Reliability and Validity of the Revised Transfer Assessment Instrument

Abstract

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.

Concurrent Validity and Reliability of the Transfer Assessment Instrument Questionnaire as a Self-Assessment Measure

“…Owing to the forces placed on the shoulder during transfers, wheelchair users are at a greater risk for upper extremity injury and pathology. 4 , 5 , 6 Overuse injuries compounded with an unnecessary amount of force owing to improper transfer techniques exponentially increases the frequency and severity of injuries. 7 In addition, the frequency of transfers puts wheelchair users at an increased risk for additional injuries.…”

“… 8 The TAI is an objective measure of transfer quality with demonstrated reliability and validity. 6 Individuals who use ergonomic transfer techniques, as determined by higher scores on the Transfer Assessment Instrument (TAI), demonstrate decreased force on their shoulders and fewer ultrasonographic markers of shoulder pathology. 9 , 10 …”

“…To date, the TAI has only been used as a clinician-lead objective measure to assess and score the quality of a transfer. 6 There are several barriers individuals with disabilities face when trying to access clinics where their wheelchair transfers could be evaluated. In a study of 153 community dwelling wheelchair users, when asked about their ability to visit locations outside of their home, those with more limitations also reported less participation in medical and nonmedical related activities.…”

“…To address these barriers, the most recent version of the TAI also allows for assessment by nonclinicians and those without training. 6 In an effort to increase accessibility to both clinicians and wheelchair users, this version of the TAI is written in plain language and includes illustrative pictures and diagrams. There is also a version in which the rater is blinded to scoring to allow for self-assessment, known as the Transfer Assessment Questionnaire (TAI-Q).…”

“…There is also a version in which the rater is blinded to scoring to allow for self-assessment, known as the Transfer Assessment Questionnaire (TAI-Q). 6 In the TAI-Q version, respondents have answer options but associated scores are shown ( supplemental appendix S1 , available online only at http://www.archives-pmr.org/ ). As such, the TAI-Q could be used for remote assessment to leverage telehealth opportunities or to complement current in-person clinical care.…”