Study design: Cross-sectional and longitudinal direct observation of a constrained consensus-building process in nine consumer panels and three rehabilitation professional panels. Objectives: To illustrate differences among consumer and clinician preferences for the restoration of walking function based on severity of injury, time of injury and age of the individual. Setting: Regional Spinal Cord Center in Philadelphia, USA. Methods: Twelve panels (consumer and clinical) came to independent consensus using the featuresresource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) at different stages of recovery. Results: Walking is given priority early in the game by eight out of nine consumer panels and by two out of three professional panels. The exception consumer panel (ISCIo50) moved walking later in the game, whereas the exception professional panel (rehRx) moved wheelchair early but walking much delayed. Bowel and Bladder was given primary importance in all panels. Conclusions: Walking is a high priority for recovery among consumers with spinal cord injury irrespective of severity of injury, time of injury and age at time of injury. Among professional staff, walking is also of high priority except in rehabilitation professionals.

Objective: To assess the intrarater and interrater reliability among rheumatologists of a standardised protocol for measurement of shoulder movements using a gravity inclinometer. Methods: After instruction, six rheumatologists independently assessed eight movements of the shoulder, including total and glenohumeral flexion, total and glenohumeral abduction, external rotation in neutral and in abduction, internal rotation in abduction and hand behind back, in random order in six patients with shoulder pain and stiffness according to a 6×6 Latin square design using a standardised protocol. These assessments were then repeated. Analysis of variance was used to partition total variability into components of variance in order to calculate intraclass correlation coefficients (ICCs). Results: The intrarater and interrater reliability of different shoulder movements varied widely. The movement of hand behind back and total shoulder flexion yielded the highest ICC scores for both intrarater reliability (0.91 and 0.83, respectively) and interrater reliability (0.80 and 0.72, respectively). Low ICC scores were found for the movements of glenohumeral abduction, external rotation in abduction, and internal rotation in abduction (intrarater ICCs 0.35, 0.43, and 0.32, respectively), and external rotation in neutral, external rotation in abduction, and internal rotation in abduction (interrater ICCs 0.29, 0.11, and 0.06, respectively). Conclusions: The measurement of shoulder movements using a standardised protocol by rheumatologists produced variable intrarater and interrater reliability. Reasonable reliability was obtained only for the movement of hand behind back and total shoulder flexion. Shoulder pain is common in the general population, its point prevalence averages between 7% and 51% and it is known to increase with age. Restricted range of motion and shoulder pain can interfere with activities in daily life and is associated with work absenteeism and use of medical services.1-5 Many patients receive some evaluation by a family doctor, rheumatologist, orthopaedic specialist, or physical therapist. 3A physical examination is often used for both diagnosis and evaluation of treatment success in patients with shoulder pain. One aspect of physical assessment of the shoulder is the evaluation of range of motion. No "gold standard" for the measurement of shoulder range of motion is yet available. Clinical trials that have assessed the efficacy of interventions for shoulder pain have commonly used range of motion of the shoulder as a measurement tool. 6 To be of value in clinical trials or routine care its reliability (that is, the repeated administration of an instrument to a stable population yielding the same results) should be established.Multiple methods for estimating shoulder range of motion have been used in the past, including visual estimation, the two armed goniometer, or a gravity referenced goniometer. [7][8][9][10][11][12][13][14][15][16] In many of these studies the methods are poorly described and most looked at...

Results suggest that the WISCI II should be a very useful outcome measure for detecting changes in walking function following chronic SCI.

Objective: To demonstrate the prospective construct validity of the walking index for spinal cord injury (WISCI) in US/European clinical population. Design: Prospective Cohort in Denmark, Germany, Italy and the USA. Participants/Method: Participants with acute complete/incomplete (ASIA Impairment Scale (AIS) A, B, C and D) traumatic spinal cord injuries were enrolled from four centers. Lower extremity motor scores (LEMS), WISCI level and Locomotor Functional Independence Measure (LFIM) levels were assessed with change in ambulatory status. WISCI progression was assessed for monotonic direction of improvement (MDI). LEMS were correlated to WISCI/LFIM. Use of walking aids/braces were analyzed.

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.