R2. Seating & Mobility Index (SMI) as an Assessment & Classification Protocol for Complex Rehabilitation Technology (CRT)

Project Leader(s): Rachel Hibbs, DPT, NCS, ATP & Gianna Rodriguez, MD

Co-Leaders:  Julie Mannlein, PT, ATP, Theresa Berner, OTR, ATP, Melissa Wright, PT, ATP, & Lauren Terhorst PhD

Other Project Personnel: Madelyn Betz, BS


One of the largest problems the field of CRT faces is funding and reimbursement for the technology. Documentation is not uniform from clinic to clinic, and it can be difficult to numerically measure the client’s need for different devices. The Centers for Medicare & Medicaid (CMS) coverage policies for CRT devices are also based more on diagnostic criteria and use within the home rather than the functional or participation needs of the person. The overall objective of this project is to systematically develop a unified and validated method for clinicians to assess and quantify a person’s need for different types and levels of CRT based on function, participation, and environmental factors rather than diagnosis. The tool will be called the Seating & Mobility Index (SMI) whereby items will be developed and operationally defined based on the International Classification of Function, Disability, and Health (ICF) constructs of body structures and function, activities and capacity, participation and performance (individual and societal), contextual factors (personal and environmental), and the importance of how these components affect and influence factors internal and external to an individual’s health status.

The clinical development and testing will be done so collaboratively through the University of Pittsburgh, The Ohio State University, and the University of Michigan all high-ranking academic institutions with Assistive Technology Centers. The project will be guided by an Advisory Group and other DRRP Team Members. This includes people with disabilities who will provide input on the development of the SMI. They will provide input into the components of the tool related to meaningfulness and burden during a CRT assessment. Clinician groups outside the project will also be engaged to assist with content validation.

The anticipated outcome of this project will be a first of its kind Seating & Mobility Index that has undergone initial content validation and inter-rater reliability as an indicator for levels of CRT interventions. It will streamline and standardize many components of the CRT assessment process to reduce burdens and more effectively document and communicate need and justification for interventions for insurance review purposes. It will also be used to build a new CRT policy model.


As of December 1, 2021

Thus far, the focus of activities has been on reviewing and evaluating existing classification systems and existing standardized and validated tools related to CRT assessment. Regarding existing classification systems, the K-Level and L-Codes used for lower limb amputees who use prostheses was found to be most similar to the proposed SMI in that it matches a level of function (or potential level of function) with a type of device recommendation (prosthetic device). Clinicians utilize a variety of functional assessments to determine an amputee’s K-Level, however these functional assessments are not standardized, as proposed for the SMI.

A review of current systematic reviews of assessment tools for measures of physical function or status, environment, participation, and activity that are related to a person’s need to use CRT was undertaken. Five hundred twelve systematic reviews were screened for inclusion, of which 223 were included for full text review to identify tools that could potentially be included as part of the SMI. From this search, 317 assessment tools were identified to be further evaluated. The team is currently reviewing these tools for clinical utility and validity to prepare a manageable list for use in survey of professionals in the field. In preparation of survey of professionals in the field, a template of the survey questions has been drafted for use when the initial list of 317 articles has been reviewed and whereby the team has eliminated tools for inclusion to less than 30.

The development of a survey for clinicians is in progress which will be followed by other stakeholder surveys for the use of objective measures. A team of clinical expert panels are reviewing and determining which measures to include in the survey based on specific clinical categories for evaluation for CRT (e.g., function for ADLs, current mobility, ambulation, wheeling, strength, coordination, balance, posture, pain, quality of life, etc.). The R2 project team is determining the best method of distributing survey to clinicians (i.e., clinical tool) and then a second survey for CRT suppliers (i.e., environmental tools).


Semancik, B., Schmeler, M.R., Schein, R.M., & Hibbs, R. (2021). Face Validity of Standardized Assessments for Wheeled Mobility & Seating Evaluations. Published online ahead of print, 2021 Sep 30. Assistive Technology. https://doi.org/10.1080/10400435.2021.1974980  

University of Pittsburgh, Network ISS: A Prelude to Pittsburgh (Producer). (2021). Complex Rehabilitation Technology Service Delivery and Clinical Assessment Research: What Happens Behind the Curtain. http://rstce.pitt.edu/RSTCE_Webinar/2021/RSTCE_ISSWS2021.04.html    

  • in collaboration with the R1 project and with invited panelists

‘Background and Development of a Seating & Mobility Index (SMI)’ – accepted for presentation at the 2021/2022 International Seating Symposium (ISS), Pittsburgh, PA, USA.

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