Core Practice Principles: A mixed-methods approach to determine what drives the use of seated trunk control assessments in spinal cord injury clinical and research practice.

AbstractObjective To examine current practices in assessing seated trunk control (STC) following spinal cord injury (SCI), a key factor in rehabilitation outcomes and independence. Enablers and barriers to uptake of assessment tools in practice were identified using the Theoretical Domain Framework (TDF) and mapped to the Capability-Opportunity-Motivation for Behavior Change (COM-B) model. Design Explanatory sequential mixed methods design using a survey of assessment tools used, followed by focus groups and interviews to triangulate survey responses, understand factors driving uptake, and identify ideal assessment characteristics. Setting Leading SCI institutions in the United States Participants US-based clinicians and clinical researchers experienced in SCI rehabilitation. Interventions NA Main Outcome Measures Survey of commonly used assessment tools. Results The survey showed that 72% of 67 respondents used STC assessments, most frequently the Berg Balance Scale (BBS), while qualitative findings highlighted the FIST-SCI and observation as key assessments of STC. Analysis using the TDF and COM-B identified barriers relating to Opportunity to use STC assessments: including limited evidence, absence of standardized guidelines, funding constraints, and insurance limitations. Capability-related facilitators to use of assessments were practitioner knowledge and practical skills, whereas Motivation-related drivers were clinical relevance and sensitivity to change of assessments. Conclusion In SCI rehabilitation in the US health care context, trunk control assessment is considered essential, although systemic and evidentiary challenges limit its integration. These findings underscore the need for co-developed guidelines and further research to demonstrate the robustness of assessments in monitoring progress, fall risk, and activity independence.