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 June 1, 2022

Sub-Project #1: Review of Literature

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 41. A clinically relevant table of these tools is being developed with information gathered from review process for distribution to clinician reference.

Dissemination Activities

A clinically relevant table listing outcome tools associated with wheeled mobility and seating assessments filtered by ICF Categories, hyperlinks to more information of the tool and what it measures can be downloaded below.

Sub-Project #2: Clinician Viewpoints on Implementation of Outcomes Survey

  • An online survey was prepared for clinical professionals in the field and approved by the IRB based on results from sub-project #1
  • Online survey distributed to clinical experts in the field with 30+ responses. Results are currently being analyzed

Dissemination Activities

Results to be presented as a conference paper followed by a manuscript to be submitted to an appropriate journal

Sub-Project #3: Development of Clinical Documentation

Members of R2 team, specifically at least one team member from each of the academic medical centers that have a seating clinic (i.e., University of Pittsburgh, The Ohio State University, and University of Michigan) are collaborating to create a checklist verifying each other’s documentation template of incorporating objective measures for each component of the assessment. The process will encompass best practice guidelines as described in the RESNA Wheelchair Service Provision Guide with additional objective measures included to be used at the discretion of the clinician from sub-project #1

Dissemination Activities

A copy of each of the documentation templates from the seating and mobility clinics will be disseminated and posted on the website

Sub-Project #4: Development of Seating Mobility Index (SMI)

Currently, team members are developing a draft template of the SMI. The SMI will be internally evaluated by its usefulness as a decision tool in determining clinical assessments, along with performing and arriving at a device as an outcome. Additional consideration includes choosing tools from different categories and summing the scores of the tools to inform which device is appropriate. This draft will be used to add the tools evaluated and surveyed as outlined above and will be tested prior to testing with model case studies. A statistical methodologist and team members are developing a strategy for creation of the SMI with subject matter experts and consumer input regarding length and type of assessments.

Dissemination Activities

Future conference papers to present findings, webcasts (collaboration with Clinician Task Force and/or internal Continuing Education program), creation of education training materials, Magazine/News Outlets (HME News/Mobility Management w/ Laurie Watanabe) and appropriate journal articles.

Other Project Dissemination Activities

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/10.1080/1 0400435.2021.1974980

In collaboration with the R2 project and with invited panelists an ISS Webinar Series: Network ISS. 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/RST CE_Webinar/2021/RSTCE_ISS WS2021.04.html

Hibbs, R., Rodriguez, G., Mannlein, J., & Wright, M. (2022, February). Development of the Seating Mobility Index. International Seating Symposium (ISS). https://www.seatingsymposium.us/event-schedule/event/3

The contents of this website were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPGE0014-01-00). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this website do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.