Palermo A1, Garcia K2, Cahalin L1, Roach K1, Nash M1,3,4,5
1University of Miami Miller School of Medicine, Physical Therapy, Miami, United States, 2Jackson Memorial Hospital, Physical Therapy, Miami, United States, 3University of Miami Miller School of Medicine, Neurological Surgery, Miami, United States, 4University of Miami Miller School of Medicine, Rehabilitation Medicine, Miami, United States, 5University of Miami Miller School of Medicine, Kinesiology & Sports Sciences, Miami, United States
Background: Individuals experience both sensory and motor loss impairing unsupported sitting ability following a spinal cord injury (SCI). Recovering trunk stability is a top priority for improved quality of life in this population1. Furthermore, there is a lack of reliable, feasible, and cost-effective measures for assessing trunk stability or dynamic sitting balance in individuals with SCI2-4. An objective measure of seated balance in people with SCI is necessary to help determine key factors such as fall risk or caregiver assistance required during essential functional tasks including transfers, weight shifting, and bed mobility.
Purpose: The purpose of this study was to adapt the Function in Sitting Test5-7 (FIST), an existing outcome measure for patients with neurologic and balance conditions including stroke, to better capture dynamic sitting balance in the SCI population (Sitting Independence Test for Spinal Cord Injury (SIT-SCI)).
Methods: Content and concurrent validity, inter and intra-rater reliability, and type 2 responsiveness of the SIT-SCI were assessed in a sample of 27 individuals with chronic SCI (>one year). Content validity was established by discussing alterations of the FIST with three Neurologic Clinical Specialist physical therapists (PT), two PTs who work with the SCI and other neurological populations, and two researchers; one who works in the SCI field and one with experience in outcome measure development.
The finalized SIT-SCI and the Motor Assessment Scale item 38 (MAS-SCI) were administered to 27 participants on two separate days within two weeks of each other. Both raters were PTs involved in the development of this tool. Rater 1 administered the measures on both days to assess Intra-rater reliability and Rater 2 tested on the second day for Inter-rater reliability. Inter-rater and intra-rater reliability was analyzed via intraclass correlation coefficients (ICCs). Construct validity was assessed via Spearman correlation analyses of the MAS-SCI and SIT-SCI scores. Responsiveness was evaluated via SEM and MDC95 using standard methods.
Results: The mean±SD age and injury duration was 40±12 years (range: 21-66) and 16±12 years (range: 2-38), respectively. Injuries ranged from C1-T9 with AIS grades A-C. The SIT-SCI took an average of 13 minutes and 25 seconds (±44 sec) to administer. The MAS-SCI and SIT-SCI were moderately correlated (r= 0.49; p=0.008). The ICCs of inter-rater and intra-rater reliability were excellent (ICC=0.98, 95%CI [0.96-0.99]; p=0.000, and ICC=0.97, 95%CI [0.93-0.98]; p=.000, respectively). SEM and MDC95 were 3.96 and 10.98, respectively. Additionally, a cut score of >43 has a sensitivity of .94 and specificity of .78 to identify individuals able to transfer independently or with a slide board.
Conclusion(s): Based on the above results, the SIT-SCI is a reliable and valid outcome measure which can be used to assess functional seated balance and possible need of assistance during transfers and other seated tasks in individuals with chronic SCI.
Implications: The SIT-SCI is a reliable, valid, low-cost, clinically feasible measure of seated balance in subjects with chronic SCI with a score > 43 providing insight of independence with transfers. However, further research is warranted.
Keywords: Spinal Cord Injury, Outcome Measure, Seated Balance
Funding acknowledgements: This project was supported by The Foundation for Physical Therapy and The Neilsen Foundation through the American Spinal Injury Association.
Purpose: The purpose of this study was to adapt the Function in Sitting Test5-7 (FIST), an existing outcome measure for patients with neurologic and balance conditions including stroke, to better capture dynamic sitting balance in the SCI population (Sitting Independence Test for Spinal Cord Injury (SIT-SCI)).
Methods: Content and concurrent validity, inter and intra-rater reliability, and type 2 responsiveness of the SIT-SCI were assessed in a sample of 27 individuals with chronic SCI (>one year). Content validity was established by discussing alterations of the FIST with three Neurologic Clinical Specialist physical therapists (PT), two PTs who work with the SCI and other neurological populations, and two researchers; one who works in the SCI field and one with experience in outcome measure development.
The finalized SIT-SCI and the Motor Assessment Scale item 38 (MAS-SCI) were administered to 27 participants on two separate days within two weeks of each other. Both raters were PTs involved in the development of this tool. Rater 1 administered the measures on both days to assess Intra-rater reliability and Rater 2 tested on the second day for Inter-rater reliability. Inter-rater and intra-rater reliability was analyzed via intraclass correlation coefficients (ICCs). Construct validity was assessed via Spearman correlation analyses of the MAS-SCI and SIT-SCI scores. Responsiveness was evaluated via SEM and MDC95 using standard methods.
Results: The mean±SD age and injury duration was 40±12 years (range: 21-66) and 16±12 years (range: 2-38), respectively. Injuries ranged from C1-T9 with AIS grades A-C. The SIT-SCI took an average of 13 minutes and 25 seconds (±44 sec) to administer. The MAS-SCI and SIT-SCI were moderately correlated (r= 0.49; p=0.008). The ICCs of inter-rater and intra-rater reliability were excellent (ICC=0.98, 95%CI [0.96-0.99]; p=0.000, and ICC=0.97, 95%CI [0.93-0.98]; p=.000, respectively). SEM and MDC95 were 3.96 and 10.98, respectively. Additionally, a cut score of >43 has a sensitivity of .94 and specificity of .78 to identify individuals able to transfer independently or with a slide board.
Conclusion(s): Based on the above results, the SIT-SCI is a reliable and valid outcome measure which can be used to assess functional seated balance and possible need of assistance during transfers and other seated tasks in individuals with chronic SCI.
Implications: The SIT-SCI is a reliable, valid, low-cost, clinically feasible measure of seated balance in subjects with chronic SCI with a score > 43 providing insight of independence with transfers. However, further research is warranted.
Keywords: Spinal Cord Injury, Outcome Measure, Seated Balance
Funding acknowledgements: This project was supported by The Foundation for Physical Therapy and The Neilsen Foundation through the American Spinal Injury Association.
Topic: Outcome measurement; Neurology: spinal cord injury; Disability & rehabilitation
Ethics approval required: Yes
Institution: University of Miami
Ethics committee: Internal Review Board
Ethics number: Study 20170852
All authors, affiliations and abstracts have been published as submitted.
