• The Transfer Assessment Instrument (TAI) is used to determine how effective a patient is at a transfer and how well the patient follows transfer techniques:
    • Part 1 of the TAI determines whether or not the patient follows each individual component of transfer technique
    • Part 2 of the TAI determines the extent to which the patient’s transfer was effective in terms of position of weight bearing arm, set up phase, conservation, and quality
  • The TAI has been updated to version 4.0; which can be administered remotely. Further, a self-assessment questionnaire (TAI-Q) has been developed from TAI 4.0 (scores range from 0-100).

Clinical Considerations

The tool can be used to assess the transfers of any full-time wheelchair user.

ICF Domain

Activity and Participation ▶ Mobility

Administration

  • TAI-Q 4.0 can be administered remotely

Number of Items

  • Part 1 has 17 items
  • Part 2 has 12 items

Equipment

  • Ruler and goniometer (if available)
  • Assessment Form

Scoring

  • Each item in part 1 is answered “yes” (1 point), “no” (0 points), or “N/A” (item removed from calculation)
  • Each item in part 2 is scales from 0 (“strongly disagree”) to 4 (“strongly agree”) or “N/A” (item removed from calculation)
  • The part 1 score is multiplied by 10 and divided by the number of items, the part 2 score is multiplied by 2.5 and divided by the number of items
  • The part 1 and part 2 scores are then summed and divided by 2

Languages

English

Training Required

No formal training required. However, reading the manual is recommended.

Availability

# of studies reporting psychometric properties: 8

Interpretability

MCID: not established in SCI

SEM:

  • TAI 4.0 SEM: Session 1 = 0.24; Session 2 = 0.23

(Worobey et al. 2018; n=44 wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7))

  • Total score remote assessment = 0.44; Wheelchair setup remote assessment = 0.42; Body setup remote assessment = 0.80; Flight/landing remote assessment = 0.88

(Worobey et al. 2022; n=44; wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7) years; 20 paraplegia, 2 tetraplegia; mean (SD) time since injury: 17.4 (11.4) years)

  • TAI-Q (self-assessment) SEM: Session 1 pre-video = 0.80; Session 1 post-video = 0.71; Session 2 = 0.59

(Worobey et al. 2020; n=44; wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7) years; 20 paraplegia, 2 tetraplegia; mean (SD) time since injury: 17.4 (11.4) years)

  • Remote Home-based/self-assessment TAI SEM: 0.38-0.79

(Abou et al. 2023; n=18 manual wheelchair users with SCI; 12 males, 6 females; mean (SD) age: 41.1 (14.2); injury level: cervical – lumbar; and mean (SD) time since injury: 7.8 (32.6) years)

MDC:

  • TAI 4.0 MDC: Session 1 = 0.68; Session 2 = 0.63

(Worobey et al. 2018; n=44 wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7))

  • Total score remote assessment = 1.23; Wheelchair setup remote assessment = 1.15; Body setup remote assessment = 2.22; Flight/landing remote assessment = 2.44

(Worobey et al. 2022; n=44; wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7) years; 20 paraplegia, 2 tetraplegia; mean (SD) time since injury: 17.4 (11.4) years)

  • TAI-Q (self-assessment) MDC: Session 1 pre-video = 2.21; Session 1 post-video = 1.97; Session 2 = 1.63

(Worobey et al. 2020; n=44; wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7) years; 20 paraplegia, 2 tetraplegia; mean (SD) time since injury: 17.4 (11.4) years)

  • Remote Home-based/self-assessment TAI MDC: 1.04-2.20

(Abou et al. 2023; n=18 manual wheelchair users with SCI; 12 males, 6 females; mean (SD) age: 41.1 (14.2); injury level: cervical – lumbar; and mean (SD) time since injury: 7.8 (32.6) years)

Typical Values

Mean Transfer Assessment Scores (±SD):

  • Part 1: 7.04 (±1.44)
  • Part 2: 7.55 (±1.61)
  • Total: 7.30 (±1.42)

(Tsai et al. 2013; n=41 wheelchair users; 31 males, 10 females; mean (SD) age: 49.9 (12.7); 8 tetraplegia, 7 high paraplegia, 14 low paraplegia)

TAI-Q (self-assessment):

  • TAI-Q total mean score for session 1 pre-video review: 7.1 (1.0)
  • TAI-Q total mean score for session 1 post-video review: 7.3 (1.0)
  • TAI-Q total mean score for session 2: 7.3 (1.1)

(Worobey et al. 2020; n=44; wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7) years; 20 paraplegia, 2 tetraplegia; mean (SD) time since injury: 17.4 (11.4) years)

TAI 4.0:

  • TAI total mean score in-person: 7.56 (1.01) and remote: 7.70 (1.05)
  • TAI wheelchair setup mean score in-person: 6.73 (2.14) and remote: 6.77 (2.10)
  • TAI body setup mean score in-person: 7.69 (1.44) and remote: 7.78 (1.50)
  • TAI flight/landing mean score in-person: 8.83 (2.14) and remote: 9.46 (1.24)

(Worobey et al. 2022; n=44; wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7) years; 20 paraplegia, 2 tetraplegia; mean (SD) time since injury: 17.4 (11.4) years)

Reliability

  • Moderate to High Inter-rater Reliability:
    ICC session 1: 0.80-0.85
    ICC session 2: 0.84-0.85
    ICC Transfer 1 (remote TAI 4.0): 0.830
    ICC Home-based/remote assessment TAI: 0.57-0.90
  • Moderate to High Intra-rater Reliability:
    ICC rater 1: 0.69-0.78
    ICC rater 2: 0.76-0.84
    ICC rater 3: 0.60-0.88
    ICC Session 1 post-video vs Session 2 post video (TAI-Q): 0.627
    ICC Transfer 1 vs 2 (remote TAI 4.0): 0.687
    ICC Home-based/remote assessment TAI: 0.90
  • Moderate to High Test-retest Reliability:
    ICC rater 1: 0.70
    ICC rater 2: 0.76
    ICC rater 3: 0.55
    ICC rater 4: 0.60
    ICC Session 1 post-video vs Session 3 post-video (TAI-Q): 0.705
    ICC Transfer 1 vs Transfer 3 (remote TAI 4.0): 0.721

(Tsai et al. 2013; n=41 wheelchair users; 31 males, 10 females; mean (SD) age: 49.9 (12.7); 8 tetraplegia, 7 high paraplegia, 14 low paraplegia) (Worobey et al. 2018; n=44 wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7))
(Worobey et al. 2020; n=44; wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7) years; 20 paraplegia, 2 tetraplegia; mean (SD) time since injury: 17.4 (11.4) years)
(Worobey et al. 2022; n=44; wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7) years; 20 paraplegia, 2 tetraplegia; mean (SD) time since injury: 17.4 (11.4) years)
(Baghel et al. 2018; N=30 manual wheelchair users; 25 males, 5 females; mean (SD) age: 31.9 (12.3) years)
(McClure et al. 2011; n=40 full-time wheelchair users (32 with SCI); 34 males, 6 females; mean (SD) age : 51.7 (11.3) years)
(Abou et al. 2023; n=18 manual wheelchair users with SCI; 12 males, 6 females; mean (SD) age: 41.1 (14.2); injury level: cervical – lumbar; and mean (SD) time since injury: 7.8 (32.6) years)

Validity

  • Low to Moderate correlation of TAI scores for each rater with global assessment of transfer skills:
    Rater 1: r = 0.279
    Rater 2: r = 0.192
    Rater 3: r = 0.690

(McClure et al. 2011; n=40 full-time wheelchair users (32 with SCI); 34 males, 6 females; mean (SD) age : 51.7 (11.3) years)

  • Low Significance in differences in final TAI scores amongst subgroups with tetraplegia, high paraplegia and low paraplegia:
    P=0.21

(Tsai et al. 2013; n=41 wheelchair users; 31 males, 10 females; mean (SD) age: 49.9 (12.7); 8 tetraplegia, 7 high paraplegia, 14 low paraplegia)

  • High correlation with the visual analog score (VAS) across all transfers:
    Rater 1: r = 0.89
    Rater 2: r = 0.89
    Rater 3: r = 0.88
    Rater 4: r = 0.90

(Baghel et al. 2018; N=30 manual wheelchair users; 25 males, 5 females; mean (SD) age: 31.9 (12.3) years)

  • TAI-Q (self-assessment): Moderate correlation with TAI 4.0 for session 1 pre-video (ICC = 0.41) and High correlation for session 2 post-video (ICC = 0.78)

(Worobey et al. 2020; n=44; wheelchair users (30 with SCI); 35 males, 9 females; mean (SD) age: 56.5 (12.7) years; 20 paraplegia, 2 tetraplegia; mean (SD) time since injury: 17.4 (11.4) years)

Responsiveness

No values were reported for the responsiveness of the QOLP-PD for the SCI population.

Floor/Ceiling Effect

Three items (items 9 and 15 in part 1 and item 7 in part 2) had a potential ceiling effect.

(McClure et al. 2011; n=40 full-time wheelchair users (32 with SCI); 34 males, 6 females; mean (SD) age : 51.7 (11.3) years)

Reviewers

Dr. Vanessa Noonan, Carlos L. Cano-Herrera

Date Last Updated

31 December 2024

Abou L, Worobey LA, Rigot SK, Estanley E, Rice LA. Reliability of home-based remote and self-assessment of transfers using the Transfer Assessment Instrument among wheelchair users with spinal cord injury. Spinal Cord Ser Cases. 2023. 9(1):10
https://pubmed.ncbi.nlm.nih.gov/36990980/

McClure LA, Boninger ML, Ozawa H, Koontz A. Reliability and validity analysis of the transfer assessment instrument. Arch Phys Med Rehabil. 2011;92(3):499-508.
http://www.ncbi.nlm.nih.gov/pubmed/21276957

Tsai CY, Rice LA, Hoelmer C, Boninger ML, Koontz AM. Basic psychometric properties of the transfer assessment instrument (version 3.0). Arch Phys Med Rehabil. 2013;94(12):2456-64.
http://www.ncbi.nlm.nih.gov/pubmed/23685096

Worobey LA, Hibss R, Rigot SK, Boninger ML, Huzinec R, Sung JH, Rice LA. Intra- and Interrater Reliability of Remote Assessment of Transfers by Wheelchair Users Using the Transfer Assessment Instrument (Version 4.0). Arch Phys Med Rehabil. 2022; 103(4):816-821
https://pubmed.ncbi.nlm.nih.gov/33711281/

Worobey LA, Rigot SK, Boninger ML, Huzinec R, Sung JH, DiGiovine K, Rice LA. Concurrent Validity and Reliability of the Transfer Assessment Instrument Questionnaire as a Self-Assessment Measure. Arch Rehabil Res Clin Transl. 2020:2(4):100088
https://pubmed.ncbi.nlm.nih.gov/33543111/

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