A systematic review of functional ambulation outcome measures in spinal cord injury

Abstract

Study design: Systematic review. Objectives: To systematically review the psychometric properties of outcome measures used to assess ambulation in people with spinal cord injury (SCI). Setting: Vancouver, BC, Canada. Methods: A keyword literature search of original articles that evaluated the psychometric properties of ambulation outcome measures in the SCI population was conducted using multiple databases. Multidimensional scales of function were included if specific data were available on ambulation-related subscales. Reliability, validity and responsiveness values were extracted and conclusions drawn about the psychometric quality of each measure. Results: Seven outcome measures were identified and were broadly categorized into timed and categorical measures of ambulation. Timed measures included timed walking tests that showed excellent reliability, construct validity and responsiveness to change. The psychometric properties of the categorical scales were more variable, but those that were developed specifically for the SCI population had excellent reliability and validity. Categorical scales also exhibited some floor or ceiling effects. Conclusion: Excellent tools are available for measuring functional ambulation capacity. Further work is required to develop and evaluate outcome measures to include environmental factors that contribute to the ability to achieve safe, functional ambulation in everyday settings. Sponsorship: Rick Hansen Man-in-Motion Foundation and Ontario Neurotrauma Fund. © 2008 International Spinal Cord Society All rights reserved.