Reliability, validity, and responsiveness of three seated trunk control assessments used during inpatient spinal cord injury rehabilitation

Abstract Study design Cohort study. Objectives To investigate the reliability, validity, and responsiveness of the Trunk Control Test (TCT) and two Function in Sitting Tests (FIST) for people with a spinal cord injury (SCI; FIST-SCI and Modified-FIST (mFIST)) during inpatient rehabilitation. Setting Inpatient Rehabilitation Hospital in Sydney, Australia. Methods Thirty adults with recent (SCI) completed four assessments led by three raters within two weeks to determine inter-rater and intra-rater reliability. Validity was determined through known-groups and Spearman Correlation analyses with the Berg Balance Scale (BBS), Spinal Cord Independence Measure, Maximal Balance Range Test, and SCI-Falls Concern Scale. Six-week follow-up responsiveness assessments and global rating of change scale (GRCS) scores were completed. Results Neurological level of injury ranged from C4 to L2 (80% motor-incomplete SCI). Time since injury was 84 days (95% CI:64,105). The TCT and FIST-SCI had excellent reliability (ICC > 0.9). The mFIST had excellent intra-rater (ICC = 0.908) and good inter-rater reliability (ICC = 0.867). All three tests differentiated between participants who were independent and required assistance with transfers (p < 0.05). All three tests correlated with the BBS (ρ TCT = 0.627, ρ SCI-FIST = 0.785, ρ mFIST = 0.823) (p < 0.05). Median (IQR) change scores were 2 (0, 4) (TCT), 3 (0, 6) (FIST-SCI), and 3 (0,11) (mFIST). Participants reported a GRCS improvement (45%), no change (50%), or a decline (5%) in their seated trunk control during usual care. Attrition limited responsiveness analyses. Conclusions The TCT, FIST-SCI, and mFIST are reliable and valid seated trunk control tests in SCI early inpatient rehabilitation. Future studies should investigate responsiveness in people with motor-complete SCI.