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Physical Activity Recall Assessment for People with Spinal Cord Injury

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Manual for the Administration of the PARA-SCI in Spanish

Purpose

The PARA-SCI was developed to measure physical activity (type, frequency, intensity, duration) in individuals with either paraplegia or tetraplegia who use a wheelchair for primary means of mobility.  Instrument was developed as there was a gap for measuring this type of data in people with SCI;  many of the general measures of physical activity for SCI have items that are not applicable and, generally do not measure intensity for people with disabilities.

Link to Instrument

Acronym PARA-SCI

Area of Assessment

Activities of Daily Living

Assessment Type

Patient Reported Outcomes

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Spinal Injuries

Key Descriptions

  • The PARA-SCI is a self-reported measure, conducted via interview, designed to capture information about leisure time activity, lifestyle activity (activities part of a daily routine), and the combination of the two over a 3 day period.
  • Participants are questioned about their activities in 8 different categories, 2 of which have 5 sub categories.
  • Individuals are asked about their activity over the previous 3 days, starting with prior day. Activity is broken down into 8 periods:
    1) Morning routine (subdivided into transferring, bowel and bladder management, bathing, personal hygiene, dressing)
    2) Breakfast
    3) Morning
    4) Lunch
    5) Afternoon
    6) Dinner
    7) Evening
    8) Evening Routine (subdivided into transferring, bowel and bladder management, bathing, personal hygiene, dressing)
  • Interviewer uses a flow chart to ask questions and follow up questions based on yes/no responses.
  • Interviewer records number of minutes of activity and codes the activity as leisure or lifestyle. Participants rank activity’s intensity as mild, moderate, heavy, or nothing based on the instrument's classification system (see Martin Ginis, 2005).
  • Number of minutes is recorded for activities in each category:
    1) mild
    2) moderate
    3) heavy
    4) nothing at all

Time to Administer

20-30 minutes

Average of 20-30 minutes for individual to complete, plus instruction time from the tester to review instrument and intensity definitions (Martin Ginis 2005).

Required Training

Training Course

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Intially reviewed by Jennifer H. Kahn, PT, DPT, NCS, Candy Tefertiller, PT, DPT, ATP, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 4/2012.

ICF Domain

Activity
Participation

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

NR

LS

LS

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

LS

LS

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

No

Not reported

Considerations

  • The PARA-SCI has good construct validity when evaluated using other measures of physical activity, particularly the day-long measure of oxygen consumption (see data under "Criterion Validity").

  • There was good evidence of validity and reliability for the total activity and leisure-time physical activity sub-scales. However, the lifestyle activity subscale could not be validated and the authors do not recommend its use as a standalone measure.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Spinal Injuries

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Standard Error of Measurement (SEM)

Chronic SCI:

(calculated from Martin Ginis 2005)

 

PARA-SCI measure and Intensity Level

SEM

Cumulative - Total

64.95

Cumulative - Mild

63.37

Cumulative - Moderate

36.30

Cumulative - Heavy

13.59

Leisure Time Activity - Total

31.75

Leisure Time Activity - Mild

15.31

Leisure Time Activity - Moderate

24.72

Leisure Time Activity - Heavy

8.49

Lifestyle Activity - Total

65.10

Lifestyle Activity - Mild

54.06

Lifestyle Activity - Moderate

29.66

Lifestyle Activity - Heavy

9.77

 

Normative Data

Chronic SCI:

(Martin Ginis 2005, n = 102, combination of: paraplegia, tetraplegia, complete, incomplete SCI)

 

PARA-SCI measure and Intensity Level

Mean (SD) in minutes of PARA-SCI results

Cumulative - Total

184.1 (141.2)

Cumulative - Mild

113.3 (107.4)

Cumulative - Moderate

66.1 (72.6)

Cumulative - Heavy

19 (30.5)

Leisure Time Activity - Total

45.3 (59.9)

Leisure Time Activity - Mild

13.5 (25.1)

Leisure Time Activity - Moderate

20.2 (33.4)

Leisure Time Activity - Heavy

11.7 (28.3)

Lifestyle Activity - Total

138.8 (138.5)

Lifestyle Activity - Mild

85.6 (93.2)

Lifestyle Activity - Moderate

45.9 (65.9)

Lifestyle Activity - Heavy

7.3 (14.8)

Test/Retest Reliability

Chronic SCI:

(Martin Ginis 2005)

 

PARA-SCI measure and Intensity Level

ICC*

Cumulative - Total

0.79

Cumulative - Mild

0.65

Cumulative - Moderate

0.75

Cumulative - Heavy

0.80

Leisure Time Activity - Total

0.72

Leisure Time Activity - Mild

0.63

Leisure Time Activity - Moderate

0.45

Leisure Time Activity - Heavy

0.91

Lifestyle Activity - Total

0.78

Lifestyle Activity - Mild

0.66

Lifestyle Activity - Moderate

0.80

Lifestyle Activity - Heavy

0.56**

 

* Authors note that these values are superior to other test-retest reliability data in other known measures of physical activity (PAR-7, CLTEQ, CARDIA)

 

**64% and 63% of participants did not report heavy activity at test 1 and test 2 respectively

Criterion Validity (Predictive/Concurrent)

Chronic SCI:

(Martin Ginis 2005, n = 9, combination of paraplegia (7), tetraplegia(2), complete, incomplete SCI)

  • Used portable VO2, collected for 7 hours during a single day, as feasible gold standard. Unable to differentiate between leisure and lifestyle activity; therefore, only cumulative score used for validity testing.

PARA-SCI measure (cumulative)

r value

Mild intensity

Poor (0.27)

Moderate intensity

Excellent (0.63*)

Heavy Intensity

Excellent (0.88**)

Total

Excellent (0.79**)

* p < 0.05, ** p < 0.01

 

 

Construct Validity

Convergent Validity

 

Chronic SCI:

(Latimer 2006, n = 73, combination of: paraplegia, tetraplegia, complete, incomplete SCI)

PARA-SCI correlations with Muscle Strength via 1 rep max

 

 

 

 

PARA-SCI measure

R biceps

L biceps

R chest

L chest

Cumulative – Mild

0.11

0.18

0.08

0.16

Cumulative - Moderate

0.01

0.00

0.06

0.08

Cumulative - Heavy

0.36**

Adequate

0.23*

Poor

0.08

0.10

Cumulative - Total

0.12

0.15

0.09

0.16

Leisure Time Activity - Mild

0.16

.015

0.01

0.03

Leisure Time Activity - Moderate

0.21* Poor

0.28*

Poor

0.10

0.23*

Poor

Leisure Time Activity - Heavy

0.18

0.22*

Poor

0.16

0.20

Leisure Time Activity - Total

0.25*

0.30**

Poor

0.11

0.19

Lifestyle Activity -Mild

0.09

0.16

0.08

0.16

Lifestyle Activity -Moderate

-0.04

-0.07

0.04

0.02

Lifestyle Activity -Heavy

0.31**

Adequate

0.14

-0.03

-0.03

Lifestyle Activity –Total

0.07

0.10

0.08

0.13

* p < 0.05, ** p < 0.01
R= right, L=left

 

 

 

 

 

PARA-SCI correlations with Aerobic Fitness

 

 

PARA-SCI measure

VO2 peak

(ml*kg -1 * min-1)

Workload (W)

Cumulative - Mild

0.06

0.02

Cumulative - Moderate

0.26*

Poor

0.22

Cumulative - Heavy

0.33**

Adequate

0.34**

Adequate

Cumulative - Total

0.21

0.16

Leisure Time Activity - Mild

-0.09

0.12

Leisure Time Activity - Moderate

0.16

0.29*

Poor

Leisure Time Activity - Heavy

0.35**

Adequate

0.33**

Adequate

Leisure Time Activity - Total

0.18

0.34**

Adequate

Lifestyle Activity -Mild

0.08

0.00

Lifestyle Activity -Moderate

0.23

0.15

Lifestyle Activity -Heavy

0.11

0.15

Lifestyle Activity –Total

0.19

0.09

* p < 0.05, ** p < 0.01

 

 

 

Discriminant Validity

Chronic SCI:

(Latimer 2006)

  • Investigated “extreme group” comparisons to determine if PARA-SCI could show a difference between individuals with SCI who have different levels of physical activity.
    • Demographics – age, sex, employment status
    • Disability- lesion level, complete/incomplete, means of mobility
    • Behavioral characteristics – gym membership, team, participation frequency as high or low
  • Significant results only in the following categories:
    o Leisure Time Activity
    • younger subjects participated in greater amounts of moderate intensity activity than older individuals
    • total activity was greater in men and younger individuals compared to women and older participants
    • those who belong to a gym or team reported more moderate and heavy intensity as well as more total activity
  • Lifestyle Activity
    • Going to school or working showed greater mild intensity than not
  • Cumulative
    • Greater heavy intensity in those who belong to a gym or team

Content Validity

Chronic SCI:

(Martin Ginis 2005, n = 28)

  • Interview protocol and flow charts developed and refined by individuals with SCI (n = 8, n = 12), SCI rehabilitation specialists (n = 7), parent of individual with SCI (n = 1)
  • Final review by individuals with SCI who agreed content was valid for assessing physical activity in people with SCI

Face Validity

Chronic SCI:

(Martin Ginis 2005, n = 26, combination of: paraplegia, tetraplegia, complete, incomplete SCI)

  • Individuals with SCI completed pilot testing of PARA-SCI and reported instrument was appropriate for assessing physical activity performed by individuals with SCI

Floor/Ceiling Effects

Chronic SCI:

(Martin Ginis 2005, n = 102, combination of: paraplegia, tetraplegia, complete, incomplete SCI)

  • In this sample, for cumulative heavy category, 64% and 63% of participants did not report heavy activity at test 1 and test 2 respectively, yielding a floor effect for this activity category

Bibliography

Ginis, K. A., Latimer, A. E., et al. (2005). "Development and evaluation of an activity measure for people with spinal cord injury." Medicine and Science in Sports and Exercise 37(7): 1099-1111.

Latimer, A. E., Ginis, K. A., et al. (2006). "The physical activity recall assessment for people with spinal cord injury: validity." Medicine and Science in Sports and Exercise 38(2): 208-216.

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