Measurement Characteristics and Clinical Utility of the Walking Index for Spinal Cord Injury

      Patients, clinicians, and researchers all aim to maximize recovery of walking after a spinal cord injury (SCI).1 To demonstrate improvement in walking ability, professionals need a reliable, valid, and responsive scale to measure progress. The Walking Index for Spinal Cord Injury (WISCI, revised to WISCI II2) is a scale developed by experts specifically for the SCI population to assess walking ability.3 It is an ordinal scale considering the amount of assist, assistive devices, and braces required to walk 10m, where 0 is unable to walk and 20 is able to walk 10m with no devices, braces, or assist.2,3 The WISCI II has excellent clinical utility and psychometrics, including data indicating a change in one level is considered a real difference.3-6 In individuals with higher walking ability, and further postinjury, the WISCI II is less sensitive to change than timed walking tests, and can potentially have a ceiling effect.7,8 However, the WISCI II is a valued complement to the timed tests. Collecting WISCI II scores, along with timed tests, can be helpful in identifying ways in which a person has improved walking, due to a decrease or change in assist and devices, or due to velocity changes.7
      A full review of the WISCI II and reviews of nearly 200 other instruments can be found at
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      • 1.
        Ditunno PL, Patrick M, Stineman M, Ditunno JF. Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study. Spinal Cord 2008;46:500-6.
      • 2.
        Dittuno PL, Ditunno JF Jr. Walking Index for Spinal Cord Injury (WISCI II): scale revision. Spinal Cord 2001;39:654-6.
      • 3.
        Ditunno JF Jr, Ditunno PL, Graziani V, et al. Walking Index for Spinal Cord Injury (WISCI): an international multicenter validity and reliability study. Spinal Cord 2000;38:234-43.
      • 4.
        Burns AS, Delparte JJ, Patrick M, Marino RJ, Ditunno JF. The reproducibility and convergent validity of the Walking Index for Spinal Cord Injury (WISCI) in chronic spinal cord injury. Neurorehabil Neural Repair 2011;25:149-57.
      • 5.
        Marino RJ, Scivoletto G, Patrick M, et al. Walking Index for Spinal Cord Injury version 2 (WISCI-II) with repeatability of the 10-m walk time: inter- and intrarater reliabilities. Am J Phys Med Rehabil 2010;89:7-15.
      • 6.
        van Hedel HJ, Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. Arch Phys Med Rehabil 2005;86:190-6.
      • 7.
        Kim MO, Burns AS, Ditunno JF Jr, Marino RJ. The assessment of walking capacity using the Walking Index for Spinal Cord Injury: self-selected versus maximal levels. Arch Phys Med Rehabil 2007;88:762-7.
      • 8.
        van Hedel HJ, Wirz M, Curt A. Improving walking assessment in subjects with an incomplete spinal cord injury: responsiveness. Spinal Cord 2006;44:352-6.
      This instrument summary is designed to facilitate the selection of outcome measures by trained clinicians. The information contained in this summary represents a sample of the peer-reviewed research available at the time of this summary's publication. The information contained in this summary does not constitute an endorsement of this instrument for clinical practice. The views expressed are those of the summary authors and do not represent those of authors' employers, instrument owner(s), the Archives of Physical Medicine and Rehabilitation, the Rehabilitation Measures Database, the United States Department of Education, or the Retirement Research Foundation. The information contained in this summary has not been reviewed externally.
      The Rehabilitation Measures Database and Instrument Summary Tear-sheets are funded by the National Institute on Disability and Rehabilitation Research, United States Department of Education through the Rehabilitation Research and Training Center on Improving Measurement of Medical Rehabilitation Outcomes (grant no. H133B09OO24) and the Retirement Research Foundation (grant no. 2011-027).