":[[2014,5,2]],"date-time":"2014-05-02T22:01:18Z","timestamp":1399068078000},"page":"976-987","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Activity Limitation Stages Empirically Derived for Activities of Daily Living (ADL) and Instrumental ADL in the U.S. Adult Community\u2010Dwelling Medicare Population"],"prefix":"10.1002","volume":"6","author":[{"given":"Margaret G.","family":"Stineman","sequence":"first","affiliation":[{"name":"Department of Biostatistics and Epidemiology The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania Philadelphia PA"},{"name":"Department of Physical Medicine and Rehabilitation Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel E.","family":"Streim","sequence":"additional","affiliation":[{"name":"Geriatric Psychiatry Section of the Department of Psychiatry Perelman School of Medicine, University of Pennsylvania Philadelphia PA"},{"name":"VISN 4 Mental Illness Research Education &amp; Clinical Center Philadelphia Veterans Affairs Medical Center Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiang","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology The Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine, University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jibby E.","family":"Kurichi","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology The Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine, University of Pennsylvania Philadelphia PA 423 Guardian Drive, 907 Blockley Hall, Philadelphia, PA 19104-6021"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia Miryam","family":"Sch\u00fcssler\u2010Fiorenza Rose","sequence":"additional","affiliation":[{"name":"Mental Illness Research Education &amp; Clinical Center Philadelphia Veterans Affairs Medical Center Philadelphia PA"},{"name":"VA Healthcare System Palo Alto Spinal Cord Injury Service"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawei","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine, University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,5,2]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281998"},{"key":"e_1_2_6_3_2","unstructured":"Committee on Disability in America. 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