Skin Management Needs Assessment Checklist (SMNAC)

Download Clinical Summary PDF

Tool Description

  • Skin management scale extracted from the Needs Assessment Checklist.
  • Developed to be a post discharge measure to assess client knowledge and ability to perform skin checks, pressure relief and prevention of skin breakdown.
  • Based on the individual’s perception of his/her ability to independently perform skin management activities.
  • Provides SCI specific information related to skin management needs. Its score may be used to identify the problems for individuals living in the community to establish priorities and goal setting or to inform community health care professionals about a clients’ ability to manage skin management activities.

ICF Domain:

Activity – Subcategory: Self-Care

Number of Items:


Brief Instructions for Administration & Scoring


  • Self-report
  • Requires individuals to demonstrate or, for an individual with a high lesion, instruct their personal care attendant to perform the activities.
  • Each item on the SMNAC receives a score ranging from 0-3 (0-complete dependence; 1-mostly dependent; 2-moderately dependent; 3-complete independence) or N/A (not applicable, representing no rehabilitation need or goal to be identified).

Equipment: None.


  • The items are summed to generate a total score ranging from 0-36. The value reported is a proportion (client score/36) x 100%.


MCID: not established in SCI
SMNAC score SEM and MDC (calculated from data obtained from Berry & Kennedy 2003):




Skin management



  • Higher scores reflect greater independence.
  • No risk specific scores or normative data for the SCI population is available at this time.
  • Published data for the SCI population is available for comparison (see Interpretability section for the Study Details sheet).



Training Required:

None, however, experience with wound care may enhance tool use.


A copy can be obtained from the author, P Kennedy. See the article “The needs assessment checklist: a clinical approach to measuring outcome.” Spinal Cord, 1999; 37: 136-139.

Clinical Considerations

  • There is minimal patient burden however some embarrassment addressing items may be evident.

Measurement Property Summary

# of studies reporting psychometric properties: 3


  • Internal consistency of the SMNAC is high (Cronbach’s a=0.851)
  • Test-retest reliability is high (ICC=0.899).

[Berry et al. 2004, Gelis et al. 2011]


  • The SMNAC score did not differ statistically between sex.
  • Negative and low correlations between age and skin management were found in incomplete tetraplegia group (r=-0.22), complete paraplegia group (r=-0.22) and incomplete paraplegia group (r=-0.27).

[Berry et al. 2004]


  • A significant difference in SMNAC score between the 2 test days (mean days apart: 103±66) using paired-sample t-test (t=-24.38) was found.

[Berry et al. 2004]

Floor/ceiling effect:

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


Dr. Vanessa Noonan, Marzena Zhou

Date Last Updated:

Mar 16, 2017

Download the measure

Download Worksheet:
A copy can be obtained from the author, P Kennedy. See the article “The needs assessment checklist: a clinical approach to measuring outcome.” Spinal Cord, 1999; 37: 136-139.





Equipment Needed


Berry C and Kennedy P. A psychometric analysis of the Needs Assessment Checklist (NAC). Spinal Cord 2002; 41: 490-501.

Berry C, Kennedy P, Hindson L. Internal consistency and responsiveness of the skin management needs assessment checklist post spinal cord injury. J Spinal Cord Med 2004;27:63-71.

Gelis A, Daures JP, Benaim C, Kennedy P, Albert T, Colin D, Joseph P-A, Pelissier J, Fattal C. Evaluating self-reported pressure ulcer prevention measures in persons with spinal cord injury using the revised Skin Management Needs Assessment Checklist: reliability study. Spinal Cord, 2011; 49:653-658.

Keith RA, Lipsey MW. The role of theory in rehabilitation assessment, treatment and outcomes. In: Glueckauf RL, Sechrest LB, Bond GR, McDonel EC. (ed). Improving Assessment in Rehabilitation and Health. Sage Publications, Newbury Park, CA, 1993, p 33-60.

Kennedy P, Hamilton LR. The needs assessment checklist: a clinical approach to measuring outcome.  Spinal Cord 1999;37:136-139.