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.
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.
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.
Number of Items
32 (short form = 19 questions)
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”).
English, Spanish, Japanese, Chinese, Korean and Italian.
# of studies reporting psychometric properties: 10
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 Research Summary).
Total scores can be a misleading assessment of handicap, thus the use of subscales is recommended.
MCID: not established for SCI SEM: CHART SEM and MDC calculated from Tozato et al. 2005:
SEM (calculated from data in this article)
MDC (calculated from data in this article)
CHART-J total score
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)
Test re-test reliability is High (r = 0.93) for the total score and ranges from Moderateto 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)
CHART domains and total score are able to differentiate groups based on:
Level of handicap
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)
No values were reported for the responsiveness of the CHART for the SCI population.
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 Research Summary sheet – Interpretability section)
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
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
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(3):167-76. http://www.ncbi.nlm.nih.gov/pubmed/15725790
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