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

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 (ρTCT = 0.627, ρSCI-FIST = 0.785, ρmFIST = 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.