Rehab Measures - Walking Index for Spinal Cord Injury

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Rehab Measures: Walking Index for Spinal Cord Injury

Link to instrument Title of Assessment Acronym Purpose

Available at spinalcordcenter.org Walking Index for Spinal Cord Injury

WISCI-II Assesses the amount of physical assistance needed as well as devices required for walking following paralysis that results from Sinal Cord Injury (SCI). Designed to be a more precise measure of improvement in functional limits.

Description

Rank orders the ability of a person to walk after spinal cord injury from most to least severe impairment (Ditunno & Dittuno, 2001).

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Level 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Area of Assessment Body Part ICF Domain Domain Assessment Type Length of Test Time to Administer Number of Items Equipment Required Training Required Type of training required

Description Client is unable to stand and/or participate in assisted walking. Ambulates in parallel bars, with braces and physical assistance of two persons, less than 10 meters. Ambulates in parallel bars, with braces and physical assistance of two persons, 10 meters. Ambulates in parallel bars, with braces and physical assistance of one person, 10 meters. Ambulates in parallel bars, no braces and physical assistance of one person, 10 meters. Ambulates in parallel bars, with braces and no physical assistance, 10 meters. Ambulates with walker, with braces and physical assistance of one person, 10 meters. Ambulates with two crutches, with braces and physical assistance of one person, 10 meters. Ambulates with walker, no braces and physical assistance of one person, 10 meters. Ambulates with walker, with braces and no physical assistance, 10 meters. Ambulates with one cane/crutch, with braces and physical assistance of one person, 10 meters. Ambulates with two crutches, no braces and physical assistance of one person, 10 meters. Ambulates with two crutches, with braces and no physical assistance, 10 meters. Ambulates with walker, no braces and no physical assistance, 10 meters. Ambulates with one cane/crutch, no braces and physical assistance of one person, 10 meters. Ambulates with one cane/crutch, with braces and no physical assistance, 10 meters. Ambulates with two crutches, no braces and no physical assistance, 10 meters. Ambulates with no devices, no braces and physical assistance of one person, 10 meters. Ambulates with no devices, with braces and no physical assistance, 10 meters. Ambulates with one cane/crutch, no braces and no physical assistance, 10 meters. Ambulates with no devices, no braces and no physical assistance, 10 meters.

Functional Mobility; Gait Not Applicable Activity Motor Observer 05 Minutes or Less

5 minutes
21 levels

None None
No Training

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Cost Actual Cost

Free

Available in: Ditunno, P. and J. Dittuno (2001). "Walking index for spinal cord injury (WISCI II): scale revision." Spinal Cord 39(12): 654-656.

Age Range Administration Mode Diagnosis Populations Tested Standard Error of Measurement (SEM) Minimal Detectable Change (MDC)

Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ Paper/Pencil Spinal Cord Injury

Spinal Cord Injury See Burn's et al (2011) SRD data below Chronic SCI: (Burns et al, 2011; n = 63; mean age = 43.3 (13.8) years; mean time since injury = 6.32 (5.99) years) ICC and SRD for WISCI Level and Walking Speed ICC SS WISCI SEM SRD 0.785 0.597 Level 0.994 0.283

Speed 0.930 0.091 0.254 m/s Max WISCI Level 0.995 0.215 Speed 0.971 0.059 0.163 m/s WISCI = Walking Index for Spinal Cord Injury SS = Self-Selected Max = Maximum ICC = intraclass correlation coefficient SEM = Standard Error of Measurement SRD = Smallest Real Difference These results suggest that a change of 1 WISCI level can be considered a real difference in a clinical context
Minimally Clinically Important Difference (MCID) Cut-Off Scores Normative Data

Not Established

Not Applicable Acute SCI: (Scivoletto et al, 2004; n = 183 males and 98 females; mean age = 50.4 (19.3) years)

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SCI Outcome Data by Sex: Admission Age (years) Lesion to admission time (days) Length of stay (days) Motor scores BI RMI WISCI Discharge Motor scores BI RMI WISCI 67.3 (19.2) 64 (32.7) 6 (4.9) 7.9 (8.2) 65 (22.3) 64.5 (28.8) 6 (4.9) 7.8 (8.5) Females 52 (19.1) 54.1 (43) Males 50.8 (19) 52.6 (39)

103.6 (73.9) 103.4 (79.3) 58.4 (14.3) 56.9 (16.8) 27.8 (21.7) 26.8 (22.6) 1.3 (2.2) 0.6 (2.7) 1.4 (2.8) 1.8 (5.4)

No significant differences between male and female scores BI = Barthel Index RMI = Rivermead Mobility Index WISCI = Walking Index for Spinal Cord Injury
Test-retest Reliability Interrater/Intrarater Reliability

Not Established Chronic SCI: (Marino et al, 2010; n = 26; sample included participants from the US and Italy) Excellent Intra-rater reliability (maximum) = 1.0 Excellent Inter-rater reliability = 0.98 WISCI Validation: (Ditunno et al, 2000, 24 raters assessed 40 video clips) Excellent inter-rater reliability (1 perfect agreement)

Internal Consistency Criterion Validity (Predictive/Concurrent)

Not applicable Concurrent Validity - Original WISCI (Ditunno et al, 2000 sample included participants from Australia, Brazil, Canada, Korea, Italy, the UK and US) Excellent WISCI and FIM score correlations (r = 0.765) Acute SCI: (van Hedel et al, 2005; mean age = 54 (20) years; ASIA A = 5%, B = 4%, C = 9% and D = 81%) WISCI II score of 0 to 10 (n = 13 to 20) Poor, WISCI II vs TUG (r = 0.16) Poor, WISCI II vs 10MWT (r = 0.24) Poor, WISCIII vs 6MWT (r = 0.22) WISCI II score of 11 to 20 (n = 47) Adequate, WISCI II vs 10MWT (r = 0.49) Excellent, WISCI II vs TUG (r = 0.65) Excellent, WISCI II vs 6MWT (r = 0.64)

Construct Validity (Convergent/Discriminant)

Chronic SCI: (Burns et al, 2011)

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Concurrent Validity: Combined Tetraplegic Combined Tetraplegic Paraplegic Tetraplegic AA WISCI WISCI Level Speed MAX WISCI WISCI Level Speed 0.647** 0.494** 0.663** 0.539** 0.812** 0.715** 0.798** 0.753** 0.704** 0.509** 0.717** 0.572** 0.852** 0.752** 0.816** 0.813** 0.479* 0.104 0.533* 0.149 0.496** 0.491* 0.502** 0.469**

Correlation Strength: > .60 = Excellent .31 to .59 = Adequate < .30 = Poor *p < .05 **p < .0001 WISCI = Walking Index for Spinal Cord Injury SS = Self-Selected Max = maximum MMT = manual muscle test LEMS = lower-extremity motor score UEMS = upper-extremity motor score
Content Validity

SCI Measure Review: (Jackson et al, 2006, review of 5 SCI measures; based on 54 votes) Expert ratings: Valid or Useful = 52% Useful but requires validation or changes = 43% Not Useful or valid for research in SCI = 6%

Face Validity

Experts (clinical physician's and physical therapists) at eight international spinal cord injury facilities were asked to rank 20 items. Kendall coefficient of concordance (W) for the pilot data set = 0.843

Floor/Ceiling Effects Responsiveness Considerations Bibliography

Not Established Not Established

Burns, A. S., Delparte, J. J., et al. (2011). "The reproducibility and convergent validity of the Walking Index for Spinal Cord Injury (WISCI) in chronic spinal cord injury." Neurorehabil Neural Repair 25(2): 149-157. Find it on PubMed Dittuno, P. L. and Ditunno, J. F., Jr. (2001). "Walking index for spinal cord injury (WISCI II): scale revision." Spinal Cord 39(12): 654-656. Find it on PubMed Ditunno, J. F., Jr., Ditunno, P. L., et al. (2000). "Walking index for spinal cord injury (WISCI): an international multicenter validity and reliability study." Spinal Cord 38(4): 234-243. Find it on PubMed Jackson, A. B., Carnel, C. T., et al. (2008). "Outcome measures for gait and ambulation in the spinal cord injury population." J Spinal Cord Med 31(5): 487-499. Find it on PubMed Marino, R. J., Scivoletto, G., et al. (2010). "Walking Index for Spinal Cord Injury Version 2 (WISCI-II) with Repeatability of the 10-m Walk Time: Inter-and Intrarater Reliabilities." American Journal of Physical Medicine & Rehabilitation 89(1): 7. Find it on PubMed

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Rehab Measures - Walking Index for Spinal Cord Injury

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Scivoletto, G., Romanelli, A., et al. (2008). "Clinical factors that affect walking level and performance in chronic spinal cord lesion patients." Spine 33(3): 259-264. Find it on PubMed van Hedel, H. J., Wirz, M., et al. (2008). "Standardized assessment of walking capacity after spinal cord injury: the European network approach." Neurol Res 30(1): 61-73. Find it on PubMed
Year published Instrument in PDF Format Summary Author(s) Summary Date External Recommendations Approval Status Attachments Approved
Dittuno-2001-Walking index for sp.pdf

2001 Yes

Created at 2/18/2011 4:50 PM by Jason Raad Last modified at 5/25/2011 2:38 PM by Jennifer Moore

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