Walking Index for Spinal Cord Injury (WISCI) and WISCI II

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Tool Description

  • The Walking Index for Spinal Cord Injury (WISCI) is a functional capacity scale designed to measure improvements in ambulation in persons with spinal cord injury, by evaluating the amount of physical assistance, braces or devices required to walk 10 meters. The WISCI II is currently the most recent version.
  • Participants are progressed systematically through a validated sequence of capacity levels, incorporating devices and personal assistance, to their maximum walking capacity.
  • The WISCI II ranks levels according to the severity of underlying impairment rather than the need for physical assistance, walking aids or braces, etc.

    Clinical Considerations

    • There is minimal additional burden for clinicians to administer the WISCI as the test falls into typical clinical practice parameters.
    • A score is possible even if the individual cannot walk 10 m. However, because the furthest walk distance is 10m, it may not be suitable for individuals with minor impairments.
    • It would be a useful to incorporate the WISCI II into clinical practice and to evaluate new SCI therapies.  Additional tests may be necessary to assess endurance (e.g. 6MWT) and/or walking speed (eg.10MWT), especially for individuals with greater walking capacity.

 

ICF Domain:

Activity – subcategory: Mobility.

Number of Items:

n/a

You Will Need:

  • Approximately 30 minutes
  • Equipment:  5-meter parallel bars and mobility aids (e.g. braces, cane, walker - typically available in a clinical setting).

Scoring:

  • The clinician observes walking and rates the level which the person is considered safe.
  • For WISCI I, a score from 1 to 19 is assigned. Level 1: “patient ambulates in parallel bars, with braces and physical assistance of two persons, less than 10 meters” to level 19: “patient ambulates with no devices, no braces and no physical assistance, 10 meters”.
  • For WISCI II, a score from 0 to 20 is assigned. Level 0: “patient is unable to stand and/or participate in walking” to level 20: “ambulates with no devices, with brace and no assistance”.

Interpretability

MCID: not established
SEM & MDC: (SEM, SRD values from Burns et al. 2011, MDC calculated from data in Burns et al. 2011)
For self-selected WISCI II level: SEM=0.283, SRD=0.785, MDC= 0.784
For self-selected WISCI II speed: SEM=0.091, SRD=0.254 m/s, MDC = 0.252
For max WISCI II level: SEM=0.215, SRD=0.597, 0.596
For max WISCI II speed: SEM=0.059, SRD=0.163 m/s, MDC=0.164

  • No normative data or cut scores are available for the SCI population but the WISCI II is gaining in popularity and comparisons can be made with existing studies.
  • Published data for the SCI population is available for comparison (see Interpretability section of the Study Details sheet).

Languages:

n/a

Training Required:

No formal training required. Knowledge of ambulation useful.

Availability:

Download the worksheet here. 

Measurement Property Summary

WISCI I

# of studies reporting psychometric properties: 1

Reliability: (N=1) [Ditunno et al. 2000]

  • Inter-rater reliability was tested by agreement between raters; 100% agreement was achieved across all 24 individual international participants and all eight teams.

Validity: (N=1) [Ditunno et al. 2000]

  • Correlation of the WISCI I is High with the Functional Independence Measure (Spearman’s r=0.765).

Responsiveness:

No values were reported for the responsiveness of the WISCI I at this time.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the WISCI for the SCI population.

WISCI II

# of studies reporting psychometric properties: 10

Reliability:

  • Test-retest reliability is High for self-selected (SS) WISCI II level (ICC=0.994) and walking speed (ICC=0.930), and maximum WISCI II level (ICC=0.995) and walking speed (ICC=0.971).
  • Inter-rater reliability is High for SS WISCI II (ICC=1.00) and max WISCI II (ICC=0.98).

[Morganti et al. 2005, Burns et al. 2011, Marino et al. 2010]

Validity:

  • Correlations for the WISCI II are:

o   High with the Berg Balance Scale (Spearman’s r=0.82-0.92)

o   High with the Functional Independence Measure (Spearman’s r=0.70-0.77)

o   High with the Timed Up and Go (Spearman’s r=-0.799)

o   High with the Spinal Cord Independence Measure- Mobility subscale (Spearman’s r=0.81)

o   High with the Rivermead Mobility Index (Spearman’s r=0.67)

o   High with the Barthel Index (Spearman’s r=0.67)

o   Low to High with the 6-Minute Walk Test (Spearman’s r=0.28-0.76)

o   Low to High with the 10 Meter Walk Test (Spearman’s r=-0.21 - -0.79)

o   Low to Moderate with the  Lower Extremity Motor Score (Spearman’s r=0.32-0.50)

[Ditunno & Ditunno 2001, Morganti et al. 2005, Van Hedel, Wirz & Curt 2005, van Hedel et al. 2006, Ditunno et al. 2007, Ditunno et al. 2008, Burns et al. 2011, Wirz et al. 2010, Lemay & Nadeau 2010]

Responsiveness:

  • WISCI II differed between interval 1 and 2 (p=0.005), but not between 2 and 3 (p=0.18) or 3 and 4 (p=0.31) – (4 time intervals: 1) within first month; 2) after 3 months; 3) after 6 months; 4) after 12 months).

[Van Hedel, Wirz & Curt 2005, van Hedel et al. 2006]

Floor/ceiling effect:

  • Ceiling effect detected in WISCI II; 44.8% of subjects reached maximal score.

[van Hedel et al. 2006, Ditunno et al. 2007, Lemay & Nadeau 2010]

Reviewers

Dr. Janice Eng, Jeremy Mak, John Zhu, Kyle Diab

Date Last Updated:

Feb 1, 2016

Download the measure

Download Worksheet:

Worksheet Document

Video

n/a

Scoring

  • The clinician observes walking and rates the level which the person is considered safe.
  • For WISCI I, a score from 1 to 19 is assigned. Level 1: “patient ambulates in parallel bars, with braces and physical assistance of two persons, less than 10 meters” to level 19: “patient ambulates with no devices, no braces and no physical assistance, 10 meters”.
  • For WISCI II, a score from 0 to 20 is assigned. Level 0: “patient is unable to stand and/or participate in walking” to level 20: “ambulates with no devices, with brace and no assistance”.

Equipment Needed

Equipment is typically available in the clinical setting: 5 meter parallel bars and mobility aids (e.g. braces, cane, walker).

WISCI I & WISCI II:

Burns AS, Delparte JJ, Patrick M, Marino RJ, Ditunno JF. The reproducibility and convergent validity of the Walking Index for Spinal Cord Injury (WISCI) in chronic spinal cord injury. Neurorehabil Neural Repair, 2011; 25:149-157.
http://www.ncbi.nlm.nih.gov/pubmed/21239706

Ditunno JF, Ditunno PL, Graziani V, Scivoletto G, Bernardi M, Castellano V, Marchetti M, Barbeau H Frankel HL D'Andrea Greve JM, Ko HY, Marshall R, Nance P. Walking index for spinal cord injury (WISCI): an international multicenter validity and reliability study. Spinal Cord 2000;38:234-243.
http://www.ncbi.nlm.nih.gov/pubmed/10822394

Ditunno PL Dittuno JF. Walking index for spinal cord injury (WISCI II): scale revision. Spinal Cord 2001;39:654-656.
http://www.ncbi.nlm.nih.gov/pubmed/11781863

Ditunno JF, Burns AS, Marino RJ. 2005. Neurological and functional capacity outcome measures: essential to spinal cord injury clinical trials. J Rehab Res Dev 2005;42(Suppl 1): 35-41.
http://www.ncbi.nlm.nih.gov/pubmed/16195961

Ditunno JF Jr, Barbeau H, Dobkin BH, Elashoff R, Harkema S, Marino RJ, Hauck WW, Apple D, Basso DM, Behrman A, Deforge D, Fugate L, Saulino M, Scott M, Chung J, Spinal Cord Injury Locomotor Trial Group. Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial. Neurorehabil Neural Repair 2007; 21: 539-550.
http://www.ncbi.nlm.nih.gov/pubmed/17507642

Ditunno JF, Scivoletto G, Patrick M, Biering-Sorensen F, Abel R, Marino R. Validation of the walking index for spinal cord injury in a US and European clinical population. Spinal Cord 2008; 46: 181-188.
http://www.ncbi.nlm.nih.gov/pubmed/17502878

Hasegawa T, Uchiyama Y, Uemura K, Harada Y, Sugiyama M, Tanaka H. Physical impairment and walking function required for community ambulation in patients with cervical incomplete spinal cord injury. Spinal Cord. 2014;52(5):396-9.
http://www.ncbi.nlm.nih.gov/pubmed/24614853

Jackson AB, Carnel CT, Ditunno JF, et al. Outcome measures for gait and ambulation in the spinal cord injury population. J Spinal Cord Med. 2008;31(5):487-99.
http://www.ncbi.nlm.nih.gov/pubmed/19086706

Kim MO, Burns AS, Ditunno JF, Marino RJ. The assessment of walking capacity using the walking index for spinal cord injury: self-selected versus maximal levels. Arch Phys Med Rehabil. 2007;88(6):762-7.
http://www.ncbi.nlm.nih.gov/pubmed/17532899

Lemay JF and Nadeau S. Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale. Spinal Cord (2010) 48, 245–250; doi:10.1038/sc.2009.119
http://www.ncbi.nlm.nih.gov/pubmed/19773797

Marino RJ, Scivoletto G, Patrick M, Tamburella F, Read MS, Burns AS, Hauck W, Ditunno Jr. J. Walking Index for Spinal Cord Injury Version 2 (WISCI-II) with repeatability of the 10-m walk time: inter- and intrarater reliabilities. Am J Phys Med Rehabil, 2010; 89:7-15.
http://www.ncbi.nlm.nih.gov/pubmed/20026943

Menon N, Gupta A, Khanna M, Taly AB. Ambulation following spinal cord injury and its correlates. Ann Indian Acad Neurol. 2015;18(2):167-70.
http://www.ncbi.nlm.nih.gov/pubmed/26019413

Morganti B, Scivoletto G, Ditunno P, Ditunno JF, Molinari M. Walking Index for spinal cord injury (WISCI): criterion validation. Spinal Cord 2005;43:27-33.
http://www.ncbi.nlm.nih.gov/pubmed/15520841

Musselman KE. Clinical significance testing in rehabilitation research: what, why, and how? Phys Ther Rev. 2007;12(4):287-96.
http://www.tandfonline.com/doi/abs/10.1179/108331907X223128

Ovechkin AV, Vitaz TW, Terson de paleville DG, Mckay WB. Quality of residual neuromuscular control and functional deficits in patients with spinal cord injury. Front Neurol. 2013;4:174.
http://www.ncbi.nlm.nih.gov/pubmed/24223568

Scivoletto G, Tamburella F, Laurenza L, Torre M, Molinari M, Ditunno JF. Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility. Spinal Cord. 2014;52(1):65-9.
http://www.ncbi.nlm.nih.gov/pubmed/24145685

Tamburella F, Scivoletto G, Iosa M, Molinari M. Reliability, validity, and effectiveness of center of pressure parameters in assessing stabilometric platform in subjects with incomplete spinal cord injury: a serial cross-sectional study. J Neuroeng Rehabil. 2014;11:86.
http://www.ncbi.nlm.nih.gov/pubmed/24886312

van Hedel HJA Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. Arch Phys Med Rehabil 2005;86:190-196.
http://www.ncbi.nlm.nih.gov/pubmed/15706542

van Hedel HJA, Wirz M, Curt A. Improving walking assessment in subjects with incomplete spinal cord injury: responsiveness. Spinal Cord 2006;44:352-356.
http://www.ncbi.nlm.nih.gov/pubmed/16304565

Wirz M, Muller R, Bastiaenen C. Falls in Persons With Spinal Cord Injury: Validity and Reliability of the Berg Balance Scale. Neurorehabil Neural Repair 2010 24: 70; DOI: 10.1177/1545968309341059
http://www.ncbi.nlm.nih.gov/pubmed/19675123