Walking index for spinal cord injury (WISCI): criterion validation

Abstract

Study design: Retrospective examination. Objectives: To compare the Walking Index for Spinal Cord Injury (WISCI) and current scales for their sensitivity to walking changes in subjects with a spinal cord lesion (SCL) and further validate the WISCI for use in clinical trails. Setting: A large rehabilitation hospital in the center of Italy. Patients and methods: Retrospective review was performed on 284 patient records with an SCL. Measurements included neurological evaluation with Lower Extremity Motor Scores (LEMS) according to the American Spinal Injury Association (ASIA) and walking status assessed by Barthel Index (BI (0-15)), Rivermead Mobility Index (RMI (three levels)), Functional Independence Measure (FIM (1-7)), Spinal Cord Independence Measure (SCIM (0-8)), and WISCI (0-20). The WISCI is a 21-level hierarchical scale which incorporates gradations of physical assistance and devices required for walking. Improvement in walking is based on the change of scores from admission to discharge. Statistical analysis included Spearman rank correlation and w 2 test; Po0.05. Results: There was a significant positive correlation between WISCI and other scales (WISCI and BI r ¼ 0.67, Po0.001; WISCI and RMI r ¼ 0.67, Po0.001; WISCI and SCIM r ¼ 0.97, Po0.001; WISCI and FIM r ¼ 0.7, Po0.001). The initial ASIA grade was predictive of mobility outcome on the WISCI: of the 78 ASIA A patients, only five achieved independent walking versus 4/17 ASIA B (P ¼ 0.02), 56/109 ASIA C (Po0.001) and 39/44 ASIA D (Po0.001). The correlation of LEMS to the WISCI was 0.58 (Po0.001). At discharge, patients were distributed into 12 WISCI levels versus four FIM, three BI, two RMI and five SCIM levels. The most frequent WISCI levels at discharge were 13 (walker, no braces or assistance), 16 (two crutches, no braces or assistance) and 20 (no devices or assistance). Conclusions: Similar correlation between the WISCI and the other scales indicates that all these measures address the same concept, mobility, which is a measure of concurrent validity. The correlation is not 100% because of conceptual differences (the WISCI incorporates gradations of physical assistance and devices required for walking while most of the other scales focus on burden of care or mobility in the environment). The WISCI is more detailed and appears more sensitive to walking recovery than the other scales, as demonstrated by our patients' score distribution at discharge. Within each of the most frequent WISCI levels (13,16,20) LEMS and other walking features varied; therefore the scale would benefit from further refinement based on speed, distance and energy cost.

Neoplastic myelopathies and traumatic spinal cord lesions: an Italian comparison of functional and neurological outcomes

“…Using criteria from previous studies, we recorded whether patients reached independence with regard to bowel management. 14 Finally, on the basis of the WISCI scale, we determined the number of patients who were able to walk without physical assistance at admission and discharge, 18 and patient destinations at discharge. 14 Because Italian health policy permits longer lengths of stay than other countries, our guidelines stipulate that patients should be discharged when they attain the maximum independence that is allowed by their lesion or when their BI and RMI scores plateau (that is, having the same scores at two evaluations 20-30 days apart).…”

Validation of the walking index for spinal cord injury in a US and European clinical population

“…It was subsequently compared to four other scales in a clinical population of mixed SCI and spinal cord lesions for demonstration of retrospective criterion validity (compared to other scales). 4 Recently, it was utilized in a multicenter randomized clinical trial, assessed by blinded observers, and showed high correlations with lower extremity motor score (LEMS), balance, walking speed, 6-min walk and locomotor FIM illustrating prospective criterion validity. 5 The prospective construct validity or validation of the theoretical formulation of monotonic function has not been published but preliminary results have been presented.…”

A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury

“…Thus the shortform QIF score correlated with the Upper Extremity Motor Score (r40.8); 32 the SCIM with the FIM (r40.8), 33,54 the WISCI (r ¼ 0.97) 38 and with the NAC (r ¼ 0.47-0.85). 40 Considerable evidence of convergent validity was presented for the WISCI: with the FIM (rX0.7), 36,38 the LEMS(r ¼ 0.47-0.91), 58 the Berg Balance Scale, 57 the BI and Rivermead mobility index (both r ¼ 0.67), 38 and the SCIM (r ¼ 0.97).…”

“…40 Considerable evidence of convergent validity was presented for the WISCI: with the FIM (rX0.7), 36,38 the LEMS(r ¼ 0.47-0.91), 58 the Berg Balance Scale, 57 the BI and Rivermead mobility index (both r ¼ 0.67), 38 and the SCIM (r ¼ 0.97). 38 The NAC correlated with the WISCI and the Hospital Anxiety and Depression Scale (HADS) (r ¼ 0.47-0.85); 40 the SCI-FAI with gait scores, walking speed (rX0.7) and the Lower Extremity Motor Score (LEMS) (r40.6) 25 ; and the SIP68 correlated with relevant domains of the SF-36 (rX0.57), ADL (somatic autonomy r ¼ 0.81), 46 and with the BI (r ¼ 0.54-0.91). 45 Responsiveness.…”

“…24 The original SCIM and SCIM version III were each found to be superior to the FIM 33,34,56 and the WISCI was possibly superior to the (Locomotor Functional Independence Measure) LFIM and SCIM 57 and had superior sensitivity to walking recovery than the BI, RMI, SCIM, LEMS or FIM. 38 Few studies used effect sizes and overall, evidence of responsiveness was generally quite weak. There was no evidence concerning the responsiveness of the MBI, the short-form QIF, the NAC, or the SIP68 in the SCI context.…”