Quality of Life Concepts

Secondary Health Conditions

Craig Handicap Assessment and Reporting Technique (CHART)

Description: The CHART was developed to assess the degree of handicap experienced by persons with spinal cord injury (SCI) across 6 domains: Orientation, Physical Independence, Mobility, Occupational Functioning, Social Integration, and Economic Self-Sufficiency [1].

Format: 32 items that are combined to provide sub-scale scores.

Scoring: The scoring scale has been calibrated to yield 100 for non-disabled respondents and 0 for persons with maximal handicap. Each domain can receive a maximum score of 100. Domain scores also can be combined to form a total score.

Administration and Burden: The CHART is administered by interview, either in person or over the telephone, and takes approximately 15 minutes. It is also possible to use the instrument as a mailed or self-administered questionnaire, although some data could potentially be lost.

Psychometrics for SCI: Test-retest reliability coefficients for the different sub-scales of the CHART range between .80 and .95. Validity of the scale has been shown to be high for individuals with SCI.

Languages: The CHART has been translated from English into Spanish, Japanese, Chinese, Korean, and Italian.

QoL Concept: The CHART is a measure of handicap, which corresponds to Boxes B (societal standards and priorities) and C (achievements; activities of daily living; community reintegration) of Dijker’s Model.

Permissions/Where to Obtain: Public Domain; The CHART can be obtained at the Centre for Outcome Measurement in Brain Injury at: http://tbims.org/combi/chart/index.html.


  1. Whiteneck G, Charlifue SW, Gerhart KA,olser JD, Richardson GN. Quantifying handicap: A new measure of long-term rehabilitation outcomes. Arch Phys Med Rehabil 1992;73:519-26.


Bowel Dysfunction SCI Studies:

  1. Hicken BL, Putzke JD, Richards JS. Bladder management and quality of life after spinal cord injury. Am J Phys Med Rehabil 2001;80:916-22.

Sensitivity to Impact: Hicken et al. (2001) used the Craig Handicap Assessment and Reporting Technique (CHART) to show that bladder/bowel dependent individuals with spinal cord injury (SCI; n = 53) reported greater overall handicap than their matched SCI bladder/bowel independent peers (n = 53). Specifically, they demonstrated higher impairment in the ‘Physical Independence’, ‘Mobility’, and ‘Occupation’ scores.

Suggestions for Use: The CHART is a recommended tool for the SCI population, but should be augmented with measures of social support when assessing the impact of bladder dysfunction or any other secondary health condition.  A limitation of the CHART is that it only assesses the extent of an individual’s social network, and not important dimensions such as frequency of supportive behaviours offered by support network or the individual’s personal evaluation of the quality of their social support [1].  In addition, it has a ceiling effect for high functioning people with SCI [2].

Because the method of scoring leads to distributions that are not normally distributed, it may be necessary to statistically remove the cap of 100 points. As well, the use of the total score may lead to a misleading summary assessment, it is important to examine scores from each of the domains.

Regardless, the tool is recommended by the Spinal Cord Outcomes Partnership Endeavor’ (SCOPE) [3], which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations.  The endorsement, however, is not specifically for assessing the impact of bowel dysfunction.

Additional References:

  1. Hicken BL, Putzke JD, Richards JS. Bladder management and quality of life after spinal cord injury. Am J Phys Med Rehabil 2001;80:916-22.

  2. Hall KM, Dijkers M, Whiteneck G, Brooks CA, Krause JS. The Craig handicap assessment and reporting technique (CHART): metric properties and scoring. Top Spinal Cord Inj Rehabil 1998;4:16-30.

  3. Alexander MS, et al. Outcome measures in spinal cord injury: Recent assessments and recommendations for future directions. Spinal Cord 2009:1-10.

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