Original research| Volume 97, ISSUE 3, P437-444, March 2016

Construct Validity of the Trunk Impairment Classification System in Relation to Objective Measures of Trunk Impairment

Published:November 06, 2015DOI:



      To determine the validity of the Trunk Impairment Classification system (TIC) with 4 possible scores (0, most impaired; 0.5; 1.0; 1.5, least impaired) in relation to objective, instrumented measures of impairment.


      Cross-sectional design.


      National wheelchair rugby and basketball competitions of The Netherlands and Belgium.


      Volunteer sample of athletes (N=34) with a minimum of 1-year experience in their sport.


      Static sitting balance tasks on a stable and unstable surface; dynamic sitting balance tasks in anterior-posterior, left-right, and oblique directions; and trunk muscle strength tasks in forward, left, right, and backward directions.

      Main Outcome Measures

      Sway area of the center of pressure in static sitting balance, maximum excursion of center of pressure displacement in dynamic sitting balance, and maximum isometric force in trunk muscle strength.


      Athletes with TIC score 0 were not able to sit unsupported. The Kruskal-Wallis test showed a significant difference in trunk muscle strength (P<.001) and dynamic balance in the oblique direction forward to the left and backward to the right between the TIC scores (P=.012). Post hoc analysis showed a significant difference between TIC score 0 and the other TIC scores for trunk muscle strength in all directions. There was a significant difference between TIC score 1.5 on one hand and TIC scores 0.5 and 1.0 on the other hand for dynamic balance in the right oblique direction.


      The TIC is a valid scale for trunk impairment, which measures neuromusculoskeletal trunk impairment, independent of the health condition causing the impairment. Additional research is needed for coordination impairment and to assess whether TIC scores 0.5 and 1.0 should continue as separate scores.


      List of abbreviations:

      COP (center of pressure), ICC (intraclass correlation coefficient), ROM (range of movement), TIC (Trunk Impairment Classification system)
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