Transfer Assessment Instrument
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Transfer Assessment Instrument

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Purpose

The Transfer Assessment Instrument (TAI) is an assessment to objectively assess the quality of independent or assisted wheelchair to surface-level transfers and an individual's adherence to optimal transfer techniques. It evaluates three major components: the set-up, the flight, and the landing. 

Link to Instrument

http://www.upmc-sci.pitt.edu/node/933

Acronym TAI

Area of Assessment

Functional Mobility

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Cost Description

Cost of equipment

CDE Status

Not a CDE (Last searched on 5/18/2023)

Populations

Wheelchair Usage

Key Descriptions

  • Objectively scores independent or assisted wheelchair to surface level transfer.
  • Can be used for manual or power wheelchair users although scoring will vary for TAI version 4.0.
  • The emphasis in all versions is on quality of the transfer and not level of assistance.
  • TAI version 1.0, 2.0, 3.0
    --Clinicians primarily evaluate the transfer
    --First section has 15- 17 items scored as 0/1 (with items having the option of not
    applicable), and the second section has 12 items scored on a
    0-4 Likert scale (with items again having the option of not applicable).
    --The two sections are scored independently and the two scores are averaged with the
    final score ranging from 0-10.
  • TAI version 4.0
    --Three transfer techniques available to score depending on transfer method
    (independent, assisted without mechanical lift, assisted with mechanical lift).
    --Three phases of transfers assessed: Wheelchair Setup, Body Setup, Flight
    --Second section eliminated.
    --Changed to first person and multiple choice responses.
    --Each item is scored as 0/1, with some items having an option of 0.5 or not
    applicable.
    --Maximum scoring:
    > Independent transfers = 20
    > Assisted transfers no mechanical lift = 23
    > Assisted transfers with mechanical lift = 5
  • The TAI version 4.0 can be administered remotely (Worobey et al., 2022).
  • A self-assessment questionnaire (TAI-Q) has been developed from TAI version 4.0; scores range from 0-10 (Worobey et al., 2020).

Number of Items

● Independent transfers = 18
● Assisted transfers no mechanical lift = 21
● Assisted transfers with mechanical lift = 5

Equipment Required

  • Ruler and goniometer (if available)
  • Assessment Form

Time to Administer

10-15  minutes

Required Training

Reading an Article/Manual

Required Training Description

An experienced clinician will be able to perform the assessment by reading the manual/assessment. In the TAI version 4.0, clinical terms were replaced with more detailed explanations and/or pictures for easier comprehension by clinicians and other users (e.g., patients/caregivers).

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Sugnesh Patel MS, OTR/L, Laura Staton MS, OTR/L, and Brocha Stern, PhD, OTR/L, MOT (New York University)

ICF Domain

Activity

Measurement Domain

Activities of Daily Living

Professional Association Recommendation

None available--last searched on 5/18/2023.

Considerations

  • The TAI 4.0 is the most recent version.
  • Shoulder pain and BMI may be limiting factors for transfer quality.
  • Wheelchair bulk may be a limiting factor for optimal set-up.
  • Consistently small sample sizes used for studies. Several validation studies use the same sample.

Wheelchair Usage

back to Populations

Standard Error of Measurement (SEM)

Mixed wheelchair users: (Tsai et al., 2013; n = 41; mean age = 49.9 (12.7) years; number of transfers 12.3 (7.4) per day; diagnoses included spinal cord injury, multiple sclerosis, brain injury, lower motor neuron injuries, and amputee)

  • TAI intrarater SEM = 0.56 - 0.71 and interrater SEM = 0.55 - 0.68 for TAI version 3.0
  • TAI intrarater SEM = 0.50 - 0.60 and interrater SEM = 0.45 - 0.75 for TAI version 2.0 (reported in this paper but not assessed in this sample)

Acute spinal cord injury: (Baghel et al., 2018; n = 30; mean age = 31.9 (12.3) years; gender = male (25); height = 163.78 (9.64) cm; potential full-time manual wheelchair users; Indian sample)

TAI version 3.0

  • TAI section 1 intrarater SEM = 0.34 - 0.43 and interrater SEM = 0.15 - 0.16
  • TAI section 2 intrarater SEM = 0.23 - 0.27 and interrater SEM = 0.18 - 0.19
  • TAI total intrarater SEM = 0.23 - 0.28 and intrarater SEM = 0.16 – 0.17

Wheelchair users: (Worobey et al., 2018; n = 44; mean age = 56.5 (12.7) years; mean time post injury/diagnosis = 17.4 (11.4) years; gender = male (35); manual wheelchair = 33, power wheelchair = 11; diagnoses included spinal cord injury, multiple sclerosis, transverse myelitis, amputee, Guillain-Barré syndrome, stroke, and lower motor neuron disease; able to transfer independently)

TAI version 4.0

  • SEM for total score: 0.24 for session 1 and 0.23 for session 2

Mixed wheelchair users: (Worobey et al., 2020; n = 44; mean age = 56.5 (12.7) years; mean time post injury/diagnosis = 17.4 (11.4) years; gender = male (35); manual wheelchair = 33, power wheelchair = 11; diagnoses included spinal cord injury, multiple sclerosis, transverse myelitis, amputee, Guillain-Barré syndrome, stroke, and lower motor neuron disease; able to transfer independently)

TAI -Q (self-assessment)

  • SEM session 1 pre-video (n = 44): 0.80
  • SEM session 1 post-video (n = 44): 0.71
  • SEM session 2 (n = 43): 0.59

Mixed wheelchair users: (Worobey et al., 2022; n = 44; mean age = 56.5 (12.7) years; mean time post injury/diagnosis = 17.4 (11.4) years; gender = male (35); manual wheelchair = 33, power wheelchair = 11; diagnoses included spinal cord injury, multiple sclerosis, transverse myelitis, amputee, Guillain-Barré syndrome, stroke, and lower motor neuron disease; able to transfer independently)

TAI version 4.0

  • SEM total score remote assessment (n = 44): 0.44
  • SEM wheelchair setup remote assessment (n = 44): 0.42
  • SEM body setup remote assessment (n = 44): 0.80
  • SEM flight/landing remote assessment (n = 44): 0.88

Minimal Detectable Change (MDC)

Mixed wheelchair users: (Tsai et al., 2013)

  • TAI version 3.0 intrarater MDC = 1.55 for total score
  • TAI version 3.0 interrater MDC = 1.53 for total score
  • TAI version 2.0 intrarater MDC* = 1.38 for total score
  • TAI version 2.0 interrater MDC* = 1.51 for total score

*Reported in this paper but not assessed in this sample

 

Acute spinal cord injury: (Baghel et al., 2018)

TAI version 3.0

  • TAI section 1 intrarater MDC = 0.94 - 1.19 and interrater MDC = 0.42 - 0.44
  • TAI section 2 intrarater MDC = 0.69 - 0.86 and interrater MDC = 0.50 - 0.53
  • TAI total intrarater MDC = 0.40 - 0.86 and interrater MDC = 0.44 – 0.47

 

Mixed wheelchair users: (Worobey et al., 2018)

TAI version 4.0

  • MDC for total score: 0.68 for session 1 and 0.63 for session 2

 

Mixed wheelchair users: (Worobey et al., 2020)

TAI-Q (self-assessment)

  • MDC session 1 pre-video (n = 44): 2.21
  • MDC session 1 post-video (n = 44): 1.97
  • MDC session 2 (n = 43): 1.63

                     

Mixed wheelchair users: (Worobey et al., 2022)

TAI version 4.0

  • MDC total score remote assessment (n = 44): 1.23
  • MDC wheelchair setup remote assessment (n = 44): 1.15
  • MDC body setup remote assessment (n = 44): 2.22
  • MDC flight/landing remote assessment (n = 44): 2.44

 

Normative Data

Mixed wheelchair users: (McClure et al., 2011; n = 40; mean age = 51.7 (11.3) years; mean time post spinal cord injury/diagnosis = 16.9 (10.7) years; type of transfers = independent transfers (82.5%) and human-assisted transfers (17.5%); diagnoses included spinal cord injury (n = 32), multiple sclerosis (n = 4), brain injury (n = 1), amputation (n = 2), and Guillain-Barré syndrome (n = 1))

TAI version 2.0

  • TAI mean score = 7.77 (1.03)

Wheelchair users with spinal cord injury: (Hogaboom et al., 2016; n = 69; mean age = 44.3 (12.6) years; gender = male (60) female (9); mean time post injury/diagnosis = 15.9 (11.1) years; able to transfer independently)

TAI version 3.0

  • TAI mean score = 6.96 (1.63)

Pediatric wheelchair users: (Rice et al, 2017; n = 12; mean age = 15.69 (1.44) years; mean time post injury/diagnosis = 10.77 (3.83) years; 41.7% had spina bifida, other diagnoses included amputation, cerebral palsy, spinal cord injury, and Charcot-Marie-Tooth)

TAI version 3.0

  • Baseline TAI mean score = 6.94 (1.60) and 7.37 (1.64) after 10-minute rest

Mixed wheelchair users: (Worobey et al., 2018)

TAI version 4.0

  • TAI mean score across all transfers = 7.58 (1.12)
  • Wheelchair setup mean score = 7.55 (1.95)
  • Body setup mean score = 7.10 (1.49)
  • Flight/Landing mean score = 8.69 (2.51)

Mixed wheelchair users: (Worobey et al., 2020)

TAI-Q (self-assessment)

  • TAI-Q total mean score for session 1 pre-video review = 7.1 (1.0)
  • TAI-Q total mean score for session 1 post-video review = 7.3 (1.0)
  • Tai-Q total mean score for session 2 = 7.3 (1.1)

Mixed wheelchair users: (Worobey et al., 2022)

TAI version 4.0

  • TAI total mean score in-person = 7.56 (1.01) and remote = 7.70 (1.05).
  • TAI wheelchair setup mean score in-person = 6.73 (2.14) and remote = 6.77 (2.10).
  • TAI body setup mean score in-person = 7.69 (1.44) and remote = 7.78 (1.50).
  • TAI flight/landing mean score in-person = 8.83 (2.14) and remote = 9.46 (1.24).

Test/Retest Reliability

Mixed wheelchair users: (Worobey et al., 2018)

TAI version 4.0

  • Poor to Acceptable test-retest reliability (1-2 days between sessions) for total score (ICCs = 0.55 - 0.76)
  • Poor test-retest reliability (1-2 days between sessions) for wheelchair setup (ICCs = 0.44 - 0.58)
  • Poor to Acceptable test-retest reliability (1-2 days between sessions) for body setup (ICCs = 0.65 - 0.83)
  • Acceptable test-retest reliability (1-2 days between sessions) for flight/landing (ICCs = 0.73 - 0.81)

Mixed wheelchair users: (Worobey et al., 2020)

TAI-Q (self-assessment)

  • Acceptable test-retest reliability (1-2 days between sessions) for total score (ICC = 0.705)
  • Poor test-retest reliability (1-2 days between sessions) for wheelchair setup (ICC = 0.668)
  • Poor test-retest reliability (1-2 days between sessions) for body setup (ICC = 0.549)
  • Poor test-retest reliability (1-2 days between sessions) for flight/landing (ICC = 0.380)

Mixed wheelchair users: (Worobey et al., 2022)

TAI version 4.0

  • Acceptable test-retest reliability (1-2 days between sessions) for total score remote assessment (ICC = 0.721)
  • Poor test-retest reliability (1-2 days between sessions) for wheelchair setup, remote assessment (ICC = 0.695)
  • Acceptable test-retest reliability (1-2 days between sessions) for body setup, remote assessment (ICC = 0.761)
  • Acceptable test-retest reliability (1-2 days between sessions) for flight/landing, remote assessment (ICC = 0.836)

Interrater/Intrarater Reliability

Acute spinal cord injury: (Baghel et al., 2018)

TAI version 3.0

  • Excellent intrarater reliability (ICCs = 0.93 - 0.98)
  • Excellent interrater reliability (ICC = 0.98 - 0.99)

Mixed wheelchair users: (McClure et al., 2011)

TAI version 2.0

  • Poor to Excellent intrarater reliability (ICCs = 0.34 – 0.89)
  • Adequate interrater reliability (ICCs = 0.51 – 0.70)

Mixed wheelchair users: (Tsai et al., 2013)

TAI version 3.0

  • Excellent interrater reliability (ICCs = 0.81 - 0.85)
  • Adequate to Excellent intrarater reliability (ICCs = 0.74 - 0.88)

Mixed wheelchair users: (Worobey et al., 2018)

TAI version 4.0

  • Excellent  interrater reliability (ICCs = 0.80 - 0.85) and Adequate to Excellent intrarater reliability (ICCs = 0.60 - 0.76) for total score
  • Excellent interrater reliability (ICCs = 0.94) and Adequate intrarater reliability (ICCs = 0.58 - 0.64) for wheelchair setup
  • Adequate interrater reliability (ICCs = 0.65 - 0.72) and Adequate to Excellent intrarater reliability (ICCs = 0.62 - 1.00) for body setup
  • Adequate to Excellent interrater reliability (ICC = 0.72 - 0.80) and Excellent intrarater reliability (ICCs = 0.79 - 0.86) for flight/landing

Mixed wheelchair users: (Worobey et al., 2020)

TAI-Q (self-assessment)

  • Adequate intrarater reliability for total score (ICC = 0.627)
  • Adequate intrarater reliability for wheelchair setup (ICC = 0.643)
  • Excellent intrarater reliability for body setup (ICC = 0.775)
  • Adequate intrarater reliability for flight/landing (ICC = 0.533)

Mixed wheelchair users: (Worobey et al., 2022)

TAI version 4.0

  • Excellent total interrater reliability (ICC = 0.830) and Adequate total intrarater reliability (ICC = 0.687) for total score, remote assessment
  • Excellent interrater reliability (ICC = 0.962) and Adequate intrarater reliability in wheelchair setup (ICC = 0.717) for wheelchair setup, remote assessment
  • Adequate interrater (ICC = 0.746) and intrarater (ICC = 0.729) reliability for body setup, remote assessment
  • Excellent interrater (ICC = 0.829) and intrarater (ICC = 0.854) reliability for flight/landing, remote assessment

Criterion Validity (Predictive/Concurrent)

Mixed wheelchair users: (McClure et al., 2011)

TAI version 2.0

  • Poor to Excellent concurrent validity (rs = 0.19 – 0.69) with a visual analog scale (VAS) of global quality of the transfer

Mixed wheelchair users: (Worobey et al., 2018)

TAI version 4.0

  • Relationships between the TAI 4.0 scores and the VAS of global assessment of the transfer were examined, and a moderate relationship was found between the two scores, with correlations averaging 0.59 (0.10). Significant correlations between the VAS and TAI subscores were found especially with the body setup (R = 0.487, p = .001) and flight/landing (R = 0.701, p < .001).

Mixed wheelchair users: (Worobey et al., 2020)

TAI-Q (self-assessment)

  • Adequate concurrent validity of the TAI-Q and TAI total score (ICC = 0.41) for session 1 pre-video and Excellent concurrent validity for session 2 post-video (ICC = 0.78)
  • Adequate concurrent validity of the TAI-Q and TAI wheelchair setup (ICC = 0.51) for session 1 pre-video and Excellent concurrent validity for session 2 post-video (ICC = 0.66)
  • Adequate concurrent validity of TAI-Q and TAI body setup (ICC = 0.46) for session 1 pre-video and Excellent concurrent validity for session 2 post-video (ICC = 0.84)
  • Poor concurrent validity of TAI-Q and TAI flight/landing (ICC = 0.29) for session 1 pre-video and Excellent concurrent validity for session 2 post-video (ICC = 0.67)

Construct Validity

Acute spinal cord injury: (Baghel et al., 2018)

TAI version 3.0

  • Excellent convergent validity (r = 0.88 - 0.90) with a global assessment of transfer scale (VAS)

Content Validity

Mixed wheelchair users: (McClure et al., 2011)

TAI version 2.0

  • For the original assessment, “content validity was established via focus group meetings with an interdisciplinary expert panel of rehabilitation professionals with either experience in teaching transfers or personal experience because of disability.” (p. 500)

Mixed wheelchair users: (Worobey et al., 2018)

TAI version 4.0

  • Content validity was established by a panel of four individuals with experience using the TAI 3.0 who completed initial revisions. “Following initial revisions, two external reviewers with more than 20 years of clinical experience provided feedback on the content, wording, and scoring of items.” (p. 218)

Face Validity

Mixed wheelchair users: (McClure et al., 2011)

TAI version 2.0

No adverse events (e.g., falls, injuries) occurred during testing. Therapists reported that this tool can be easily integrated into a clinical setting. Patients reported acceptability of assessment.

Floor/Ceiling Effects

Mixed wheelchair users: (McClure et al., 2011)

TAI version 2.0

  • 3 items had a potential ceiling effect

Bibliography

Baghel, P., Walia, S., & Noohu, M. M. (2018) Reliability and validity of transfer assessment instrument version 3.0 in individuals with acute spinal cord injury in early rehabilitation phase. Hong Kong Physiotherapy Journal, 3(2), 115-123. https://doi.org/10.1142/S1013702518500099

Hogaboom, N. S., Worobey, L. A., & Boniger, M. L. (2016). Transfer technique is associated with shoulder pain and pathology in people with spinal cord injury: A cross sectional investigation. Archives of Physical Medicine and Rehabilitation, 97(10), 1710-1776. https://doi.org/10.1016/j.apmr.2016.03.026

McClure, L. A., Boninger, M. L., Ozawa H., & Koontz, A. (2011). Reliability and validity analysis of the Transfer Assessment Instrument. Archives of Physical Medicine and Rehabilitation, 92(3), 499-508. https://doi.org/10.1016/j.apmr.2010.07.231

Rice, L. A., Dysterheft, J. L., Sanders, E., & Rice, I. M. (2016). Short-term influence of transfer training among full time pediatric wheelchair users: A randomized trial. The Journal of Spinal Cord Medicine, 40(4), 396-404. https://doi.org/10.1080/10790268.2016.1149292

Tsai, C-Y., Rice, L. A., Hoelmer, C., Boniger, M. L., & Koontz, A. M. (2013). Basic psychometric properties of the Transfer Assessment Instrument (version 3.0). Archives of Physical Medicine and Rehabilitation, 94(12), 2456-2464. https://doi.org/10.1016/j.apmr.2013.05.001

Worobey, L., Hibbs, R., Riggot, S., Boniger, M., Huzinec, R., Sung, J., and Rice, L. (2022). Intra-and interrater reliability of remote assessment of transfers by wheelchair users using the Transfer Assessment Instrument (version 4.0). Archives of Physical Medicine and Rehabilitation, 103(4), 816-821. https://doi.org/10.1016/j.apmr.2020.12.032

Worobey, L. A., Riggot, S. K., Boniger, M. L., Huzinec, R., Sung, J. H., DiGiovine, K., & Rice, L. A. (2020). Concurrent validity and reliability of the Transfer Assessment Instrument Questionnaire as a self-assessment measure. Archives of Rehabilitation Research and Clinical Translation, 2(4), 100088. https://doi.org/10.1016/j.arrct.2020.100088

Worobey, L. A., Zigler, C. K., Huzinec, R., Rigot. S. K., Sung, J., and Rice, L. A. (2018). Reliability and validity of the revised transfer assessment instrument. Topics in Spinal Cord Injury Rehabilitation, 24(3), 217-226. https://doi.org/10.1310/sci2403-217

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