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RehabMeasures Instrument

Sydney Psychosocial Reintegration Scale

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Purpose

The SPRS assesses handicaps that occur following traumatic brain injury. Handicaps are defined according to the World Health Organization's models. The focus is on change from pre-injury performance rather than current capacity to perform.

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Instrument Details

Acronym SPRS

Area of Assessment

Life Participation

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Brain Injury Recovery

Populations

Key Descriptions

  • Original version available in Tate RL, Hodgkinson AE, Veerabangsa A, Maggiotto S. (1999). Measuring psychosocial recovery after traumatic brain injury: psychometric properties of a new scale. J Head Trauma Rehabil 14:543-57.
  • Form B of the SPRS available in Tate RL, Pfaff A, Veerabangsa A, Hodgkinson AE. (2004). Measuring psychosocial recovery after brain injury: change versus competency. Arch Phys Med Rehabil, 85:538-45.
  • Item description of the Sydney Psychosocial Reintegration Scale (SPRS) and re-coding rules from the 7-point scale to a 5-point scale available in Tate, R. L., Simpson, G. K., Soo, C. A., & Lane-Brown, A. T. (2011). Participation after acquired brain injury: Clinical and psychometric considerations of the Sydney Psychosocial Reintegration Scale (SPRS). Journal of Rehabilitation Medicine, 43, 609–618.
  • Self-report, 7-point Likert-scale response scale (0=extreme change, 6=no change).
  • The final version of the scale consists of 12 items organized into 3 domains of 4 items each: Occupational activities (4 items), interpersonal relationships (4 items), independent living skills (4 items).
  • Total scores range from 0-72; sub-scale scores range from 0-24.
  • Two forms of the SPRS measure “change since injury” (Form A; Tate et al., 1999) and “current status” (Form B; Tate, Pfaff, Veerabangsa, & Hodgkinson,2004). It is suggested that Form B is used in situations where the injury occurred more than a few years previously or in situations such as intervention studies where the intention is to compare findings at two different points in time.
  • For each form, there are three versions: clinician, self, and informant, each of which uses the same 12 items but phrased as appropriate for the respondent.
  • May be completed in an interview with significant other, close relative or involved healthcare professional with adequate knowledge of patient prior to the injury or with a patient respondent.
  • In 2004, a second test (Form B) was developed by Tate et al to evaluate the current levels of competency instead of the change from pre-injury levels. Items are unchanged and use the same 7-point Likert scale, but rephrased to remove references to pre-injury function (Test is reproduced in Tate RL, Pfaff A, Veerabangsa A, Hodgkinson AE. Measuring psychosocial recovery after brain injury: change versus competency. Arch Phys Med Rehabil 2004;85:538-45).
  • In 2011, the 7-point Likert scale has been replaced by a 5-point Likert scale, referred as SPRS-2.
  • SPRS-2: Each item is rated from 0 (equivalent to “an extreme amount of change” on Form A or “extremely poor” on Form B) to 4 (equivalent to “no change at all” on Form A or “very good” on Form B). Specific behavioral descriptors are attached to response categories 0–3 for each item. The total score ranges from 0 to 48 (0–16 for each domain), with higher scores representing better levels of psychosocial reintegration.

Number of Items

12

Time to Administer

5 or 15 minutes

15 minutes (interview-style); 5 minutes (clinician-rating)

Required Training

Training Course

Instrument Reviewers

Initially reviewed by Anna de Joya, PT, MS, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 5/2012.

ICF Domain

Participation

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

NR

NR

NR

R

R

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

TBI EDGE

No

Yes

Yes

Not reported

Considerations

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Brain Injury

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Normative Data

Traumatic Brain Injury: (Tate et al., 2011; n=105, mean age=39.7 (16.68), healthy adults; n=510, mean age=35 (sample A) and 33 (sample B), TBI)

 

Mean (SD)

Form B: Healthy Adults (n = 105)

Form A: Rehab DC (n = 104)

Form A: Community (n = 201)

Form B: Rehab DC (n  = 55)

For B: Community (n  = 150)

Total Score

35.88(3.09)

19.54(10.02)

26.18(12.87)

21.92(9.18)

26.57(12.45)

Occupational Activities

11.28(1.34)

3.56(2.94)

6.54(4.95)

4.09(3.00)

6.49(4.62)

Interpersonal Relationships

11.94(1.46)

9.16(3.83)

9.37(4.31)

9.96(3.40)

9.41(4.43)

Living Skills

12.66(1.52)

6.82(4.22)

10.28(4.62)

7.62(4.13)

10.68(4.59)

 

Test/Retest Reliability

Traumatic Brain Injury: (Tate et al., 1999; subacute group n=20 assessed for responsiveness of measure (admission and 3 months later or at discharge, whichever came first; long term group n=40 assessed for reliability and validity of measure (close relative was interviewed with the measure, SPRS readministered one month later)

  • Excellent reliability for total score (ICC=0.90)
  • Excellent reliability for occupational activities (ICC=0.93)
  • Excellent reliability for interpersonal relationships (ICC=0.0.77)
  • Excellent reliability for living skills (ICC=0.88)

 

Brain Injury: (Tate et al., 2004; n=66; mean age=35.2 (14.22); 47 males and 19 females. Assessed Form B) 

FORM B (n = 46)

Test-retest Reliability

ICC

Total Score

Excellent

.90

Occupational Activities

Excellent

.86

Interpersonal Relationships

Excellent

.76

Living Skills

Excellent

.83

FORM A (n = 46)

 

 

Total Score

Excellent

.90

Occupational Activities

Excellent

.87

Interpersonal Relationships

Excellent

.84

Living Skills

Excellent

.88

 

 

Traumatic Brain Injury: (Tate et al., 2011; n=105, mean age=39.7 (16.68), healthy adults; n=510, mean age=35 (sample A) and 33 (sample B), TBI)

 

 

SPRS (7-point) Test-retest (1-month)

SPRS-2 (5-point) Test-retest (1-month)

Total Score

.90

.91

Occupational Activities

.93

.94

Interpersonal Relationships

.79

.80

Living Skills

.88

.87

Interrater/Intrarater Reliability

Traumatic Brain Injury: (Tate et al., 1999; subacute group n=20 assessed for responsiveness of measure (admission and 3 months later or at discharge, whichever came first; long term group n=40 assessed for reliability and validity of measure (close relative was interviewed with the measure, SPRS readministered one month later)

  • Excellent reliability for total score (ICC=0.95) 
  • Excellent reliability for occupational activities (ICC=0.92)
  • Excellent reliability for interpersonal relationships (ICC=0.86)
  • Excellent reliability for living skills (ICC=0.94) 

 

Brain Injury: (Tate et al., 2004; n=66; mean age=35.2 (14.22); 47 males and 19 females. Assessed Form B) 

 

Interrater Agreement

FORM B (n = 46)

Rater 1 vs Rater 2 (n = 66)

Clinician vs Relative (n  = 25)

Total Score

.84 (Excellent)

.67 (Adequate)

Occupational Activities

.63 (Adequate)

.71 (Adequate)

Interpersonal Relationships

.70 (Adequate)

.37 (Poor)

Living Skills

.82 (Excellent)

.52 (Adequate)

FORM A (= 46)

 

 

Total Score

.82 (Excellent)

.57 (Adequate)

Occupational Activities

.65 (Adequate)

.66 (Adequate)

Interpersonal Relationships

.66 (Adequate)

.35 (Poor)

Living Skills

.79 (Excellent)

.53 (Adequate)

 

 

FORM A vs FORM B: Clinician

FORM A vs FORM B: Relative

Total Score

.97

.95

Occupational Activities

.93

.90

Interpersonal Relationships

.96

.89

Living Skills

.94

.94

 

Traumatic Brain Injury: (Tate et al, 2011; n=105, mean age=39.7 (16.68), healthy adults; n=510, mean age=35 (sample A) and 33 (sample B), TBI) 

 

SPRS (7-point) ICC

SPRS-2 (5-point) ICC

Total Score

.95

.94

Occupational Activities

.93

.93

Interpersonal Relationships

.86

.85

Living Skills

.94

.93

Internal Consistency

Traumatic Brain Injury: (Tate et al., 1999; subacutesub acute group n=20 assessed for responsiveness of measure (admission and 3 months later or at discharge, whichever came first; mean age at injury=32.80 (14.07); long term group n=40 assessed for reliability and validity of measure (close relative was interviewed with the measure, SPRS re-administered one month later); mean age at injury= 34.95 (15.49) 

  • Intercorrelations among domains were adequate: occupational activities with interpersonal relationships (r=.56), occupational activities with living skills (r=.77) , and interpersonal relationships with living skills (r=.64); each P < .001 

 

Brain Injury: (Tate et al., 2004; n=66; mean age=35.2 (14.22); 47 males and 19 females. Assessed Form B)

  • Excellent internal consistency (Cronbach’s alpha=0.93)
  • Excellent item-total correlation coefficients (greater than 0.7) for 9 of the 12 items, with the exceptions being item 1 (work, Cronbach’s alpha=.39), item 2 (work skills, Cronbach’s alpha=.67), and item 6 (family, Cronbach’s alpha=.51)

 

Traumatic Brain Injury: (Tate et al., 2011; n=105, mean age=39.7 (16.68), healthy adults; n=510, mean age=35 (sample A) and 33 (sample B), TBI) 

 

SPRS (7-point) Cronbach's alpha

SPRS-2 (5-point) Cronbach's alpha

Total Score

.90 (Excellent)

.89 (Excellent)

Occupational Activities

.89 (Excellent)

.88 (Excellent)

Interpersonal Relationships

.69 (Poor)

.72 (Adequate)

Living Skills

.77 (Adequate)

.75 (Adequate)

 

Neurological diagnoses: Primary Brain Tumor (PBT), Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI) (Tate et al., 2012; PBT n=54; SCI n=50; TBI n=130)

  • PBT population: Excellent internal consistency (Cronbach’s alpha=0.87)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

Acquired Brain Injury: (Kuipers et al., 2004; n=521; diagnoses: TBI, stroke, tumor, infection, others)

  • Adequate: Community Integration Questionnaire (CIQ) total scores correlated with SPRS total scores: r=0.56
  • Adequate: CIQ home competency with SPRS living skills: r=0.42
  • Adequate: CIQ social interaction with SPRS interpersonal relationships: r=0.45
  • Adequate: CIQ productive activity with SPRS occupational activity: r=0.42 

 

Traumatic Brain Injury: (Draper et al., 2007; n=53)

  • Significant correlations (P < .001) were found between the GOSE and the SPRS subscales
  • Adequate to excellent validity (r = 0.72, 0.78, 0.54, and 0.58) between Glasgow Outcome Scale-Extended (GOSE) and TBI participants’ SPRS total, Occupational Activities (OA), Interpersonal Relationships (IR), and Living Skills (LS) ratings, respectively
  • Excellent validity (= 0.68, 0.68, 0.62, and 0.61) between GOSE and relatives’ SPRS total, OA, IR, and LS ratings, respectively

 

Traumatic Brain Injury: (Tate et al., 2011; n=105, mean age=39.7 (16.68), healthy adults; n=510, mean age=35 (sample A) and 33 (sample B), TBI) 

 

 

SPRS (7-point) r

 

 

SPRS-2 (5-point) r

 

London Handicap Scale

-0.85

-0.86

Katz Adjustment Scale

0.76

0.74

Glasgow Outcome Scale-Extended

-0.77

-0.72

Sickness Impact Profile

-0.76

-0.78

 

Construct Validity

Construct Validity:

Acquired Brain Injury: (Kuipers et al., 2004; n= 521; diagnoses: TBI, stroke, tumor, infection, others)

  • 2-factor solution on multidimensional scaling analysis supported a continuum of productivity vs personal life and independent activity vs dependent involvement. 

 

Discriminant Validity: 

Traumatic Brain Injury:

  • SPRS demonstrated significant differences between groups defined by high vs low community integration (Winkler et al, 2006) 

 

Convergent validity and discriminant validity:

Traumatic Brain Injury: (Tate et al., 1999; subacute group n=20 assessed for responsiveness of measure (admission and 3 months later or at discharge, whichever came first; long term group n=40 assessed for reliability and validity of measure (close relative was interviewed with the measure, SPRS readministered one month later)

  • SPRS total score showed excellent correlation coefficients with all four scales administered: r=-.76 with both Sickness Impact Profile (SIP) and Katz Adjustment Scale (Form R2); r=-0.77 with Glasgow Outcome Scale-Extended (GOSE); and r=-.85 with London Handicap Scale. 
  • No significant correlation was found between the total score and age (r=-.25), although those for PTA and chronicity were statistically significant (r=-.41 and r=-.36, respectively, each P < .05). 
  • SIP physical domain showed the highest correlation with SPRS living skills subscale (r=-0.58; P < .001) and a low and non-significant correlation with interpersonal relationships subscale (r=-0.23; P >.05). 
  • SIP-psychosocial domain showed the highest correlation with SPRS interpersonal relationships (r=-0.76;P < .001), and adequate correlation living skills (r=-0.59). 
  • SIP combined score for work and recreation/pastimes correlated most highly with the SPRS occupational activities domain (r=-0.72; P < .001). 
  • Construct validity with respect to group differences on the GOS: significant subgroup differences between good recovery versus moderate disability and moderate disability versus severe disability were found for each of the domains. 
  • No differences were found between the moderate and severe disability subgroups for the interpersonal relationship domain. 
  • Variability was evident among each of the three SPRS domains, but for every GOS disability level, the greatest amount of change was found for the occupational activities domain.

 

Traumatic Brain Injury: (Draper et al., 2007; n=53)

  • Gender, age, and the GCS score were not significantly correlated with either patients’ or relatives’ SPRS total score. 
  • The correlation between PTA and SPRS total according to ratings of the person with TBI was not significant (r = ?0.26, P = .057). 
  • PTA duration (r=?0.39, P = .004) and age (r = ?0.33, P =.019) were significantly correlated with the OA subscale.

HADS Anxiety

HADS Depression

FSS

AUDIT

NFI Agression

 

SPRS (patients)

-0.695?

-0.522?

-0.629?

-0.156

-0.650?

SPRS (relatives)

-0.444?

-0.193

-0.505?

-0.037

-0.384?

HADS Anxiety

---

0.455?

0.493?

0.237

0.518?

HADS Depression

---

---

0.426?

0.105

0.547?

FSS

---

---

---

0.026

0.637?

AUDIT

---

---

---

---

0.346§

?AUDIT, The Alcohol Use Disorders Identification Test; FSS, Fatigue Severity Scale; HADS, Hospital Anxiety and Depression

Scale; NFI, Neurobehavioral Functioning Inventory; and SPRS, Sydney Psychosocial Reintegration Scale Total.

?Pearson’s correlation is significant at the .001 level (2-tailed).

?Pearson’s correlation is significant at the .01 level (2-tailed).

§Pearson’s correlation is significant at the .05 level (2-tailed).

 

 

 

 

 

 

Convergent and Divergent Validity:

Traumatic Brain Injury: (Tate et al., 2011; n=105, mean age=39.7 (16.68), healthy adults; n=510, mean age=35 (sample A) and 33 (sample B), TBI) 

 

SPRS (7-point) r

SPRS-2 (5-point) r

Sickness Impact Profile with SPRS Living Skills

-0.58

-0.61

Sickness Impact Profile with SPRS Relationships

-0.23

-0.27

 

 

Discriminant Validity: 

Traumatic Brain Injury: (Tate et al., 2011; n=105, mean age=39.7 (16.68), healthy adults; n=510, mean age=35 (sample A) and 33 (sample B), TBI)

  • Those with duration of PTA less than 30 days: higher SPRS-2 scores (mean=32.98 ( 11.22) and mean = 33.27 (9.62) on Forms A and B, respectively) than those with PTA duration between 1 and 3 months (mean= 25.48 (10.55) and mean= 27.05 (11.28), respectively), who in turn had higher SPRS-2 scores than those with PTA greater than 3 months (mean= 14.70 (9.47) and mean= 13.97 (8.80), respectively). 

 

Neurological diagnoses - Primary Brain Tumor (PBT), Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI): (Tate et al., 2012; PBT n=54; SCI n=50; TBI n=130)

  • Participants with the more severe TBI demonstrated poorer SPRS total and domain scores than those with PTA less than 30 days. 
  • Within the PBT sample, there were no significant differences in participation related to severity. 
  • A significant difference was observed between high and low impairment SCI participants on living skills with the high impairment group performing more poorly, but no differences were found for the total or other domain scores.

Floor/Ceiling Effects

Traumatic Brain Injury: (Tate et al., 1999; subacute group n=20 assessed for responsiveness of measure (admission and 3 months later or at discharge, whichever came first; long term group n=40 assessed for reliability and validity of measure (close relative was interviewed with the measure, SPRS readministered one month later)

  • At discharge from rehabilitation, percentage of participants scoring at the scale minimum ranged 3.0% (interpersonal relationships ) to 18.2% (occupational activities) while patients scoring at the scale maximum ranged from 1.5% (living skills) to 7.6% (interpersonal relationships 
  • Initial floor effects noted, however, data indicated that SPRS was sensitive to detect changes over time. 

 

Traumatic Brain Injury: (Tate et al., 2011; n=105, mean age=39.7 (16.68), healthy adults; n=510, mean age=35 (sample A) and 33 (sample B), TBI)

  • No significant floor or ceiling effects were present for the total score for either Form A (0% and 2.5%, respectively) or Form B (1.3% for both floor and ceiling). 
  • For each of the domains, both floor and ceiling effects were less than the stringent criterion of 15% 

 

Neurological diagnoses - Primary Brain Tumor (PBT), Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI): (Tate et al., 2012; PBT n=54; SCI n=50; TBI n=130)

  • PBT population: There was a ceiling effect on the living skills domain with 28% achieving the highest score on this subscale. 
  • At the item level, analysis of the frequencies found that there was a spread of responses on all items; however, six items (items 5–10) showed ceiling effects with more than 50% of the sample achieving the highest score.

Responsiveness

Traumatic Brain Injury: (Tate et al., 1999; subacute group n=20 assessed for responsiveness of measure (admission and 3 months later or at discharge, whichever came first; long term group n=40 assessed for reliability and validity of measure (close relative was interviewed with the measure, SPRS readministered one month later)

  • Significant change (p<.001) was reported for total SPRS scores and all sub-scales between admission to and discharge from in-patient rehabilitation.

Bibliography

Draper, K., Ponsford, J., et al. (2007). "Psychosocial and emotional outcomes 10 years following traumatic brain injury." J Head Trauma Rehabil 22(5): 278-287. 

Kuipers, P., Kendall, M., et al. (2004). "Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): psychometric properties." Brain Inj 18(2): 161-177. 

Tate, R., Hodgkinson, A., et al. (1999). "Measuring psychosocial recovery after traumatic brain injury: psychometric properties of a new scale." J Head Trauma Rehabil 14(6): 543-557. 

Tate, R., Simpson, G., et al. (2012). "Sydney Psychosocial Reintegration Scale (SPRS-2): Meeting the Challenge of Measuring Participation in Neurological Conditions." Australian Psychologist 47(1): 20-32. 

Tate, R. L. (2004). "Assessing support needs for people with traumatic brain injury: the Care and Needs Scale (CANS)." Brain Inj 18(5): 445-460. 

Tate, R. L., Simpson, G. K., et al. (2011). "Participation after acquired brain injury: clinical and psychometric considerations of the Sydney Psychosocial Reintegration Scale (SPRS)." J Rehabil Med 43(7): 609-618.