Craig Handicap Assessment & Reporting Technique (CHART)

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Tool Description

  •  Designed to measure the level of handicap in a community setting. Basically, CHART collects information on the degree to which the respondent fulfills the roles typically expected from people without disabilities.
  • The CHART assesses ability in 6 domains:
    A) Physical independence – the individual’s ability to sustain a customarily effective independent existence
    B) Cognitive independence - the individual’s ability to sustain a customary level of independence without need of assistance
    C) Mobility – the individual’s ability to move about effectively in his/her surroundings
    D) Occupation – the individual’s ability to occupy time in the manner customary to that person’s sex, age and culture.
    E) Social integration – the individual’s ability to participate in and maintain customary social relationships
    F) Economic self-sufficiency – the individual’s ability to sustain customary socio-economic activity and independence
  • A short form (CHART-SF) has been developed; it has the same domains as the CHART.

ICF Domain:

Participation

Number of Items:

32 (short form = 19 questions)

Brief Instructions for Administration & Scoring

Administration:

  • Patient-reported
  • The questions can be answered in a quantifiable, behavioral terms (e.g.: hours of physical assistance, how much time is someone with you to assist you, how many relatives do you visit, etc.).
  • The scale takes up to 30 minutes for the CHART and up to 15 min for the CHART-SF.

Equipment: None

Scoring:

  • For each CHART dimension, a scoring procedure allows a score from 0 to 100 points, the latter being the maximum attainable corresponding to a role fulfillment equivalent to that of most individuals without disabilities.
  • For more detailed scoring instructions, refer to the CHART manual (see “Availability”).

Interpretability

MCID: not established for SCI
SEM:
CHART SEM and MDC calculated from Tozato et al. 2005:

Domain: SEM (calculated from data in this article): MDC (calculated from data in this article):
Physical independence

8.2

22.8

Mobility

5.2

14.4

Occupation

14.8

41.1

Social Integration

11.6

32.1

Economy

0

0

CHART-J total score:

40.7

112.9

MDC: CHART MDC = 53.3 between Time 1 (6 weeks post-discharge from inpatient rehabilitation) and Time 2 (1 year post-discharge) – De Wolf et al. 2010

  • No normative data or cut-points have been established for the SCI population
  • published data for the SCI population are available for comparison for both the CHART and CHART-SF (see the Interpretability section of the Study Details sheet).
  • Total scores can be a misleading assessment of handicap, thus the use of subscales is recommended.

Languages:

English, Spanish, Japanese, Chinese, Korean and Italian.

Training Required:

None, but reading the manual is recommended. Manual can be located at: https://craighospital.org/uploads/CraigHospital.CHARTManual.pdf

Availability:

Freely available at http://tbims.org/combi/chart/

Clinical Considerations

  • The CHART is widely used, particularly in the U.S. National Spinal Cord Injury Database.  However, questions on cognitive independence might be seen as irrelevant in SCI population.
  • The economic self-sufficiency domain is based on US financial values and may not be applicable in other countries.

Measurement Property Summary

For the CHART:

# of studies reporting psychometric properties: 10

Reliability:

  • Test re-test reliability is High (r=0.93) for the total score and ranges from Moderate to High for the domains (low: r=0.53 for Physical Independence – high: r=1.00 for Economic Self-sufficiency).
  • Proxy values are High or Moderate for all domains except cognitive independence (ICC=0.34, ‘poor’ rating).

[Cusick 2001, Whiteneck 1992, Tozato 2005]

Validity:

  • CHART domains and total score are able to differentiate groups based on:
    • Level of handicap
    • Gender
    • Age
    • Time since injury
  • Domains social integration and economic self-sufficiency did not differentiate groups based on injury factors.
  • Correlations between the CHART total score ranges from High for the SPRS (r=0.72) to Moderate for the CIM (r=0.47)
  • Associations with measures of subjective quality of life are Moderate to High.
  • Significant sensitivity to change was reported (P=.002) of 408.2±50.1 for Time 1, 431.6±57.4 for Time 2.

[Whiteneck 1992, Hall et al. 1998, De Wolf et al. 2010, Dijkers 1999, Masedo et al. 2005, Tozato 2005]

Responsiveness:
No values were reported for the responsiveness of the CHART for the SCI population.

Floor/ceiling effect:

  • No floor effects reported for CHART total or for any of the CHART domains.
  • Ceiling effects were reported only for the Social integration and Cognitive Independence subscales.

[De Wolf et al. 2010]

For the CHART-SF:

No papers have been found reporting on the psychometric properties of the CHART-SF for the SCI population; one paper (Gontkovsky et al. 2009) provides mean CHART-SF domain scores for comparison (See Study Details sheet – Interpretability section)

Reviewer

Dr. Ben Mortenson, Jeremy Mak, John Zhu

Date Last Updated:

Dec 1, 2016

Download the measure

Download Worksheet:
Freely available at http://tbims.org/combi/chart/

Video

n/a

Scoring

  • For each CHART dimension, a scoring procedure allows a score from 0 to 100 points, the latter being the maximum attainable corresponding to a role fulfillment equivalent to that of most individuals without disabilities.
  • For more detailed scoring instructions, refer to the CHART manual (see “Availability”).

Equipment Needed

CHART:

Cusick C, Brook C, Whiteneck G. The Use of Proxies in Community Integration Research. Arch Phys Med Rehabil 2001;82:1018-1024.
http://www.ncbi.nlm.nih.gov/pubmed/11494179

Dijkers MPJM. Correlates of life satisfaction among persons with spinal cord injury. Arch Phys Med Rehabil, 1999; 80:867-76.
http://www.ncbi.nlm.nih.gov/pubmed/10453761

Golhasani-keshtan F, Ebrahimzadeh MH, Fattahi AS, Soltani-moghaddas SH, Omidi-kashani F. Validation and cross-cultural adaptation of the Persian version of Craig Handicap Assessment and Reporting Technique (CHART) short form. Disabil Rehabil. 2013;35(22):1909-14.
http://www.ncbi.nlm.nih.gov/pubmed/23480647

Gontkovsky ST, Russum P, Stokic DS. Comparison of the CIQ and CHART short form in assessing community integration in individuals with chronic spinal cord injury: A pilot study. NeuroRehabilitation 2009; 24:185-192.
http://www.ncbi.nlm.nih.gov/pubmed/19339757

Hall KM; Dijkers M; Whiteneck G; Brooks CA; Krause JS. The Craig Handicap Assessment and Reporting Technique. Topics in Spinal Cord Injury Rehabilitation (TOP SPINAL CORD INJ REHABIL), 1998 Summer; 4(1): 16-30.

Johnston MV, Diab ME, Kim SS, Kirshblum S. Health literacy, morbidity, and quality of life among individuals with spinal cord injury. J Spinal Cord Med. 2005;28(3):230-40.
http://www.ncbi.nlm.nih.gov/pubmed/16048141

Masedo AI, Hanley M, Jensen MP, Ehde D, Cardenas DD. Reliability and validity of a self-report FIM (FIM-SR) in persons with amputation or spinal cord injury and chronic pain. Am J Phys Med Rehabil 2005;84:167-176.
http://www.ncbi.nlm.nih.gov/pubmed/15725790

Middleton JW, Tate RL, Geraghty TJ. Self-Efficacy and Spinal Cord Injury: Psychometric Properties of a New Scale. Rehabil Psychol. 2003; 48(4):281-288
http://dx.doi.org/10.1037/0090-5550.48.4.281

Tozato F, Tobimatsu Y, Wang CW, Iwaya T, Kumamoto K, Ushiyama T. Reliability and validity of the Craig Handicap Assessment and Reporting Technique for Japanese individuals with spinal cord injury. Tohoku J Exp Med, 2005; 205: 357-366.
http://www.ncbi.nlm.nih.gov/pubmed/15750332

Whiteneck G, Charlifue S, Gerhart K, Overholser J, Richardson G. Quantifying handicap: a new measure of long-term rehabilitation outcomes. Arch Phys Med Rehabil 1992;73:519-526.
http://www.ncbi.nlm.nih.gov/pubmed/1622299

de Wolf A, Lane-Brown A, Tate RL, Middleton J, Cameron ID. Measuring community integration after spinal cord injury: validation of the Sydney psychosocial reintegration scale and community integration measure. Qual Life Res, 2010; 19: 1185-1193.
http://www.ncbi.nlm.nih.gov/pubmed/20582722

World Health Organization. International Classification of Functioning, Disability and Health. Geneva, Switzerland: World Health Organization, 1980.
http://www.ncbi.nlm.nih.gov/pubmed/19537677