Špoljar J1, Vidmar G1, Goljar N1, Puh U2
1University Rehabilitation Institute, Ljubljana, Slovenia, 2University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia
Background: Assessment of functional walking ability is one of the key assessment procedures in physiotherapeutic treatment of patients with spinal cord injury. The most commonly used standardized outcome measures of gait for patients with incomplete spinal cord injury are the 10 Meter Walk Test, the 6 Minute Walk Test, the Walking Index for Spinal Cord Injury II (WISCI II) and the Timed Up and Go Test. They are all highly recommended by the Neurology Section of the American Physical Therapy Association`s Spinal Cord Injury Taskforce. For all listed measures both intra-rater and inter-rater reliability are excellent and concurrent validity of each one of them is adequate or excellent. With none of them we assess the quality of gait in terms of deviations from normal gait pattern. The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) is a standardized outcome measure, that assesses functional walking ability in ambulatory individuals with spinal cord injury. The SCI-FAI includes assessment of kinematics, assistive devices and mobility, specific for this patient group. In clinical settings researchers recommend SCI-FAI for assessing patients with incomplete spinal cord injury regardless of time from injury.
Purpose: To evaluate intra-rater and inter-rater reliability, concurrent validity and ceiling effect of Slovenian translation of SCI-FAI.
Methods: Thirty patients with incomplete spinal cord injury participated in the study. Reliability was assessed for the gait kinematics part of the SCI-FAI. Validity and ceiling effect were assessed for assistive devices and mobility part of the SCI-FAI. We calculated intra-rater reliability for five raters. One rater assessed participants on-site for the first evaluation and from the video record for the second one. Other four raters, between which we also evaluated inter-rater reliability, assessed participants twice from the video record. We calculated intraclass correlation coefficients (ICC) for both reliability measures. For validity evaluation we calculated Pearsons (r) and Spearmans (ro) correlation coefficients between parts of the SCI-FAI and the 10 Meter Walk Test, the WISCI II and the 6 Minute Walk Test. Ceiling effect was reported as percentage of participants achieving maximal possible score.
Results: We evaluated excellent (ICC = 0.82-0.86) intra-rater reliability and adequate (ICC = 0.46-0.61) inter-rater reliability. Concurrent validity was also excellent (r = 0.98-0.99; ro = 0.61-0.92) depending on the compared outcome measures. 47 % of participants achieved maximal possible score for assistive devices assessment, 73 % for mobility assessment.
Conclusion(s): Other authors also observed excellent intra-rater reliability, excellent validity and ceiling effect of the SCI-FAI. Further research should point out the reasons for only adequate inter-rater reliability of the Slovenian translation of SCI-FAI. It would be meaningful to investigate consistency between raters regarding all evaluated SCI-FAI kinematics parameters.
Implications: Further testing of intra-rater and inter-rater reliablity as well as concurrent validity should take place, since we had only small sample size and did not divide physiotherapists to experienced or inexperienced. SCI-FAI is now a part of physiotherapy assessment procedure in everyday practice for patients with spinal cord injury in Slovenia.
Keywords: gait assessment, psychometric properties, incomplete spinal cord injury
Funding acknowledgements: The work was unfunded.
Purpose: To evaluate intra-rater and inter-rater reliability, concurrent validity and ceiling effect of Slovenian translation of SCI-FAI.
Methods: Thirty patients with incomplete spinal cord injury participated in the study. Reliability was assessed for the gait kinematics part of the SCI-FAI. Validity and ceiling effect were assessed for assistive devices and mobility part of the SCI-FAI. We calculated intra-rater reliability for five raters. One rater assessed participants on-site for the first evaluation and from the video record for the second one. Other four raters, between which we also evaluated inter-rater reliability, assessed participants twice from the video record. We calculated intraclass correlation coefficients (ICC) for both reliability measures. For validity evaluation we calculated Pearsons (r) and Spearmans (ro) correlation coefficients between parts of the SCI-FAI and the 10 Meter Walk Test, the WISCI II and the 6 Minute Walk Test. Ceiling effect was reported as percentage of participants achieving maximal possible score.
Results: We evaluated excellent (ICC = 0.82-0.86) intra-rater reliability and adequate (ICC = 0.46-0.61) inter-rater reliability. Concurrent validity was also excellent (r = 0.98-0.99; ro = 0.61-0.92) depending on the compared outcome measures. 47 % of participants achieved maximal possible score for assistive devices assessment, 73 % for mobility assessment.
Conclusion(s): Other authors also observed excellent intra-rater reliability, excellent validity and ceiling effect of the SCI-FAI. Further research should point out the reasons for only adequate inter-rater reliability of the Slovenian translation of SCI-FAI. It would be meaningful to investigate consistency between raters regarding all evaluated SCI-FAI kinematics parameters.
Implications: Further testing of intra-rater and inter-rater reliablity as well as concurrent validity should take place, since we had only small sample size and did not divide physiotherapists to experienced or inexperienced. SCI-FAI is now a part of physiotherapy assessment procedure in everyday practice for patients with spinal cord injury in Slovenia.
Keywords: gait assessment, psychometric properties, incomplete spinal cord injury
Funding acknowledgements: The work was unfunded.
Topic: Neurology: spinal cord injury; Outcome measurement
Ethics approval required: Yes
Institution: University Rehabilitation Institute of Republic of Slovenia
Ethics committee: Medical Ethics Committee of the University Rehabilitation Institute
Ethics number: 9 May, 2016
All authors, affiliations and abstracts have been published as submitted.
