The Function in Sitting Test – Spinal Cord Injury (FIST-SCI) was designed by physiotherapists (Palermo et al. 2020) for trunk skills assessment in patients with SCI. The tool represents a further development of the original FIST scale, developed by Gorman et al. (2010) for individuals with stroke.
The FIST-SCI evaluates static, reactive and proactive balance and sensory integration. It includes a set of fourteen motor tasks divided into three macro-areas:
- Static balance
- Dynamic balance
- Proprioceptive sensitivity
Clinical Considerations
The scale allows the quantification of trunk abilities in all patients with paraplegia, irrespective of the level of injury and compatible with residual abilities/assistance needs; and administration is possible in both hospital and home settings.
ICF Domain
Activity ▶ Mobility
Administration
- Observational functional outcome measure.
- The process to perform the FIST-SCI scale comprises:
- Standard positioning of patient: Seating at the edge of the mat, plinth, or standard hospital bed, with proximal thigh (space for three to four fingers to fit between popliteal fossa and mat) in support, hips, and knees flexed to 90º, and feet flat in support. Thighs should be positioned in neutral hip abduction and adduction, and neutral rotation, with hands resting comfortably unless needed for balance support.
- Administration of static motor tasks, both for maintaining balance against resistance (front, side, rear thrust) and for maintaining sitting position with open/closed eyes (proprioceptive control).
- Administration of active motor tasks, which include rotations of the neck and the entire spinal column, moving on the couch surface, reaching backwards, and moving a leg. This second area assesses dynamic balance exercised through active muscle contraction.
Number of Items
14
Equipment
- Tape measure
- Stopwatch
- It may require a stool or step, depending on table or mat height
Scoring
- Items are rated on the amount of assistance required to accomplish each task on a 5-point scale of 0 (complete assistance – patient cannot perform the task at all) to 4 (independent – patient completely autonomous in performing the task).
- Scores can be added together for a total score ranging from 0 to 56.
Languages
English and Italian.
Training Required
None.
Availability
Can be found here.
Measurement Property Summary
# of studies reporting psychometric properties: 4
Interpretability
(Palermo et al. 2020; n=38; 34 males, 4 females; mean age 39.7 years; ASIA A-C; tetraplegia and paraplegia; mean (SD) time since injury: 14.1 (11.5) years)
- Higher scores represent higher trunk skills.
Typical Values
A FIST-SCI cutoff score of 45 or greater was 92% sensitive and specific in characterizing transfer ability.
(Palermo et al. 2020; n=38; 34 males, 4 females; mean age 39.7 years; ASIA A-C; tetraplegia and paraplegia; mean (SD) time since injury: 14.1 (11.5) years)
Reliability – High
- Inter-rater Reliability is High (kw = 0.985 (0.971-0.992) for the FIST-SCI.
- Intra-rater Reliability is High (kw = 0.983 (0.966-0.991) for the FIST-SCI.
- Internal consistency is High (Cronbach’s a = 0.94) for the FIST-SCI.
(Palermo et al. 2020; n=38; 34 males, 4 females; mean age 39.7 years; ASIA A-C; tetraplegia and paraplegia; mean (SD) time since injury: 14.1 (11.5) years)
Validity – Moderate to High
- Moderate correlation with the Motor Assessment Scale item 3 (MAS-SCI):
r = 0.522
(Palermo et al. 2020; n=38; 34 males, 4 females; mean age 39.7 years; ASIA A-C; tetraplegia and paraplegia; mean (SD) time since injury: 14.1 (11.5) years)
- High correlation with the UEMS:
r = 0.720 - Moderate correlation with the Maximal Inspiratory Pressure (MIP):
r = 0.480 - Moderate correlation with the Sustained MIP (SMIP):
r = 0.467
(Palermo et al. 2022; n=37; 34 males, 3 females; mean age 39.8 years; ASIA A-C; tetraplegia and paraplegia; mean (SD) time since injury: 13.6 (11.2) years)
- Moderate correlation with the level of injury:
r = 0.507-0.527
(Palermo et al. 2020; n=38; 34 males, 4 females; mean age 39.7 years; ASIA A-C; tetraplegia and paraplegia; mean (SD) time since injury: 14.1 (11.5) years)
(Palermo et al. 2022; n=37; 34 males, 3 females; mean age 39.8 years; ASIA A-C; tetraplegia and paraplegia; mean (SD) time since injury: 13.6 (11.2) years)
Responsiveness
- FIST-SCI scores distinguished individuals requiring assistance to transfer from those who were independent (t=4.51; P<.05).
(Palermo et al. 2020; n=38; 34 males, 4 females; mean age 39.7 years; ASIA A-C; tetraplegia and paraplegia; mean (SD) time since injury: 14.1 (11.5) years)
- Responsiveness to change (6 weeks): 3.6 (1.6 – 5.7)
(Gambhir et al. 2025; n=40; mean age: 28 (7) years; tetraplegia and paraplegia; ASIA A-B; mean time since injury: 15 (16) months; RCT)
Floor/Ceiling Effect
- No values were reported for the presence of floor/ceiling effects in the FIST-SCI for the SCI population.
Reviewers
Dr. Carlos Leonardo Cano-Herrera, Matthew Querée.
Date Last Updated
31 December 2024
https://pubmed.ncbi.nlm.nih.gov/37326268/
Gambhir K, Mitra S, Palermo AE. Inspiratory Muscle Training enhances Functional Sitting Balance more than Usual Care in Individuals with Spinal Cord Injury: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2025 Sep 30:S0003-9993(25)00936-0. doi: 10.1016/j.apmr.2025.09.017.
https://pubmed.ncbi.nlm.nih.gov/41038425/
Gorman SL, Radtka S, Melnick ME, Abrams GM, Byl NN. Development and validation of the Function In Sitting Test in adults with acute stroke. J Neurol Phys Ther. 2010; 34 (3):150-60. doi: 10.1097/NPT.0b013e3181f0065f.
https://pubmed.ncbi.nlm.nih.gov/20716989/
Palermo AE, Cahalin LP, Garcia KL, Nash MS. Psychometric Testing and Clinical Utility of a Modified Version of the Function in Sitting Test for Individuals With Chronic Spinal Cord Injury. Arch Phys Med Rehabil. 2020; 101 (11):1961-1972. doi: 10.1016/j.apmr.2020.06.014.
https://pubmed.ncbi.nlm.nih.gov/32673654/
Palermo AE, Kirk-Sanchez NJ, Garcia KL, Nash MS, Cahalin LP. Inspiratory Muscle Performance Is Related to Seated Balance Function in People With Spinal Cord Injury: An Observational Study. Arch Phys Med Rehabil. 2022; 103 (7):1303-1310. doi: 10.1016/j.apmr.2021.11.006.
https://pubmed.ncbi.nlm.nih.gov/34922931/
