Development of a new assessment of effort and assistance in standing pivot transfers with functional electrical stimulation

Background: Currently available clinical tools for assessing rehabilitation outcomes do not capture both the effort exerted and assistance required for persons with spinal cord injuries to perform a standing pivot transfer using functional electrical stimulation (FES). This study was undertaken to develop and apply a clinical tool to measure the ability to stand and transfer with electrical stimulation. Methods: The Functional Performance Measure (FPM) methodology was chosen to develop a tool to measure performance. Through an iterative review of videotaped FES transfers, fundamental components of the standing pivot transfer were identified and standardized performance criteria for user effort and helper assistance were developed for every phase using the 8-point FPM scales. Results: Interrater and intrarater reliability were established with a simple kappa coefficient for the effort scale and assistance scale. The final version of the tool has been applied to users of the implanted FES standing neuroprosthesis to describe the effort and assistance required for the transfer. Conclusion: The tool has been shown to capture the effort and assistance needed during FES-assisted standing pivot transfers throughout all phases of the transfer.