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The results from this study helped to understand fall circumstances among full-time wheelchair users with MS and SCI. Findings from this study can inform the development of evidenced-based interventions to improve the effectiveness of clinically based treatment protocols. Implications for rehabilitation Falls are a common health concern in full-time wheelchair users living with multiple sclerosis and spinal cord injury. The circumstances surrounding falls reported by full-time wheelchair users living with multiple sclerosis and spinal cord injuries were found to be multifactorial. The complex nature of falls must be taken into consideration in the development of fall prevention programs. Findings from this study can inform the development of comprehensive evidence-based, population-specific interventions to manage falls among full-time wheelchair users living with multiple sclerosis and spinal cord injury.

Context: Trunk impairment among non-ambulatory individuals with spinal cord injury (SCI) reduces the ability to maintain a functional sitting position and perform activities of daily living. Measuring functional sitting balance is complex and difficult in a clinical setting. The function in sitting test (FIST) is a clinical measure that includes the assessment of all the components of sitting balance. The purpose of this study is to assess the reliability and validity of the 14-item FIST among non-ambulatory individuals with SCI. Participants: Twenty-six individuals with chronic SCI. Outcome measures: Participants were evaluated with the FIST, the modified Functional Reach Test (lateral and forward mFRT) and a posturography assessment (virtual time to contact -VTC). The FIST was re-assessed during a second study visit 12 weeks later. Test-retest reliability was evaluated using intraclass coefficient correlation (ICC), the minimal detectable change (MDC) was calculated and the internal consistency reliability was assessed using Cronbach's coefficient-α. Concurrent validity of the FIST was also tested with the mFRT and the VTC. Results: Test-retest reliability was found to be excellent (ICC = 0.95) with a MDC of 4. The internal consistency was satisfactory (0.81). Moreover, the FIST correlates with the lateral mFRT (r = 0.64, P = 0.001) but not with the forward mFRT and the VTC. Conclusion: These observations provide evidence that the FIST is a reliable clinical measure with partially established validity for non-ambulatory individuals with SCI. Further studies are needed to strengthen the validity of the FIST and explore this measure in a larger sample.

Poor seated balance negatively impacts the performance of activities of daily living in nonambulatory individuals with multiple sclerosis (MS) and is frequently a target of rehabilitation interventions. However, there is a lack of clinical measures of seated balance in nonambulatory individuals with MS, thus limiting evaluation of rehabilitation treatments. The aim of this investigation is to determine the reliability and concurrent validity of the Function in Sitting Test (FIST) as a measure of sitting balance in nonambulatory individuals with MS. Twenty nonambulatory individuals with MS [mean age±SD=56.8±10.9 years, women n=15 (75%), mean MS duration±SD=17.8±9.2 years, mean wheelchair usage duration±SD=5.9±4.7 years] underwent a FIST and posturography assessment. The FIST is a 14-item clinical functional assessment of sitting balance validated in adults with acute stroke. The seated posturography assessment involved participants sitting on a force platform without support for 30 s. On the basis of the center of pressure trajectory obtained from the force platform software, two force platform outcomes were quantified: sway area (mm) of the center of pressure and virtual time to contact to the functional boundary (seconds). Internal consistency reliability was assessed using Cronbach's coefficient-α. The test-retest reliability was evaluated using the intraclass correlation coefficient (ICC). Concurrent validity of the FIST was assessed by Spearman's rank correlation analysis. Cronbach's-α as an index of internal consistency of the FIST was 0.91. The test-retest reliability was found to be excellent (ICC=0.92). The FIST was significantly correlated with virtual time to contact to the functional boundary (ρ=0.487, P=0.02), but not with sway area (ρ=-0.267, P=0.25). The observations provide evidence that the FIST is a reliable and valid tool to assess seated postural control in nonambulatory individuals with MS.

Proper transfer technique is associated with improved biomechanics and decreased pain and pathology. However, many users do not use proper technique, and appropriate assessment and training are needed to address these deficits. The transfer assessment instrument (TAI) 4.0 was designed to meet those needs and improve on past versions by removing the need for clinician training, shortening administration time, and simplifying question content. Evaluate the psychometric properties of the TAI 4.0. A convenience sample of full-time wheelchair users was scored on multiple transfers by four raters to assess interrater, intrarater, and test-retest reliability and concurrent validity of the TAI 4.0. Each user also was scored using a visual analog scale (VAS). For 44 participants, the mean TAI 4.0 and VAS across all transfers were 7.58 ± 1.12 and 7.44 ± 1.78, respectively, and scores were significantly correlated ( = 0.52-0.7). VAS scores were more strongly influenced by the flight/landing and body setup phases of the transfer. There were no significant associations between TAI 4.0 score and demographics. Intraclass correlation coefficients (ICC) ranged from 0.80 to 0.85 for interrater reliability, 0.60 to 0.76 for intrarater reliability, and 0.55 to 0.76 for test-retest reliability. The minimum detectable change (MDC) for the total score ranged from 1.02 to 1.30. The TAI 4.0 provides reliable and valid quantitative assessment of an individual's transfer without the need for comprehensive training, as is the case with the TAI 3.0. The tool can be completed in 3 minutes (average) in a clinical setting with only a ruler and goniometer.

Bladder dysfunction is related to falls history independently of mobility in individuals with MS. Future research examining whether bladder management programmes have an impact on fall incidence in MS is warranted. Implications for rehabilitation Bladder dysfunction and falls are common health concerns in individuals with multiple sclerosis. Bladder dysfunction was associated with the number of falls in individuals with MS, and this association was independent of mobility. Bladder management should be included in fall prevention strategies in individuals with MS.

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Participant descriptions provide an in-depth description of the circumstances and aftermath of falls experienced by power wheelchair users.