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Interrater reliability of the Standing and Walking Assessment Tool for spinal cord injury

Spinal Cord volume 61, pages 556–561 (2023)Cite this article

Subjects

Abstract

Study design

Psychometric study.

Objectives

The Standing and Walking Assessment Tool (SWAT) is a standardized approach to the evaluation of standing and walking capacity following traumatic spinal cord injury (tSCI) in Canada. The SWAT classifies individuals with a tSCI into 12 stages of standing and walking capacity that are paired with well-established outcome measures, such as the Berg Balance Scale and 10-m Walk Test. Prior research has demonstrated the validity and responsiveness of the SWAT stages; however, the reliability remains unknown. The objective of this study was to evaluate the interrater reliability of the SWAT stages.

Setting

Inpatient units of two Canadian rehabilitation hospitals.

Methods

Adults with sub-acute tSCI were recruited. SWAT stage was evaluated for each participant by two physical therapists separately. The two therapists aimed to complete the evaluations within one day of each other. To evaluate interrater reliability, the percentage agreement between the SWAT stages rated by the two physical therapists was calculated, along with a linear weighted kappa statistic with a 95% CI.

Results

Forty-five individuals with sub-acute tSCI (36 males, 9 females, mean (SD) age of 54.8 (17.9) years) participated. The percentage agreement in SWAT stages between the two physical therapists was 75.6%. A kappa statistic of 0.93 with a 95% CI, 0.81–1.05 was obtained. In cases where therapists disagreed (18% of participants), therapists differed by 1–2 stages only.

Conclusions

The SWAT stages have high interrater reliability, providing further support for the use of the SWAT in rehabilitation practice in Canada.

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Fig. 1: The Standing and Walking Assessment Tool (SWAT).
Fig. 2: The distribution of SWAT stages across participants.
Fig. 3: Comparison of SWAT stages between physical therapists.

Data availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

Thank you to the physical therapists who participated as assessors: Chelsea Wong, Gillian Johnston, Marissa Constand, Marianne Cossette-Levasseur, Daniel Badra, Andrea Moreau, Catherine Dansereau, Josée Jubinville, Philippe Ménard, and Christiane Garneau.

Funding

This study was funded by the Praxis Spinal Cord Institute.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Sara Ngan & Kristin E. Musselman

  2. School of Physical and Occupational Therapy, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada

    Jean-François Lemay

  3. Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada

    Jean-François Lemay & Dany H. Gagnon

  4. KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada

    Katherine Chan & Kristin E. Musselman

  5. Praxis Spinal Cord Institute, Vancouver, BC, Canada

    Kristen Walden

  6. Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Montréal, QC, Canada

    Dany H. Gagnon

  7. Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Kristin E. Musselman

Authors
  1. Sara Ngan
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  2. Jean-François Lemay
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  3. Katherine Chan
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  4. Kristen Walden
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  5. Dany H. Gagnon
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  6. Kristin E. Musselman
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Contributions

KEM, KW, JFL and DHG conceptualized the study. KC and JFL were responsible for data collection. KC, SN and KEM analyzed the data. SN and KEM wrote the manuscript. KC, KW, JFL and DHG reviewed and provided edits to the manuscript.

Corresponding author

Correspondence to Kristin E. Musselman.

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Competing interests

The authors declare no competing interests.

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We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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Ngan, S., Lemay, JF., Chan, K. et al. Interrater reliability of the Standing and Walking Assessment Tool for spinal cord injury. Spinal Cord 61, 556–561 (2023). https://doi.org/10.1038/s41393-023-00921-2

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