The Perspectives of Individuals with Incomplete Spinal Cord Injury on the Tools Used to Measure the Intensity of Balance Challenge During Reactive Balance Training

Research Objectives: To explore the perspectives of individuals with incomplete spinal cord injury (iSCI) on the tools used to measure the intensity of balance challenge during reactive balance training (RBT) and contribute to the development of enhanced scales that offer more valid and meaningful measurements of balance intensity.

Design: A qualitative exploratory study.

Setting: SCI rehabilitation centre.

Participants: Ten individuals (8 Male, 2 Female, 69.9 ± 12.2 years old) with iSCI who were receiving RBT for impaired reactive stepping ability.

Interventions: Participants were asked to rate the intensity of balance challenge for each exercise practiced during 6 weeks of RBT. Balance intensity was assessed using an 11-point scale, where a score above 7 indicated adequate challenge. Participants were asked to elaborate on factors influencing their difficulty ratings and a researcher recorded these responses as field notes. After completing at least 10 training sessions, participants completed a semi-structured interview with a researcher. Participants were asked open-ended questions related to their definitions of balance challenge and factors affecting their ratings on the 11-point scale. The Balance Intensity Scale (BIS) was introduced to gather opinions on an alternative scale.

Main Outcome Measures: Audio recordings of the interviews were transcribed verbatim. An inductive thematic analysis was applied to the field notes and interview transcripts by two researchers.

Results: Three themes emerged: 1) Ambiguity of the 11-point Scale: While participants generally found the 11-point scale helpful in assessing their performance, many were uncertain about the specific meaning of each number on the scale due to the lack of accompanying descriptions. 2) Preference for a Shorter Rating Scale: Participants expressed a preference for a rating scale that is concise and efficient, citing concerns about the time-consuming nature of scales and the potential for missing valuable training time if assessments are too time-intensive. 3) Influence of Task Familiarity on Perceived Challenge: Participants indicated that unfamiliar tasks tended to be more challenging in terms of balance, highlighting the role of task novelty in shaping their perception of difficulty.

Conclusions: Participants’ perspectives on the use of balance measurement tools shed light on the complexity of assessing balance intensity. The findings suggest the 11-point scale could be modified to reduce ambiguity; for example, by adding written descriptors to each numerical rating that address the level of task familiarity associated with each intensity level. Ongoing advancements in measurement tools to assess balance intensity are essential for optimizing the rehabilitation process across diverse clinical populations, specifically SCI.

Author(s) Disclosures: None.