Using the unbiased perspectives of people living with a SCI in assessments of mobility

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By Lynda Bennett

Original article: H Booth, LA Harvey, S Denis, D Barratt, GT Allison and RD Adams. “Using the unbiased perspectives of people living with a spinal cord injury in assessments of mobility” Spinal Cord (2013) 51, 843–846; doi:10.1038/sc.2013.100; published online 17 September 2013. Click here for the original article.


What if you were shown two videos that captured a person with a Spinal Cord Injury (SCI) performing the same action months apart? If you were asked to assess whether there were any differences in performance, would you be able to make a good evaluation? If you are a person with SCI your assessment is probably close to a trained professional’s!

The purpose of this study was to explore the potential of involving people with a SCI to rate change in mobility from videos. Could people with a recent or stable SCI reliably rate change in motor performance of their peers? How would those results compare with those of physiotherapists?

In this study, each participant watched two videos of the same individual (with a recent SCI) and used the Global Impression of Change Scale (GICS) to assess the change in mobility of the individuals in the videos, i.e. the change in their ability to transfer and walk. Some of the participants rating these changes were people with SCI and some were trained physiotherapists. The ratings made by each group were compared.

Most important finding

Participants with a SCI could reliably rate change in their SCI peers’ abilities to transfer and walk. Physiotherapists were only marginally more reliable at making the same rating. There was no difference between people with recent SCI and those with established SCI.

The study also found that participants with SCI captured changes that people with a SCI would consider meaningful. The trained professionals tended to forget how much they or their patients changed over time, and were also biased by their experience and expectations.

Things to consider

Most assessments of mobility for people with SCI rely on standardised measures, devised and used by health-care professionals. However, these measures of mobility may not reflect the priorities of people living with SCI. Although the physiotherapists were able to provide slightly more reliable ratings, those findings may not be as directly meaningful to people with SCI.

What does this mean for people with SCI?

The results of this study did not provide enough data to justify the widespread use of the GICS by people with SCI in clinical trials. There are still many issues to be resolved and investigated. The study does, however, for the first time provide details about a promising methodology for better capturing the perspectives of people with a SCI for mobility-related clinical trials.