Convergent Validity and Responsiveness of the Standing and Walking Assessment Tool (SWAT) among Individuals with Non-Traumatic Spinal Cord Injury

Mohammad Alavinia¹ Farnoosh Farahani¹ Kristin Musselman^{2, 3} Kristina Plourde^{2, 4} Maryam Omidvar¹ Molly C. Verrier^{1, 2, 5} Saina Aliabadi^{1, 6} Catharine B. Craven^{1, 7, 8*}

• ¹The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Canada
• ²Department of Physical Therapy, Faculty of Medicine, University of Toronto, Canada
• ³Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada
• ⁴Toronto Rehabilitation Institute, University Health Network, Canada
• ⁵Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Canada
• ⁶School of Graduate Studies, University of Toronto, Canada
• ⁷Department of Medicine, Faculty of Medicine, University of Toronto, Canada
• ⁸Temerty Faculty of Medicine, University of Toronto, Canada

Aim: 1) To describe the use of the Standing and Walking Assessment Tool (SWAT) among individuals with Non-traumatic Spinal Cord Injury or Disease (NT-SCI/D); 2) to evaluate the convergent validity of SWAT for use among inpatients with NT-SCI/D; 3) to describe SWAT responsiveness; and, 4) to explore the relationship between hours of walking therapy and SWAT change. Method: A quality improvement project was conducted at University Health Network between 2019–2022. Participants' demographics and impairments data, rehab length of stay and FIM scores were obtained from the National Rehabilitation Reporting System. The walking measures data were collected by therapists as part of routine practice. Hours of part or whole gait practice were abstracted from medical records. To determine convergent validity, Spearman's correlation coefficients were calculated between SWAT stages (admission and discharge) and the walking measures. The change in SWAT levels was calculated to determine responsiveness. Spearman's correlation coefficient was calculated between SWAT change and hours of walking therapy. Results: Among adult NT-SCI/D participants with potential walking capacity (SWAT≥1B), the majority were classified as American Spinal Injury Association (ASIA) Impairment Scale D (AIS D) at admission. SWAT category of 1C (N=100, 18%) was the most frequent at admission. The most frequent SWAT stage at discharge was 3C among participants with NT-SCI/D, with positive conversions in SWAT stages from admission to discharge (N=276, 33%). The mean change in SWAT score was 3 for participants with T-SCI and NT-SCI/D. Moderate correlations between SWAT stages and walking measures were observed. The correlation of hours of gait therapy with the SWAT change (admission to discharge) was 0.44 (p-value<0001). Conclusion: The SWAT has sufficient convergent validity and responsiveness for describing standing and walking recovery and communicating/monitoring rehabilitation progress among patients with NT-SCI/D.