Validity and Reliability of the Physical Activity Scale for the Elderly in Malay Language (PASE-M)

Authors: Devinder Kaur Ajit Singh, Nor Najwatul Akmal Ab. Rahman, Bidor Sarojini Rajaratnam, Suzana Shahar, Noor Ibrahim Mohamed Sakian

Affiliations: Physiotherapy Programme & Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

Published: 2018  |  Malaysian Journal of Public Health Medicine, Special Volume (1): 116-123

Last reviewed: March 2026

Background and Rationale

Physical activity is widely recognised as one of the most important modifiable factors for healthy ageing. Regular physical activity among older adults helps prevent chronic diseases, preserves functional independence, and improves mental health outcomes. However, accurately measuring physical activity levels in elderly populations poses unique challenges, especially when culturally appropriate instruments are lacking.

The Physical Activity Scale for the Elderly (PASE) was originally developed by Washburn and colleagues in 1993 as a brief, self-administered questionnaire designed specifically for adults aged 65 years and older. The instrument covers three domains of physical activity: leisure activities (including sport and recreation), household activities (such as housework and gardening), and work-related activities. While the original English-language PASE has been validated across multiple populations—including Chinese, Japanese, Turkish, and Norwegian elderly groups—a Malay-language version for use among Malaysia’s older population had not been established.

Malaysia’s demographic landscape is changing rapidly. The nation is projected to achieve aged-nation status by 2030, with the population aged 60 and above constituting more than 15% of the total. This demographic shift necessitates validated tools that can accurately assess physical activity among Malay-speaking older adults, enabling clinicians, researchers, and public health practitioners to design targeted interventions for promoting active ageing.

Study Design and Methodology

This validation study employed a cross-sectional design among community-dwelling older adults in Malaysia. The translation process followed established guidelines for cross-cultural adaptation of health-related questionnaires, involving forward translation from English to Malay, back-translation, expert review, and pilot testing.

A total of 44 community-dwelling older adults (12 men and 32 women; mean age 66.95 ± 5.34 years) were initially recruited. Participants were required to be aged 60 years and above, able to ambulate independently, and fluent in the Malay language. Those with severe cognitive impairment or acute illness were excluded. Of the initial cohort, 33 participants (8 men and 25 women; mean age 66.64 ± 5.51 years) met the minimum accelerometer wearing criteria and completed the PASE-M questionnaire on two occasions separated by one week.

Objective physical activity was measured using an ActiGraph accelerometer worn continuously for seven days. The accelerometer provided objective measures including vector magnitude (VM) counts, time spent in moderate-to-vigorous physical activity (MVPA), energy expenditure, and walking steps. Participants completed the PASE-M questionnaire on day 8 (PASE-M1) and again on day 15 (PASE-M2).

Statistical Analysis

Concurrent validity between PASE-M1 scores and accelerometer outputs was assessed using Spearman’s rank correlation coefficient. Test-retest reliability was evaluated using both Spearman’s correlation and intraclass correlation coefficients (ICC) based on a two-way mixed-effects model with consistency-type single measurement.

Results

Concurrent Validity

The PASE-M score demonstrated statistically significant correlations with multiple accelerometer-derived measures. The correlation between PASE-M scores and vector magnitude counts was moderate and significant (r = 0.54, p < 0.01). Similarly, significant correlations were observed between PASE-M and time spent in moderate-to-vigorous physical activity (r = 0.55, p < 0.01), energy expenditure (r = 0.53, p < 0.01), and walking steps (r = 0.39, p < 0.05).

Test-Retest Reliability

The PASE-M demonstrated excellent test-retest reliability over the one-week interval. The ICC was 0.96 (p < 0.01, 95% CI: 0.92–0.98), indicating highly consistent results across repeated administrations. This level of reliability exceeds the generally accepted threshold of 0.70 for clinical instruments and is comparable to or better than validation studies of PASE in other languages.

Discussion and Contextual Significance

The validation results confirm that the PASE-M is a psychometrically sound instrument for assessing physical activity levels among Malaysian community-dwelling older adults. The concurrent validity coefficients observed in this study are comparable to those reported in the original English PASE validation and in Chinese, Japanese, and Norwegian adaptations.

The particularly strong ICC of 0.96 suggests that the PASE-M produces highly stable measurements over time, which is essential for longitudinal research and for evaluating the effectiveness of physical activity interventions. The moderate correlations with objective accelerometer measures are within the expected range for self-report physical activity questionnaires, which inherently capture dimensions of activity (such as perceived intensity and household activities) that accelerometers may not fully detect.

The availability of the PASE-M addresses a critical gap in geriatric assessment tools for Malaysia’s multicultural healthcare context. With validated instruments in the national language, researchers can more accurately characterise physical activity patterns among Malay-speaking older adults and design culturally appropriate programmes to promote active ageing.

Public Health Implications

The validated PASE-M instrument has several important applications for Malaysian public health. First, it enables standardised assessment of physical activity levels across community health settings, facilitating the identification of older adults who are physically inactive and may benefit from targeted interventions. Second, the instrument can be used in population-based surveys to establish normative data for physical activity among Malaysian elderly, providing a baseline against which future trends and intervention outcomes can be measured.

Given Malaysia’s rapid population ageing, validated tools like the PASE-M are essential for implementing the National Policy for Older Persons and achieving active ageing goals. Primary healthcare providers can integrate the PASE-M into routine geriatric assessments to screen for physical inactivity—a major modifiable risk factor for falls, frailty, and chronic disease progression among older adults.

Limitations

Several limitations should be acknowledged. The sample size was relatively small (n = 33 for the final analysis), which may limit the generalisability of the findings. The study was conducted primarily in an urban setting around Kuala Lumpur, and findings may not fully represent older adults in rural areas where activity patterns may differ substantially. The sample was predominantly female (76%), which may affect the applicability of findings across genders. Additionally, approximately 25% of participants did not meet the minimum accelerometer wearing criteria, potentially introducing selection bias. Future studies with larger, more diverse samples across multiple Malaysian states would strengthen the evidence base for the PASE-M’s psychometric properties.