Walking Index for Spinal Cord Injury Version 2 (WISCI-II) with Repeatability of the 10-m Walk Time: Inter- and Intrarater Reliabilities

Marino RJ, Scivoletto G, Patrick M, Tamburella F, Read MS, Burns AS, Hauck W, Ditunno J: Walking Index for Spinal Cord Injury version 2 (WISCI-II) with repeatability of the 10-m walk time. Objective:To demonstrate the inter-/intrarater reliability of the Walking Index for Spinal Cord Injury version 2 scale and the repeatability of the time to walk 10 m in chronic subjects. Design:In this reliability study, 26 subjects from the United States and Italy with spinal cord injury/disorder were tested by two blinded raters on two separate days to determine self-selected and maximum Walking Index for Spinal Cord Injury levels and the time to complete a 10-m walk. Subjects were progressed from self-selected to maximum Walking Index for Spinal Cord Injury incrementally until they failed the higher level. Intraclass correlations were calculated for Walking Index for Spinal Cord Injury levels and repeatability coefficients for the 10-m time. Results:Twenty-two of 26 subjects showed increases of one to eight levels from self-selected to maximum Walking Index for Spinal Cord Injury, whereas 10-m walking time remained relatively unchanged (n = 15) or increased markedly (n = 7). Inter- and intrarater reliabilities were 1.00 for the self-selected Walking Index for Spinal Cord Injury level. Intrarater reliability for the maximum level was 1.0; interrater reliability was 0.98. Repeatability coefficients for time to walk 10 m were smaller (better) at self-selected than at maximum Walking Index for Spinal Cord Injury and on the same day than on different days. On same-day assessments, repeatability coefficients were 18%–20% of 10-m walk time, excluding subjects with discrepant Walking Index for Spinal Cord Injury levels (n = 2). For different-day assessments, repeatability coefficients were 27%–35% of 10-m walk time. Conclusions:The determination of both self-selected and maximum Walking Index for Spinal Cord Injury levels is highly reliable, whereas 10-m walking time is more variable. Walking “profiles” of speed at self-selected and maximum Walking Index for Spinal Cord Injury may better characterize walking ability than a single Walking Index for Spinal Cord Injury level.

[1]  D. Altman,et al.  Measuring agreement in method comparison studies , 1999, Statistical methods in medical research.

[2]  John F Ditunno,et al.  Neurological and functional capacity outcome measures: essential to spinal cord injury clinical trials. , 2005, Journal of rehabilitation research and development.

[3]  W. Donovan,et al.  The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury , 1994, Paraplegia.

[4]  B J Whipp,et al.  Oxygen uptake kinetics for various intensities of constant-load work. , 1972, Journal of applied physiology.

[5]  V. Dietz,et al.  Providing the clinical basis for new interventional therapies: refined diagnosis and assessment of recovery after spinal cord injury , 2004, Spinal Cord.

[6]  Józef Opara,et al.  Walking index for spinal cord injury. , 2007, Ortopedia, traumatologia, rehabilitacja.

[7]  B. Dobkin,et al.  Comparison of Speeds Used for the 15.2-Meter and 6-Minute Walks Over the Year After an Incomplete Spinal Cord Injury: The SCILT Trial , 2007, Neurorehabilitation and neural repair.

[8]  Heleen Beckerman,et al.  Smallest real difference, a link between reproducibility and responsiveness , 2001, Quality of Life Research.

[9]  P. London.  Injury , 1969, Definitions.

[10]  V. Dietz,et al.  Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial. , 2005, Archives of physical medicine and rehabilitation.

[11]  Volker Dietz,et al.  Assessment of Walking Speed and Distance in Subjects With an Incomplete Spinal Cord Injury , 2007, Neurorehabilitation and neural repair.

[12]  H Barbeau,et al.  Walking index for spinal cord injury (WISCI): an international multicenter validity and reliability study , 2000, Spinal Cord.

[13]  H Ring,et al.  The Catz-Itzkovich SCIM: a revised version of the Spinal Cord Independence Measure. , 2001, Disability and rehabilitation.

[14]  R. Marino,et al.  The assessment of walking capacity using the walking index for spinal cord injury: self-selected versus maximal levels. , 2007, Archives of physical medicine and rehabilitation.

[15]  R Marino,et al.  Validation of the walking index for spinal cord injury in a US and European clinical population , 2008, Spinal Cord.

[16]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[17]  J. Fawcett,et al.  Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures , 2007, Spinal Cord.

[18]  J. Steeves,et al.  Outcome measures in spinal cord injury: recent assessments and recommendations for future directions , 2009, Spinal Cord.

[19]  Gary Dudley,et al.  Methods for a Randomized Trial of Weight-Supported Treadmill Training Versus Conventional Training for Walking During Inpatient Rehabilitation after Incomplete Traumatic Spinal Cord Injury , 2003, Neurorehabilitation and neural repair.

[20]  Volker Dietz,et al.  Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. , 2005, Archives of physical medicine and rehabilitation.

[21]  V. Dietz,et al.  Standardized assessment of walking capacity after spinal cord injury: the European network approach , 2008, Neurological research.