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Peer-reviewedCC BY 4.0Spinal Cord

Reliability, validity, and responsiveness of three seated trunk control assessments used during inpatient spinal cord injury rehabilitation

  • Anne E. Palermo1,2,3,4
  • Sophie Denis5
  • Edward J. Gorgon4,6
  • Rachel J. Spillane1,2
  • Lynn V. Blecher5
  • Fernanda Di Natal5
  • Claire L. Boswell-Ruys1,2,4,5
6 affiliations
  1. 1Neuroscience Research Australia, Sydney, Australia
  2. 2University of New South Wales, Sydney, Australia
  3. 3University of Miami, Miami, USA
  4. 4Kolling Insitute and School of Medical Sciences, The University of Sydney, Sydney, Australia
  5. 5Prince of Wales Hospital, Sydney, Australia
  6. 6Department of Physical Therapy, College of Allied Medical Professions, University of the Philippines Manila, Manila, Philippines
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Abstract

Study design: Cohort study.

Objectives: To investigate the reliability, validity, and responsiveness of the Trunk Control Test (TCT) and two Function in Sitting Tests (FIST) for people with a spinal cord injury (SCI; FIST-SCI and Modified-FIST (mFIST)) during inpatient rehabilitation.

Setting: Inpatient Rehabilitation Hospital in Sydney, Australia.

Methods: Thirty adults with recent (SCI) completed four assessments led by three raters within two weeks to determine inter-rater and intra-rater reliability. Validity was determined through known-groups and Spearman Correlation analyses with the Berg Balance Scale (BBS), Spinal Cord Independence Measure, Maximal Balance Range Test, and SCI-Falls Concern Scale. Six-week follow-up responsiveness assessments and global rating of change scale (GRCS) scores were completed.

Results: Neurological level of injury ranged from C4 to L2 (80% motor-incomplete SCI). Time since injury was 84 days (95% CI:64,105). The TCT and FIST-SCI had excellent reliability (ICC > 0.9). The mFIST had excellent intra-rater (ICC = 0.908) and good inter-rater reliability (ICC = 0.867). All three tests differentiated between participants who were independent and required assistance with transfers (p < 0.05). All three tests correlated with the BBS (ρTCT = 0.627, ρSCI-FIST = 0.785, ρmFIST = 0.823) (p < 0.05). Median (IQR) change scores were 2 (0, 4) (TCT), 3 (0, 6) (FIST-SCI), and 3 (0,11) (mFIST). Participants reported a GRCS improvement (45%), no change (50%), or a decline (5%) in their seated trunk control during usual care. Attrition limited responsiveness analyses.

Conclusions: The TCT, FIST-SCI, and mFIST are reliable and valid seated trunk control tests in SCI early inpatient rehabilitation. Future studies should investigate responsiveness in people with motor-complete SCI.

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Cite

BibTeXRIS
BibTeX
@article{palermo2026reliability,
  title = {{Reliability, validity, and responsiveness of three seated trunk control assessments used during inpatient spinal cord injury rehabilitation}},
  author = {Anne E. Palermo and Sophie Denis and Edward J. Gorgon and Rachel J. Spillane and Lynn V. Blecher and Fernanda Di Natal and Claire L. Boswell-Ruys},
  journal = {Spinal Cord},
  year = {2026},
  month = sep,
  doi = {10.1038/s41393-026-01272-4},
  url = {https://doi.org/10.1038/s41393-026-01272-4},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Reliability, validity, and responsiveness of three seated trunk control assessments used during inpatient spinal cord injury rehabilitation
AU  - Anne E. Palermo
AU  - Sophie Denis
AU  - Edward J. Gorgon
AU  - Rachel J. Spillane
AU  - Lynn V. Blecher
AU  - Fernanda Di Natal
AU  - Claire L. Boswell-Ruys
PY  - 2026
DA  - 2026/09/25
JO  - Spinal Cord
DO  - 10.1038/s41393-026-01272-4
UR  - https://doi.org/10.1038/s41393-026-01272-4
AB  - Study design: Cohort study.  Objectives: To investigate the reliability, validity, and responsiveness of the Trunk Control Test (TCT) and two Function in Sitting Tests (FIST) for people with a spinal cord injury (SCI; FIST-SCI and Modified-FIST (mFIST)) during inpatient rehabilitation.  Setting: Inpatient Rehabilitation Hospital in Sydney, Australia.  Methods: Thirty adults with recent (SCI) completed four assessments led by three raters within two weeks to determine inter-rater and intra-rater reliability. Validity was determined through known-groups and Spearman Correlation analyses with the Berg Balance Scale (BBS), Spinal Cord Independence Measure, Maximal Balance Range Test, and SCI-Falls Concern Scale. Six-week follow-up responsiveness assessments and global rating of change scale (GRCS) scores were completed.  Results: Neurological level of injury ranged from C4 to L2 (80% motor-incomplete SCI). Time since injury was 84 days (95% CI:64,105). The TCT and FIST-SCI had excellent reliability (ICC > 0.9). The mFIST had excellent intra-rater (ICC = 0.908) and good inter-rater reliability (ICC = 0.867). All three tests differentiated between participants who were independent and required assistance with transfers (p < 0.05). All three tests correlated with the BBS (ρTCT = 0.627, ρSCI-FIST = 0.785, ρmFIST = 0.823) (p < 0.05). Median (IQR) change scores were 2 (0, 4) (TCT), 3 (0, 6) (FIST-SCI), and 3 (0,11) (mFIST). Participants reported a GRCS improvement (45%), no change (50%), or a decline (5%) in their seated trunk control during usual care. Attrition limited responsiveness analyses.  Conclusions: The TCT, FIST-SCI, and mFIST are reliable and valid seated trunk control tests in SCI early inpatient rehabilitation. Future studies should investigate responsiveness in people with motor-complete SCI.
SN  - 1362-4393
SN  - 1476-5624
ER  -