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Core Practice Principles: A Mixed Methods Approach to Determine What Drives the Use of Seated Trunk Control Assessments in Spinal Cord Injury Clinical and Research Practice

Year: 2026

Type: article

Abstract: OBJECTIVE: To examine current practices in assessing seated trunk control (STC) after spinal cord injury (SCI), a key factor in rehabilitation outcomes and independence. Enablers and barriers to uptake of assessment tools in practice were identified using the Theoretical Domains Framework and mapped to the Capability-Opportunity-Motivation for Behavior Change model. DESIGN: Explanatory sequential mixed methods design using a survey of assessment tools used, followed by focus groups and interviews to triangulate survey responses, understand factors driving uptake, and identify ideal assessment characteristics. SETTING: Leading SCI institutions in the United States. PARTICIPANTS: US-based clinicians and clinical researchers experienced in SCI rehabilitation. (Survey: n= 67; Focus Groups and Interviews: n= 66) INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Survey of commonly used assessment tools. RESULTS: The survey showed that 72% of 67 respondents used STC assessments, most frequently the Berg Balance Scale, whereas qualitative findings highlighted the Function in Sitting Test for SCI and observation as key assessments of STC. Analysis using the Theoretical Domains Framework and Capability-Opportunity-Motivation for Behavior Change identified barriers relating to Opportunity to use STC assessments: including limited evidence, absence of standardized guidelines, funding constraints, and insurance limitations. Capability-related facilitators to the use of assessments were practitioner knowledge and practical skills, whereas Motivation-related drivers were clinical relevance and sensitivity to change of assessments. CONCLUSIONS: In SCI rehabilitation in the US health care context, trunk control assessment is considered essential, although systemic and evidentiary challenges limit its integration. These findings underscore the need for codeveloped guidelines and further research to demonstrate the robustness of assessments in monitoring progress, fall risk, and activity independence.

Source: Archives of Physical Medicine and Rehabilitation

DOI: 10.1016/j.apmr.2026.03.017

Authors: Anne E. Palermo, Edward Gorgon, Riley Nicholson, Keith McNaughton, Georgia Fisher

Institutions: UNSW Sydney, Neuroscience Research Australia, The University of Sydney, Macquarie University

Language: English

Topic: Spinal Cord Injury Research

Subfield: Pathology and Forensic Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,000