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Clinical tools that measure sitting posture, seated postural control or

functional abilities in children with motor impairments: A systematic review

Article in Clinical Rehabilitation · July 2013

DOI: 10.1177/0269215513488122 · Source: PubMed

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488122
2013
CRE271110.1177/0269215513488122Clinical RehabilitationField and Livingstone

CLINICAL
Article REHABILITATION

Clinical Rehabilitation
Clinical tools that measure sitting 27(11) 994­–1004
© The Author(s) 2013

posture, seated postural control Reprints and permissions:

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DOI: 10.1177/0269215513488122
or functional abilities in children cre.sagepub.com

with motor impairments: a

systematic review

Debra Field1,2 and Roslyn Livingstone1

Abstract
Objective: To identify and critically appraise clinical measurement tools used to assess sitting posture,
seated postural control or functional abilities for children with motor impairment who are candidates for
seating interventions.
Data sources: Searches were run in 15 electronic databases along with hand searching. The search
included articles published in English to December 2011.
Review methods: Key terms included: posture, sitting, sitting posture, seated posture, seated postural
control, sitting position, seating, wheelchair(s), outcome and assess(ment). The PRISMA statement was
followed with inclusion criteria set a priori. Two reviewers independently screened titles, reviewed
abstracts and identified full-text articles that met criteria. Data extraction included tool description and
clinical utility. Two quality-rating scales were used to evaluate conduct of the studies and psychometric
properties of the tools.
Results: Of the 497 titles found in the search, 29 full-text articles met the inclusion criteria and 19
tools were identified. Tools represented all components of the International Classification of Functioning,
Disability and Health for Children and Youth (ICF-CY), with emphasis on body structure and function and
activity components. Evidence supporting reliability and validity varied, with small sample sizes influencing
quality ratings. Evidence of the tools’ reliability was more prevalent than evidence of the tools’ validity.
Only four tools reported on responsiveness, an important consideration for evaluating change. Little
information on clinical utility was provided.
Conclusion: Although a number of tools are available, evidence supporting their use for seating
interventions is limited, as is the evidence supporting the strength of their measurement properties. Few
tools address participation, environmental factors or the child’s and family’s perspective.

Keywords
Measurement, wheelchair, posture, child rehabilitation, systematic review
Received: 7 December 2012; accepted: 7 April 2013

1Sunny Hill Health Centre for Children, Canada Corresponding author:

2Graduate Programs in Rehabilitation Sciences, University of Debra Field, Therapy Department, Sunny Hill Health Centre
British, Columbia, Canada for Children, 3644 Slocan St., Vancouver, British Columbia,
V5M 3E8, Canada.
Email: dfield@cw.bc.ca
Field and Livingstone
Introduction
Children with motor impairments such as cerebral
palsy, muscular dystrophy and spina bifida com-
monly have limited postural control abilities.
Specialized seating is a therapeutic intervention
used to address the needs of individuals with lim-
ited postural control.1,2 Seating interventions, rang-
ing from simple to complex, may facilitate optimal
health and maximize participation despite limited
postural control.
The International Classification of Functioning,
Disability and Health for Children and Youth
(ICF-CY)3 should be adopted when evaluating seat-
ing interventions in order that ‘clinicians, research-
ers, families, and policy makers may share a
common understanding of the functional role of
seating devices in children’ (ref. 4, p.108). Costigan
and Light5 suggest that seating can be used to
enhance body structure and functioning as well as
activity and participation. Seating interventions
directed at the level of body structure and function-
ing impairments may, for example, enhance respi-
ratory function, influence muscle tone or reflexes,
reduce risk of, or accommodate for, anatomical
deformity or address skin interface pressure man-
agement.5–7 Seating directed at the level of activity
limitations may be aimed at improving stability in
sitting, safety and comfort, or enhancing fine motor
activity performance.4,8,9 Seating designed to foster
engagement in life roles may reduce participation
restrictions.5
Although measurement tools assist in evaluat-
ing the effects of therapists’ interventions,10 a lack
of appropriate clinical tools exists to address the
needs of individuals who have postural compensa-
tions affecting the entire body.7 A limited number
of tools capture information related to seated pos-
tural control specific to seating interventions,11
with most such measures developed for adults.12–14
Well-developed tools assure confidence that the
tools measure what they are supposed to measure
consistently, are responsive to change, and have
clinical meaning interpretable by the user.12,15
Reviews on the effectiveness of seating interven-
tions have been published for children with differ-
ent diagnoses,1,4,8,16–18 with few touching on the
995
measurement tools used in the studies.9,19,20 A sys-
tematic review summarizing the range of tools
available would be useful for clinicians with lim-
ited time and resources.10
We conducted a systematic review of the litera-
ture to identify and critically appraise the evi-
dence underlying measurement tools for assessing
sitting posture, seated postural control or func-
tional abilities for children with motor impair-
ments who are candidates for seating intervention.
Our clinical question was: ‘For children under 19
years of age with motor impairments (who are
candidates for seating intervention), what clinical
measurement tools are used to assess sitting pos-
ture, seated postural control or functional abili-
ties?’ Related questions were ‘What are the
psychometric properties of these measurement
tools?’ and ‘What components of the ICF-CY3 do
these tools address?’
Methods
Two reviewers with graduate-level research train-
ing in the field of rehabilitation conducted the
search. Health librarians experienced in systematic
review development assisted in planning and
recording the search, which was restricted to studies
published in English to December 2011 and
included peer-reviewed articles from 15 electronic
databases: OT Seeker; Physiotherapy Evidence
Database (PEDro); Cochrane Central Register of
Controlled Trials; Cochrane Database of Systematic
Reviews; Database of Abstracts of Reviews of
Effects; ACP Journal Club; CINAHL; Medline
OVID SP; EMBASE; PsychInfo; ERIC; Google
Scholar; National Quality Measures Clearinghouse;
Health and Psychosocial Instruments; and Health
Technology Assessment.
A core set of key terms was identified based on
several eligible articles: posture, sitting, sitting pos-
ture, seated posture, seated postural control, sitting
position, seating, wheelchair(s), outcome and
assess(ment). Two types of searches were per-
formed; the first used the terms as subject headings
or medical subject heading (MeSH) descriptors, and
the second used the terms as keywords.
996
Two reviewers independently screened titles,
and abstracts were retrieved for those appearing to
meet criteria. Both reviewers independently
reviewed all abstracts to decide if the full text
should be obtained. The terms ‘screen’, ‘tool’,
‘instrument’, ‘measure’, ‘scale’ and ‘outcome’ were
used to identify studies where data had been cap-
tured in a standardized manner. A manual search of
electronically retrieved bibliographies was com-
pleted to identify other relevant peer-reviewed arti-
cles. Targeted searching of authors and other known
titles that did not appear in the electronic search was
also completed. The two reviewers independently
reviewed full-text articles to determine if they met
inclusion criteria. Consensus was achieved through
discussion at all stages without need to involve a
third reviewer.
Inclusion criteria were identified prior to the
search to determine all relevant literature: (1)
participant(s) had a motor impairment or movement
disorder related to a neurological or neuromuscular
condition; (2) a seating system, seating compo-
nents, or wheelchair, and/or physical characteristics
of the participants were described in enough detail
to determine that they would typically use a seating
and mobility system (e.g. Gross Motor Function
Classification System21 levels III–V for children
with cerebral palsy); (3) a detailed description of
the assessments used as outcomes in the evaluation
of sitting posture or seated postural control, includ-
ing psychometric properties (reliability, validity,
responsiveness) and/or clinical utility; and (4)
inclusion of at least one child or adolescent (0–19
years of age). To capture a broad spectrum of litera-
ture, a variety of research designs were included
with no restrictions on measurement methods.
Exclusion criteria were: (1) non-English lan-
guage publications; (2) studies related specifically
to adults; (3) studies related only to children who
were typically developing; (4) measurement method
not feasible for use in a typical rehabilitation clini-
cal setting (e.g. X-ray, EMG, force-platform); and
(5) non-peer-reviewed articles, including disserta-
tions or conference proceedings.
To assess study quality, we used both the
COnsensus-based Standards for the selection of
health status Measurement INstruments (COSMIN)
Clinical Rehabilitation 27(11)
checklist22,23 and the McMaster Outcome Measures
Rating Form,24 referred to hereafter simply as the
McMaster Rating. The COSMIN checklist22,23 was
chosen to rate the overall methodological quality
and conduct of individual studies, whereas the
McMaster Rating24 provided ratings of reliability
and validity results while emphasizing clinical util-
ity of the measurement tools. The PRISMA state-
ment25 was used to structure this systematic review.
The reviewers extracted data including evidence
source, psychometric properties, conduct and rigour
of tool development. Evidence source information
included author, outcome measures, study design
and population characteristics. Psychometric details
of the measurement tools, the focus of this review,
included evidence for reliability and validity, with a
particular emphasis on responsiveness. Clinical
utility and response format of each tool were also
extracted. Because the reviewers conducting this
review have been involved in the research develop-
ment and clinical use of two of the measures being
evaluated, the Seated Postural Control Measure26
and the Level of Sitting Scale,26 an external reviewer
independently completed ratings on these two mea-
sures to reduce potential for bias.
Tools were divided into three groups: those
developed specifically to assess posture within a
seating system in order to assess the outcome of
seating interventions (seating tools); tools of sitting
posture or balance that have wider therapeutic
application (sitting balance and posture tools); and
those designed to evaluate functional ability that
may be impacted by seated postural control (func-
tional ability tools). Whenever only a portion of a
tool was relevant for our review, only that informa-
tion is reported. For example, the Chailey Levels of
Ability27 has several scales addressing lying, stand-
ing and sitting. Only the Box Sitting Ability Scale is
relevant to this review and we refer to it as the
Chailey scale.27 The Seated Postural Control
Measure26 has two different sections – Alignment
and Function28; reliability information is reported
separately. Similarly, the Sitting Assessment for
Children with Neurological Dysfunction29 has a
subsection called Abnormal Postural Responses,
and the Sitting Assessment Scale30,31 has a subsec-
tion called Counting Pathological Movements; for
Field and Livingstone 997

Identification
Records identified through Additional records identified
database searching through other sources
(n = 600) (n = 121)

Record safter duplicates Records excluded,

removed (n = 497) based on title
(n = 318)
Screening

Records excluded,
Records screened based on abstract
(n = 179) (n = 139)

Full-text articles assessed Full-text articles excluded,

Eligibility

for eligibility with reasons

(n =48) (n = 19)

Studies included in
quantitative synthesis
(n =29)
Included

[27studies; twopapers
described different
aspects of same study]

Figure 1. PRISMA 2009 flow diagram. Reproduced with kind permission from PLOS Medicine.25

these reliability information is reported separately.
For the Spinal Alignment and Range of Motion
Measure,32 only the alignment items are relevant for
this review.
Results
Figure 1 illustrates the PRISMA flowchart,25 outlin-
ing each step. Six hundred articles were identified
through electronic database searches, with another
121 identified through manual searching. After de-
duplication, there were 497 titles, with 48 articles
(10%) meeting inclusion criteria based on title and
abstract. Agreement between reviewers on
abstractsthat should be reviewed as full text was
98% (n = 47). From full-text review, 29 articles
(60%) met the inclusion criteria, with 95% agree-
ment between reviewers; 21 of these articles (72%)
were identified through manual searching.
Of the 19 articles that did not fully meet criteria,
three (16%) did not address the desired popula-
tion,33–35 three (16%) were descriptive or theoretical
in focus,5,36,37 one (5%) was not feasible for use in
clinical practice,38 one’s (5%) purpose related to
ADL performance,39 and finally 11 (58%) failed to
include details of the psychometric properties of
their outcome measures.40–50
Table 1 (online) summarizes the evidence source
characteristics of each study, presented alphabetically,
998
in which 29 articles representing 27 studies were
included. Several studies reported on more than one
tool,26,28,54,56,57 while several articles reported on dif-
ferent aspects of the same study.56,57,63,64 Of the 27
studies, 11 (41%) were methodological with a focus
on tool development and evaluation of measurement
properties.26–29,32,51,54,55,70,76,79 The remaining 16 stud-
ies (59%) were primarily intervention studies that
used a measurement tool for evaluation and provided
some information on psychometric proper-
ties.30,31,51,53,56,57,58,59,61,63–66,69,71,73,74,78 Because our
review focused on evaluating the tools used and not
the specific intervention outcomes of the study, read-
ers are referred to other reviews of paediatric seating
interventions for an evaluation of the quality of evi-
dence provided in these intervention studies.1,7–9,16–20
Three reviews9,19,20 highlighted psychometric proper-
ties of tools used to evaluate seating interventions: the
Sitting Ability Scale,30 the Modified Schober
Measurement of Spinal Extension (referred to simply
as Schober for the remainder of this article),61,62 and
Hulme’s assessment instrument.56,57
Table 2 (online) summarizes the psychometric
details of the 19 measurement tools identified.
Evidence for reliability and validity are presented.
Measurement tool ratings are summarized in
Table 3 (online) for reliability evidence and Table 4
(online) for validity evidence. After independently
appraising the evidence, the initial agreement
between reviewers was 87%. Consensus for all rat-
ings (the COSMIN checklist22,23 for overall rating
of the conduct of each study and the two McMaster
Ratings24) was achieved through discussion. The
two sections of the McMaster Rating24 included
both an individual study rating and an overall rating
based on the number of studies completed. For
example, one or two studies with adequate or excel-
lent evidence ratings would merit an overall rating
of adequate. For studies in which the statistical
results were not low enough to merit a poor rating
on the McMaster Rating,24 we created a combined
rating of ‘P/A’ to highlight our concerns about the
conduct of the study or the statistical methodology
used. There were several tools with evidence from
numerous sources; while evaluation of all these
sources was beyond the scope of this review, their
psychometric properties were reported.
Clinical Rehabilitation 27(11)
Reliability using the COSMIN
checklist22,23
Most seating tools and six of the sitting balance and
posture tools received poor ratings, due mainly to
small sample size. The Level of Sitting Scale26,28,54
and Seated Postural Control Measure26,28,54 achieved
excellent,28 good54 and fair26 inter-rater reliability
ratings, and good54 and fair26 test-retest reliability
ratings. The Trunk Control Measurement Scale55
and Segmental Assessment of Trunk Control51,52
achieved good and fair ratings respectively for inter-
rater reliability. For the functional ability tools, most
ratings were reported as they included numerous
sources.72,75 However, those functional ability tools
evaluated by the reviewers rated poor.53,59,60,66–68
Reliability using the McMaster
Rating24
The Seated Postural Control Measure-Function26,28,54
achieved an excellent overall inter-rater reliability rat-
ing. Overall inter-rater reliability was adequate for the
Level of Sitting Scale,26,28,54 Sitting Assessment of
Children with Neurological Dysfunction,29,58,69,70
Spinal Alignment and Range of Motion Measure,32,79
Sitting Assessment Scale,30,31,65 Segmental Assessment
of Trunk Control,51,52 Seated Postural Control Measure-
Alignment,26,28,54 Trunk Control Measurement Scale55
and Trunk Impairment Scale.76,77 Overall intra-rater
reliability (where original video-recordings are re-
scored by the same rater) was adequate for the Sitting
Assessment Scale,30,31,65 Segmental Assessment of
Trunk Control51,52 and Trunk Impairment Scale.76,77
Test–retest reliability was more commonly reported for
tools that require hands-on assessment and is more rel-
evant for clinical use. Overall test–retest reliability rat-
ings were adequate for the Level of Sitting Scale,26,28,54
Sitting Assessment for Children with Neurological
Dysfunction,29,58,69,70 Spinal Alignment and Range of
Motion Measure,32,79 Seated Postural Control Measure-
Function26,54 and Trunk Control Measurement Scale,55
while the Schober,61,62 and Head Position Trainer59,60
were reported to have adequate test–retest reliability.
Evidence for reliability was reported in numerous stud-
ies88,89 for the Canadian Occupational Performance
Measure72 and the Pediatric Evaluation of Disability
Field and Livingstone
Inventory Caregiver Assistance Scale.75 The remaining
tools either did not present evidence for reliability, or
were rated poor to adequate, or poor.
Validity using the COSMIN
checklist22,23
The Level of Sitting Scale,26,28,54 Sitting Assessment
of Children with Neurological Dysfunction,29,58,69,70
Spinal Alignment and Range of Motion Measure,32,79
Segmental Assessment of Trunk Control,51,52 Seated
Postural Control Measure26,28,54 and Trunk Control
Measurement Scale55 achieved excellent ratings for
content validity, while the Chailey scale27 achieved
a good rating. The Chailey scale,27 Spinal Alignment
and Range of Motion Measure,32,79 and Segmental
Assessment of Trunk Control51,52 achieved fair rat-
ings for hypothesis testing; the remaining tools
rated poor, again mostly due to sample size.
Evidence for responsiveness was provided only for
the Level of Sitting Scale26,28,54 and Seated Postural
Control Measure,26,28,54 with both achieving a fair
rating. Evidence for responsiveness was reported in
numerous studies for the Canadian Occupational
Performance Measure72 and the Pediatric Evaluation
of Disability Inventory Caregiver Assistance
Scale.75
Validity using the McMaster Rating24
Adequate overall content and construct validity rat-
ings were achieved by the Chailey scale,27 Sitting
Assessment for Children with Neurological
Dysfunction,29,58,69,70 Spinal Alignment and Range
of Motion Measure,32,79 Segmental Assessment of
Trunk Control,51,52 and Trunk Control Measurement
Scale.55 The Jebsen–Taylor Hand Function Test66–68
achieved adequate overall construct validity66 and
reported adequate overall content validity,67,68 while
the Schober61,62 reported adequate overall ratings
for both. Evidence for responsiveness was provided
for the Level of Sitting Scale26,28,54 and Seated
Postural Control Measure,26,28,54 with both achiev-
ing adequate overall responsiveness ratings in addi-
tion to having adequate overall content validity. The
Canadian Occupational Performance Measure72 and
the Pediatric Evaluation of Disability Inventory75
999
overall ratings for responsiveness, content and con-
struct validity were reported to be adequate to excel-
lent from numerous sources. The remaining tools
either did not present evidence for validity, or were
rated poor to adequate.
Table 5 (online) provides information related to
test description and clinical utility in addition to the
associated ICF-CY3 component(s). Three tools
were developed specifically for seating intervention
studies: Hulme’s assessment,56,57 videography78 and
direct selection of targets on a speech-generating
device (referred to as Targeting on a speech-gener-
ating device).53 Although little was done to evaluate
psychometric properties, enough information was
provided in the articles to meet our inclusion crite-
ria. Seven tools can be used within the seating sys-
tem to measure outcome of seating interventions:
force transducer and interface pressure measure-
ment,63 Hulme’s assessment,56,57 Sitting Assessment
for Children with Neurological Dysfunction,29,58,69,70
Sitting Assessment Scale,30,31,65 Seated Postural
Control Measure26,28,54 and videography.78 Seven
additional tools quantify or classify sitting ability
and generally involve sitting on a bench or box: the
Chailey scale,27 Level of Sitting Scale,26,28,54
Schober,61,62 Spinal Alignment and Range of Motion
Measure,32,79 Segmental Assessment of Trunk
Control,51,52 Trunk Control Measurement Scale55
and Trunk Impairment Scale.76,77 Five tools evalu-
ate functional abilities that may be impacted by
seated postural control: Canadian Occupational
Performance Measure,72 Head Position Trainer,59,60
Jebsen–Taylor Hand Function Test,66–68 Pediatric
Evaluation of Disability Inventory Caregiver
Assistance Scale75 and Targeting on a speech-gener-
ating device.53
Discussion
In this systematic review, 19 measurement tools
were identified for evaluating sitting posture, seated
postural control or functional abilities for children
with motor impairments who are candidates for
seating intervention. There were no measures that
met all criteria for instrument development,12,15 sug-
gesting room for improvement in establishing
1000
robust and appropriate measurement tools that
reflect all components of health as determined by
the ICF-CY.3
Although some authors commented on clinical
usefulness26,61,64–66,78 there was little objective evi-
dence. Most tools use items commonly found in clin-
ical practice (e.g. tape measures, goniometers and
toys). However, four tools (Segmental Assessment of
Trunk Control,51,52 Spinal Alignment and Range of
Motion Measure,32,79 Trunk Control Measurement
Scale55 and Trunk Impairment Scale76,77) have
requirements that may limit their clinical utility. The
Trunk Impairment Scale76,77 and Trunk Control
Measurement Scale55 are appropriate only for chil-
dren in Gross Motor Function Classification System21
levels I–III, limiting use for children who require
external support to maintain a sitting position (typi-
cally Gross Motor Function Classification System
levels IV and V). This review highlights the need for
research on clinical utility of the tools, as this is
essential for the adoption of outcome measurement
tools in clinical practice.2
It is important that measurement tools represent
the range of ICF-CY3 health components.4,12 This
review confirmed that there are tools available to
evaluate the different components. All the seating
tools address the ICF-CY components of body
structure and function and activity.3 Two of the sit-
ting balance and posture tools address body struc-
ture and function: Schober,61,62 and Spinal
Alignment Range of Motion Measure32,79; whereas
five tools address activity: the Chailey scale,27 Level
of Sitting Scale,26,28,54 Segmental Assessment of
Trunk Control,51,52 Trunk Control Measurement
Scale55 and Trunk Impairment Scale.76,77 Within the
functional ability tools group, there was more varia-
tion in ICF-CY3 components. The modified
Pediatric Evaluation of Disability Inventory75
addresses environmental factors whereas the
Jebsen–Taylor Hand Function Test66–68 and
Targeting a speech-generating device53 address
activity. The Head Position Trainer59,60 addresses
body structure and function and activity while the
Canadian Occupational Performance Measure72
addresses user-defined goals related to participation
and activity. Tools that evaluate participation or
environmental factors, or tools that capture the
Clinical Rehabilitation 27(11)
child’s and/or parent’s perspective are limited. Most
tools were fairly evenly distributed between body
structure and function and activity, in keeping with
the evolution of theoretical frameworks used to sup-
port clinical practice over the years. Participation
and environmental factors have more recently been
acknowledged as important components to measure
when evaluating health status.12 The results of this
review may assist in identifying tools aimed at spe-
cific ICF-CY3 components to evaluate seating inter-
vention outcomes.
Ryan4 discussed the need for tools with adequate
reliability and validity that are responsive to mean-
ingful change specific to seating interventions.
Although there are a number of tools available to
measure sitting posture, seated postural control and
functional abilities, most do not fully meet the stan-
dards for a well-developed tool.12,15 The two rating
scales used in this review22–24 focused on different
perspectives of quality assessment, and together
they provided a comprehensive overview of the
strengths and limitations of each tool. There is far
more evidence supporting reliability for the identi-
fied tools than for validity or responsiveness; this is
in keeping with standard test development proce-
dures15 and the growth of critical evaluation for this
clinical specialty.12,86
Evidence of inter-rater reliability was more prev-
alent in this review than test–retest reliability, with
even less evidence for intra-rater reliability. This is
understandable given that establishing test–retest
reliability is challenging in this population due to
variability in posture and functional abilities.
Evidence regarding face and content validity was
provided for most tools while evidence for discrimi-
native validity and responsiveness was limited.
Given that validity standards encompass a broad
range of evidence for construct validity,87 further
research is warranted.
The Canadian Occupational Performance
Measure,72 and Pediatric Evaluation of Disability
Inventory75 are reported to have adequate to excel-
lent reliability, validity and responsiveness but it
was beyond the scope of this review to analyse all
the studies published on these tools.88,89 The
Pediatric Evaluation of Disability Inventory75 was
modified for use in the study included in this
Field and Livingstone
review74; psychometric properties of the original
tool may not apply. Although work has been done
establishing the validity of the Canadian
Occupational Performance Measure72 by parent/
caregiver proxy90–92 and by children with disabili-
ties,93,94 use of this tool for seating intervention out-
comes is limited.71,74,95 Psychometric properties
related to its use for this specific purpose have not
been explored fully.
Some tools, such as force transducers and
interface pressure measurement devices,63 are
commonly used in other therapeutic applications
or other technical fields. However, confirmation
of the reliability, validity and responsiveness of
these tools for the specific purposes of seated
postural control evaluation would be helpful.
More importantly, the psychometric properties
for the particular device models should have been
included.
Several limitations to this review could affect the
applicability of the results. First, there may be use-
ful tools published in non-English language jour-
nals that contribute to this topic but were not
included. Second, selective reporting within studies
may have limited exposure to meaningful informa-
tion about tool development. Third, two tools were
reviewed by another reviewer to help minimize
bias. Finally, the long time span over which the
studies occurred was a challenge, as reporting stan-
dards have changed over the years. While some ear-
lier studies were considered high quality for their
time, study description and statistical methods used
no longer meet contemporary expectations, influ-
encing rating of individual studies and comparisons
across tools.
Conclusion
In this systematic review, a critical appraisal of 19
measurement tools determined that no single tool
met all criteria for instrument development.12,15
Establishing credible measurement tools will ulti-
mately strengthen the evidence for seating interven-
tions, increase confidence in the results of future
studies and make findings more meaningful to cli-
ents, their families, clinicians and equipment
1001
funders4; priorities recognized by others in the
field.2,7,11 Chung et al. stated ‘there is limited high
quality research available to determine the effective-
ness of adaptive seating … studies with higher levels
of evidence need to be conducted’ (ref. 1, p.14). This
must begin by using measurement tools that are of
higher quality – a theme echoed by several authors
over the years.4,9,19
Clinical messages
•• There are 19 tools available to measure
sitting posture, seated postural control and
functional abilities for children with motor
impairments who may use seating inter-
ventions, but none meet all criteria for a
well-developed measure.
•• Few tools address participation, environ-
mental factors, or the child’s and family’s
perspective.
Contributors
DF initiated the idea, but both authors (DF and RL)
designed the study, undertook the search, evaluated the
evidence and wrote the manuscript. DF is the guarantor.
Acknowledgements
Special thanks to Jackie Casey MSc, BSc (Hons) OT,
PgCHEP, Lecturer in Occupational Therapy, School of
Health Sciences, University of Ulster, for agreeing to be an
independent reviewer for the Seated Postural Control
Measure and Level of Sitting Scale quality assessments.
Acknowledgements to UBC and Sunny Hill Health Centre
for Children health science librarians for their assistance in
planning and carrying out the literature search; Susan R.
Harris, PhD, PT, Professor Emerita, UBC, for her editorial
expertise and Lori Roxborough MSc OT/PT, Associate
Director, Therapy Department, Sunny Hill Health Centre
for Children, for her guidance, support and encourage-
ment. Recognition goes to our colleagues on the
Positioning and Mobility team at Sunny Hill Health Centre
for Children who provided inspiration for this manuscript
from their discussions regarding evidence-based practice.
Conflict of interest
The authors declare that there is no conflict of interest.
1002
Funding
Debra Field would like to acknowledge the Canadian
Institutes of Health Research Fellowship Award, and the
Canadian Occupational Therapy Foundation Blake
Medical Distribution Scholarship Award for funding her
time to write this manuscript.
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and Harris, SR. Effectiveness of adaptive seating on sitting
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2. Wright C, Casey J and Porter-Armstrong A. Establishing
best practice in seating assessment for children with physi-
cal disabilities using qualitative methodologies. Disabil
Rehabil Assist Technol 2010; 5: 34–47.
3. World Health Organization. International Classification of
Functioning, Disability, and Health Children and Youth.
Geneva: World Health Organization, 2007.
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