Core Practice Principles: A mixed-methods approach to determine what drives the use of seated trunk control assessments in spinal cord injury clinical and research practice.

OBJECTIVE: To examine current practices in assessing seated trunk control (STC) following spinal cord injury (SCI), a key factor in rehabilitation outcomes and independence. Enablers and barriers to uptake of assessment tools in practice were identified using the Theoretical Domain Framework (TDF) and mapped to the Capability-Opportunity-Motivation for Behavior Change (COM-B) model. DESIGN: Explanatory sequential mixed methods design using a survey of assessment tools used, followed by focus groups and interviews to triangulate survey responses, understand factors driving uptake, and identify ideal assessment characteristics. SETTING: Leading SCI institutions in the United States PARTICIPANTS: US-based clinicians and clinical researchers experienced in SCI rehabilitation. INTERVENTIONS: NA MAIN OUTCOME MEASURES: Survey of commonly used assessment tools. RESULTS: The survey showed that 72% of 67 respondents used STC assessments, most frequently the Berg Balance Scale (BBS), while qualitative findings highlighted the FIST-SCI and observation as key assessments of STC. Analysis using the TDF and COM-B identified barriers relating to Opportunity to use STC assessments: including limited evidence, absence of standardized guidelines, funding constraints, and insurance limitations. Capability-related facilitators to use of assessments were practitioner knowledge and practical skills, whereas Motivation-related drivers were clinical relevance and sensitivity to change of assessments. CONCLUSION: In SCI rehabilitation in the US health care context, trunk control assessment is considered essential, although systemic and evidentiary challenges limit its integration. These findings underscore the need for co-developed guidelines and further research to demonstrate the robustness of assessments in monitoring progress, fall risk, and activity independence.