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RehabMeasures Instrument

Needs Assessment Checklist

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Purpose

Assesses patient attainment of rehabilitation outcomes through a self-rating of perceived independence at mobilization and prior to discharge, used specifically for patients with Spinal Cord Injury (SCI).

Link to Instrument

Instrument Details

Acronym NAC

Area of Assessment

Activities of Daily Living
General Health
Range of Motion
Social Relationships
Social Support
Incontinence

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Key Descriptions

  • The Needs Assessment Checklist consists of nine rehabilitation domains, each with specific indicators:
    1) ADL (29 indicators)
    2) Skin Management (14 indicators)
    3) Bladder Management (10 indicators)
    4) Bowel Management (7 indicators)
    5) Mobility (17 indicators)
    6) Wheelchair and Equipment (33 indicators)
    7) Community Preparation (24 indicators)
    8) Discharge Coordination (32 indicators)
    9) Psychological Issues (19 indicators)
  • Scores are derived by summing sub-scale items; a “percentage achieved” is also calculated for each of the 9 sub-scale's ranging from 0-100% with higher scores indicating greater independence.
  • This score isused in Goal Planning Meetings to establish rehabilitation goals that include explicit behavioral targets.

Number of Items

199

Time to Administer

60 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated by Jennifer Kahn, PT, DPT, NCS, Candy Tefertiller, PT, DPT ATP, NCS, and SCI EDGE task force of the Neurology Section of the APTA in 2012

ICF Domain

Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Motor
Sensory

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

R

R

LS

 

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

R

R

 

  

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

No

Not reported

Considerations

  • The Child Needs Assessment Checklist (ChNAC) is also available (see Webster & Kennedy, 2007; for more information)

  • NAC is a measure of an individual’s perceptions of their own independence and may be subjective and influenced by other factors. 

  • NAC assesses both verbal and physical independence so individuals have potential to reach 100% on all subscales. 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Spinal Injuries

back to Populations

Normative Data

Subacute, Chronic SCI : (Berry & Kennedy, 2003; n = 43; 13.9% = complete tetraplegia, 37.2% = incomplete tetraplegia, 23.3% = complete paraplegia, and 25.6% = incomplete paraplegia; mean age = 42.19 (14.6) years)

NAC Means (SD)

 

 

 

 

Subscale

Number of items

Scale mean

Scale SD

 

ADL

29

59.07

25.88

0.9697

Skin Management

14

25.67

10.54

0.8830

Bladder Management

10

22.81

7.23

0.8356

Bowel Management

7

13.91

6.27

0.8097

Mobility

17

24.28

13.30

0.8729

Wheelchair and Equipment

33

46.09

27.27

0.9527

Community Preparation

24

39.28

12.73

0.7805

Discharge Coordination

32

47.86

25.52

0.9251

Psychological Issues

19

45.49

7.99

0.7347

SCIM Self-Care

6

12.63

7.61

0.9608

Respiration and Sphincter Management

4

23.84

10.60

0.6454

Mobility

8

14.02

11.21

0.9288

Full-Scale Score

18

50.49

26.91

0.9227

HADS Anxiety

7

5.14

4.32

0.8463

Depression

7

5.51

4.17

0.8122

Test/Retest Reliability

Subacute, Chronic SCI : (Berry & Kennedy, 2002) 

Test-retest reliability (mean time between two tests 7.2 (2.88) days), compared by correlating clinical NAC subscale scores with test-retest NAC subscale scores.)

NAC subscale

r value

ADL

0.884

Skin Management

0.904

Bladder Management

0.694

Bowel Management

0.783

Mobility

0.883

Wheelchair and Equipment

0.883

Community Preparation

0.830

Discharge coordination

0.805

Psychological Issues

0.748

All correlations significant at 0.01 level

 

Internal Consistency

Subacute, Chronic SCI: (Berry 2002, n= 43, complete, incomplete, paraplegia, tetraplegia ) 

 

Acute SCI : (Kennedy et at, 2003; n = 147, mean age = 40.7 (16.5) years; complete tetraplegia (18%), incomplete tetraplegia (14%), complete paraplegia (16%), and incomplete paraplegia (11%))

 

NAC subscale

Berry 2002 alpha

Kennedy 2003 alpha

Across all subscales 

Excellent 0.8587 

Excellent 0.83 

ADL 

Excellent 0.9697 

Excellent 0.9467 

Skin Management 

Excellent 0.8830 

Excellent 0.8478 

Bladder Management 

Excellent 0.8356 

Adequate 0.7753 

Bowel Management 

Excellent 0.8097 

Excellent 0.8741 

Mobility 

Excellent 0.8729 

Excellent 0.8358 

Wheelchair and Equipment 

Excellent 0.9527 

Excellent 0.9239 

Community Preparation 

Adequate 0.7805 

Adequate 0.7146 

Discharge coordination 

Excellent 0.9251 

Excellent 0.8855 

Psychological Issues 

Adequate 0.7347 

Poor 0.6729

Criterion Validity (Predictive/Concurrent)

Subacute, Chronic SCI: (Berry & Kennedy, 2002)

Concurrent Validity: NAC, SCIM and HADS:

Subscale

SCIM Self-care

SCIM Respiration and Sphincter Management

SCIM Mobility

SCIM Full Scale

HADS-Anxiety

HADS-Depression

HADS (combined scales)

 

ADL

0.850 (Excellent)

 

 

0.783 (Excellent)

 

 

 

Bladder and Bowl

 

0.681 (Excellent)

 

0.754 (Excellent)

 

 

 

Mobility

 

 

0.691 (Excellent)

0.696 (Excellent)

 

 

 

Psychological (mood)

 

 

 

 

-0.709 (Excellent)

-0.633 (Excellent)

-0.726 (Excellent)

Psychological (Full scale)

 

 

 

 

-0.501 (Adequate)

-0.466 (Adequate)

-0.523 (Adequate)

SCIM = The Spinal Cord Independence Measure

HADS = Hospital Anxiety and Depression Scale

All correlations are significant at the 0.01 level (two-tailed)

 

Bibliography

Berry, C. and Kennedy, P. (2002). "A psychometric analysis of the Needs Assessment Checklist (NAC)." Spinal Cord 41(9): 490-501. Find it on PubMed

Duff, J., Evans, M. J., et al. (2004). "Goal planning: a retrospective audit of rehabilitation process and outcome." Clinical rehabilitation 18(3): 275. Find it on PubMed

Kennedy, P., Evans, M., et al. (2003). "Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury." Spinal Cord 41(1): 44-52. Find it on PubMed

Kennedy, P. and Hamilton, L. R. (1999). "The needs assessment checklist: a clinical approach to measuring outcome." Spinal Cord 37(2): 136-139. Find it on PubMed

Webster, G. and Kennedy, P. (2007). "Addressing children's needs and evaluating rehabilitation outcome after spinal cord injury: the child needs assessment checklist and goal-planning program." J Spinal Cord Med 30 Suppl 1: S140-145. Find it on PubMed

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