The TCT and FIST-SCI are appropriate clinical assessments of functional sitting balance in spinal cord injury rehabilitation

Fernanda Di Natal, Claire Boswell-Ruys, Edward Gorgon, Anne E Palermo, Sophie Denis, Rachel Spillane
Purpose:

This study investigated the reliability, validity, and responsiveness of the TCT and FIST-SCI in people with recent SCI.

Methods:

In this psychometric study, physiotherapists assessed 30 adults receiving initial SCI rehabilitation using the TCT and FIST-SCI. Participants were assessed on 4 occasions within 2 weeks to investigate inter-rater and intra-rater reliability via ICC analysis, and then once 6 weeks later to estimate responsiveness. Validity was determined through correlations with the Berg Balance Scale (BBS), Spinal Cord Independence Measure (SCIM-III), and SCI-Falls Concern Scale (SCI-FCS). Participants self-rated how their FSB changed from the first assessment to the 6-week follow-up on a 14-level Global Rating of Change Scale (GRCS) from “A very great deal worse” (-7) to “A very great deal better” (+7), to identify meaningful change.

Results:

Participants’ neurological level of injury ranged from C4 to L2, with 80% of the sample having motor-incomplete SCI. Mean time since injury was 84 days (95% CI=64 to 105). The TCT and FIST-SCI had excellent inter- and intra-rater reliability (ICC>0.9). The TCT and FIST-SCI were able to distinguish individuals who were independent and those who required assistance in transfers (p.05), establishing known-groups validity. Both assessments were related to the BBS (ρTCT=0.627, ρFIST-SCI=0.785), SCIM-III total score (ρTCT=0.477, ρFIST-SCI=0.555), and SCIM-III Mobility subscore (ρTCT=0.639, ρFIST-SCI=0.552) (all p.05). Responsiveness and GRCS data were collected from 17 participants. Median (range) change scores on the TCT and FIST-SCI were 2 (0 to 6) and 3 (-4 to 9), respectively. Median (range) GRCS score was 4 (-7 to 7), with 4 participants reporting that their FSB was “A great deal/very great deal better” (GCRS=6 to 7) and one reporting their FSB was “A very great deal worse” (GRCS=-7). Two of the 4 people who reported “positive” GRCS scores also reached the minimal detectible change score for the FIST-SCI (4 points).

Conclusion(s):

These findings show that the TCT and FIST-SCI are reliable and valid for use in people with SCI undergoing inpatient rehabilitation. Further investigation is required to understand the responsiveness of these measures in this population, especially those with motor-complete SCI.

Implications:

Prior to this study, there was no robust evidence supporting FSB measures for people with SCI in the inpatient rehabilitation setting. The TCT and FIST-SCI are translatable tools to aid in physiotherapy goal setting, care planning, and potentially documentation for insurance where current assessments are inadequate.

Funding acknowledgements:
This work was supported by a RES-ON Southeastern Sydney Local Health District Research Grant.
Keywords:
spinal cord injury
sitting balance
trunk stability
Primary topic:
Neurology: spinal cord injury
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Southeast Sydney Local Health District Research Ethics and Governance
Provide the ethics approval number:
Project Number: 2019/ETH00638
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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