Intra- and Inter-Rater Reliability of Remote Assessment of Transfers by Wheelchair Users Using the Transfer Assessment Instrument (version 4.0)

Objective: To evaluate the reliability, standard error of measurement, minimum detectable change, and item-level consistency of the Transfer Assessment Instrument (TAI) version 4.0 when used to evaluate transfer quality remotely. Design: Participants transferred from their wheelchair to a mat table (transfer 1), repeated this after a 10-minute delay to assess intrarater reliability (transfer 2), and repeated this 1-2 days later to assess test-retest reliability (transfer 3). Each transfer was scored in person by 4 raters and asynchronously by a remote clinician rater. Setting: 2017 National Veterans Wheelchair Games. Participants: Convenience sample of 44 full-time wheelchair users (N=44). Interventions: Not applicable. Main Outcome Measures: TAI total score, subscores (wheelchair setup, body setup, flight/landing), and item scores (15 items). Results: Moderate to excellent reliability was found when scoring remotely for TAI total and subscores for intrarater (intraclass correlation coefficient (ICC(3,1)=0.687-0.854), test-retest (ICC(3,1)=0.695-0.836), and interrater reliability (ICC(3,5)=0.746-0.962). Remote rater total score and flight/landing subscore were greater (indicating higher transfer quality) compared to the average in-person raters (P=.021 and P=.005, respectively). There were no differences between transfers 1-3 in remote rater scores. Item-level percentage agreement between the remote rater and in-person exceeded the 75% cutoff for clinical utility for all items. Conclusions: The TAI is a reliable outcome measure for assessing transfer technique remotely.