Development and Validation of a Sitting-Balance Confidence Scale for Individuals with Spinal Cord Injury

Background/Objectives: Participation in sport and daily activities among individuals with spinal cord injury (SCI) is influenced not only by physical capacity but also by psychological factors such as balance confidence. Existing measures primarily assess performance or fear of falling, leaving a gap in evaluating how perceived balance impacts activity choice. This study aimed to (1) develop a Patient-Reported Sitting Balance Confidence (PR-SBC) interview instrument to enable therapists to assess and evaluate non-ambulatory individuals with SCI, (2) incorporate participation-based activities relevant to perceived confidence in community and sport activities, and (3) evaluate its psychometric properties. Methods: Instrument development used a Delphi process with clinicians, researchers, individuals with SCI, and care partners to create and refine items. The final 19-item PR-SBC was administered to 31 individuals with SCI (inpatient and outpatient). Inter-rater reliability was assessed using intraclass correlation coefficients (ICC), internal consistency via Cronbach's alpha, and validity through correlation with the SCI Falls Concern Scale (SCI-FCS). Exploratory regression analyses examined demographic and clinical predictors of PR-SBC scores. Results: The PR-SBC demonstrated promising inter-rater reliability (ICC = 0.96) and internal consistency (α = 0.931). A moderate inverse correlation with SCI-FCS scores was also observed (r = -0.51). Outpatient setting and manual wheelchair use were associated with higher balance confidence, while injury-related variables were not significant predictors. Conclusions: The PR-SBC is a potential interview instrument for assessing sitting balance confidence in individuals with SCI. By capturing perceived balance across functional and participation contexts, it complements existing measures and may support improved clinical decision-making, targeted interventions, and enhanced participation outcomes.