Convergent validity and responsiveness of The Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury

Mohammad Alavinia; Farnoosh Farahani; Kristin Musselman; Kristina Plourde; Maryam Omidvar; Molly C Verrier; Saina Aliabadi; B Catharine Craven

doi:10.3389/fneur.2023.1280225

Convergent validity and responsiveness of The Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury

Front Neurol. 2024 Jan 23:14:1280225. doi: 10.3389/fneur.2023.1280225. eCollection 2023.

Authors

Mohammad Alavinia¹, Farnoosh Farahani¹, Kristin Musselman^{2

3}, Kristina Plourde^{2

4}, Maryam Omidvar¹, Molly C Verrier^{1

2

5}, Saina Aliabadi^{1

6}, B Catharine Craven^{1

7

8}

Affiliations

¹ The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
² Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
⁵ Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁶ School of Graduate Studies, University of Toronto, Toronto, ON, Canada.
⁷ Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract

Aim: This study aimed to (1) describe the use of the Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury or disease (NT-SCI/D); (2) evaluate the convergent validity of SWAT for use among inpatients with NT-SCI/D; (3) describe SWAT responsiveness; and (4) explore the relationship between hours of walking therapy and SWAT change.

Methods: A quality improvement project was conducted at the University Health Network between 2019 and 2022. Participants' demographics and impairments data, rehabilitation length of stay, and FIM scores were obtained from the National Rehabilitation Reporting System. The walking measure data were collected by therapists as part of routine practice. Hours of part- or whole-gait practice were abstracted from medical records. To determine convergent validity, Spearman's correlation coefficients were calculated between SWAT stages (admission and discharge) and the walking measures. The change in SWAT levels was calculated to determine responsiveness. Spearman's correlation coefficient was calculated between SWAT change and hours of walking therapy.

Results: Among adult NT-SCI/D participants with potential walking capacity (SWAT≥1B), the majority were classified as American Spinal Injury Association (ASIA) Impairment Scale D (AIS D) at admission. The SWAT category of 1C (N = 100, 18%) was the most frequent at admission. The most frequent SWAT stage at discharge was 3C among participants with NT-SCI/D, with positive conversions in SWAT stages from admission to discharge (N = 276, 33%). The mean change in SWAT score was 3 for participants with T-SCI and NT-SCI/D. Moderate correlations between SWAT stages and walking measures were observed. The correlation of hours of gait therapy with the SWAT change (admission to discharge) was 0.44 (p < 0001).

Conclusion: The SWAT has sufficient convergent validity and responsiveness for describing standing and walking recovery and communicating/monitoring rehabilitation progress among patients with NT-SCI/D.

Keywords: outcome assessment; psychometric properties; spinal cord injuries; walking; walking speed.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the Ontario Neurotrauma Foundation (Grant ID# 2019-RHI-SITE1-1065), the Ministry of Health (Grant ID# 719B), the Praxis Spinal Cord Institute (Grant ID# G2021-48), the Praxis Spinal Cord Institute (Grant ID# G2023-24), and the UHN Foundation. BC acknowledges support from the UHN Foundation as the University of Toronto/ Toronto Rehabilitation Institute Chair in Spinal Cord Injury Rehabilitation Research. KM acknowledges funding from CIHR as a CRC 2 Chair in Multi-morbidity and Complex Rehabilitation.