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RehabMeasures Instrument

Spinal Cord Injury Functional Ambulation Profile

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Purpose

The SCI-FAP measures functional walking in individuals with incomplete spinal cord injury through a variety of timed walking related tasks.

Link to Instrument

Instrument Details

Acronym SCI-FAP

Area of Assessment

Functional Mobility

Assessment Type

Performance Measure

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Key Descriptions

  • 7 timed walking tasks
  • The maximum score is 2100. Lower scores indicate higher functioning and reflect less time and less assistance to complete a task.
  • Scoring is based on time it takes to complete a task at a comfortable walking pace and a multiplication factor to quantify the assistance needed. Scores are then normalized using mean scores from individuals without SCI, to avoid a task in the measure dominating the scoring. In sum, each item is scored as follows:

    Task score = (Time x Factor)/Mean able-bodied time
  • Participants are instructed to use an assistive device and/or braces as needed. The tester can provide physical assistance as needed guarding from behind. No feedback during tasks is given. If a participant cannot complete a task, they are given the maximum score for that task. The tester provides an explanation of the 7 tasks comprising the SCI-FAP. Prior to performance of each task, the tester explains and demonstrates the task. The participant is informed that performance of each task is timed. Detailed instructions for each item is included in the copy of the instrument.

Number of Items

7

Equipment Required

  • Masking Tape
  • Stopwatch
  • Carpet – no less than 7m long and 2m wide (5m are timed)
  • Standard armchair (44cm seat height)
  • 2 standard bricks
  • A trash can
  • 4 stairs with bilateral handrails 29-cm stair depth, 76-cm stair width, 15-cm stair height, 76-cm platform depth, and 76-cm platform width.
  • A shoulder bag with 5lb weight inside
  • A step
  • A door, 4-cm door depth, 95-cm door width, and 211-cm door height

Time to Administer

15-45 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Initially reviewed by Jennifer H. Kahn PT, DPT, NCS, Candy Tefertiller, PT, DPT, ATP, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 04/2012.

Body Part

Lower Extremity

ICF Domain

Activity

Measurement Domain

Motor

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 (VEDGE) 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

LS

LS

R

 

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

LS

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 SCI-FAP does not differentiate between varying levels of manual assistance, but this information can be noted in the “comments” section. 
  • The SCI-FAP does not take into account any bracing or orthosis required for the individual to walk. 
  • The tasks can be used as independent tests as each test's psychometrics have been established. 

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Spinal Injuries

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Standard Error of Measurement (SEM)

Spinal Cord Injury:

(Musselman and Yang, 2013; n = 20 individuals with an incomplete SCI, > 7 months post-injury and able to ambulate at least 5 meters without manual assistance; participants free from cognitive or musculoskeletal impairments that might affect walking; mean age = 46.0(13.6) years; mean time post-injury = 5.4(8.8) years; sex = 6 females and 14 males)

  • SEM for overall SCI-FAP Score = 34.5
  • SEM for overall SCI-FAP Time = 41.2
  • SEM for overall SCI-FAP Tasks: 
    • Carpet = 3.2 
    • Tug = 5.0 
    • Obstacles = 5.3 
    • Stairs = 7.5 
    • Carry = 4.5 
    • Step = 13.0 
    • Door = 3.7

Minimal Detectable Change (MDC)

Spinal Cord Injury:

(Musselman and Yang, 2013)

  • MDC for overall SCI-FAP Score = 95.7 
  • MDC for overall SCI-FAP Time = 114.2 
  • MDC for overall SCI-FAP Tasks: 
    • Carpet = 9.0
    • Tug = 14.0 
    • Obstacles = 14.7 
    • Stairs = 20.6 
    • Carry = 12.4 
    • Step = 36.1 
    • Door = 10.2

Normative Data

Able-bodied Individuals:

(Musselman et al, 2011,  = 60, mean age: 42.9(16.0) years; age range: 28-88 years)

 

  • Floor 4.4 + 0.6s 
  • Carpet 4.4+ 0.6s 
  • Up & Go 9.1 + 1.2s 
  • Obstacles 11.4 + 1.3s 
  • Stairs 6.2 + 0.8s 
  • Carry 4.4 + 0.5s 
  • Step 3.7 + 0.5s 
  • Ramp 6.2 +1.0s 
  • Door 5.0 + 0.7s 

 

Mean times from the able-bodied data are used to normalize the task scores for the SCI-FAP. 

No difference in total SCI-FAP score across ages, except for Up & Go where individuals in their 20s performed significantly faster (= 0.031) than those in their 50s.

Test/Retest Reliability

Chronic Incomplete SCI:

(Musselman et al, 2011, = 22; AIS C and D, paraplegia and tetraplegia; Test 1 and 2 completed 1-2 weeks apart) 

  • Excellent test-retest reliability (ICC = 0.983 for total score) 
  • Excellent test-retest reliability for all individual items

 

Item

ICC

Carpet

0.972

Up & Go

0.978

Obstacles

0.977

Stairs

0.964

Carry

0.992

Step

0.959

Door

0.982

Total Time (sum of normalized times)

0.952

Total Assistance (sum of normalized assistance ratings)

0.998

Interrater/Intrarater Reliability

Chronic Incomplete SCI:

(Musselman et al, 2011, AIS C and D, paraplegia and tetraplegia)

  • Intrarater Reliability – Not established 
  • Excellent Interrater Reliability (ICC= 1.000 for total score)
  • Excellent Interrater Reliability for all individual items 

 

Item

ICC

Carpet

1.000

Up & Go

1.000

Obstacles

0.996

Stairs

0.994

Carry

1.000

Step

1.000

Door

0.999

Total Time (sum of normalized times)

1.000

Total Assistance (sum of normalized assistance ratings)

1.000

Internal Consistency

Chronic Incomplete SCI:

(Musselman et al, 2011, AIS C and D, paraplegia and tetraplegia) 

  • Excellent Cronbach’s alpha =0.95 

 

Of note, original test was developed with 9 tasks, but reduced to 7 as redundancy was found.

Construct Validity

Discriminative Validity

Chronic Incomplete SCI:

(Musselman et al, 2011) 

  • Scores of able-bodied individuals and those with SCI were compared via a t-test. Participants with SCI scored significantly higher on the SCI-FAP, P=.002, for the total score; 5 subjects with SCI demonstrated similar scores as able-bodied subjects. 

 

Convergent Validity

Chronic Incomplete SCI:

(Musselman et al, 2011) 

  • Adequate – total SCI-FAP with the 10MWT, and 6min walk test,(r = -0.59, -0.59 respectively). 
  • Excellent – total SCI-FAP with self selected WISCI II and maximum WISCI II (r = -0.68, -0.70 respectively). 
  • Adequate to Excellent individual items:

Item

6 min

10M

Self-selected WISCI II

Maximum WISCI II

Carpet

-0.53

-0.53

-.058

-0.61

Up & Go

-0.58

-0.58

-0.63

-0.65

Obstacles

-0.55

-0.55

-0.62

-0.63

Stairs

-0.51

-0.51

-0.66

-0.66

Carry

-0.47

-0.47

-0.54

-0.57

Step

-0.64

-0.63

-0.64

-0.69

Door

-0.50

-0.49

-0.67

-0.67

Total Time (sum of normalized times)

-0.63

-0.62

-0.67

-0.71

Total Assistance (sum of normalized assistance ratings)

-0.80

-0.78

-0.82

-0.86

Content Validity

Developed by SCI focus group and based on Modified Emory Functional Ambulation Profile (mEFAP); Confirmed by those who are experts in area of rehabilitation of incomplete spinal cord injury (= 6)

Floor/Ceiling Effects

Ceiling Effect

SCI:

(Musselman et al, 2011) 

  • Adequate In individuals who are higher functioning and walked at normal speeds without devices, the SCI-FAP did not discriminate between SCI and able-bodied individuals, 15.63% of the sample (5/32). 
  • Assistance ratings reduce the ceiling effect 

 

Floor Effect

SCI:

(Musselman et al, 2011)

  • Individuals who are unable to walk, or unable to complete the walking tasks, will score the maximum on the measure of 2100.

Responsiveness

SCI:

(Musselman and Yang, 2013)

  • The SCI-FAP is responsive to change in walking function in individuals who walk slow speeds (i.e., < 0.5 m/s), but without manual assistance
  • SRM for SCI-FAP Score = 0.59
  • Future work with a greater sample size should focus on confirming responsiveness in individuals with lower walking function

Bibliography

Musselman, K., Brunton, K., et al. (2011). "Spinal cord injury functional ambulation profile: a new measure of walking ability." Neurorehabil Neural Repair 25(3): 285-293. Find it on PubMed

Musselman, K. and Yang, J. F. (2013). "The Spinal Cord Injury Functional Ambulation Profile (SCI-FAP): A Preliminary Look at Responsiveness." Physical therapy. Find it on PubMed

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