BI Asessment Tools
Craig Handicap Assessment and Reporting Technique (CHART)
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The Craig Handicap Assessment and Reporting Technique (CHART) (Whiteneck et al, 1992) was designed to provide a simple, objective measure of the degree to which impairments and disabilities result in handicaps in the years after initial rehabilitation. The original CHART, developed in 1992, included domains to assess five of the WHO dimensions of handicap: 1) Physical Independence: ability to sustain a customarily effective independent existence; 2) Mobility: ability to move about effectively in his/her surroundings; 3) Occupation: ability to occupy time in the manner customary to that person's sex, age, and culture; 4) Social Integration: ability to participate in and maintain customary social relationships; and 5) Economic Self-Sufficiency: ability to sustain customary socio-economic activity and independence. In 2000, the developers of CHART (Craig Handicap Assessment and Reporting Technique), designed and tested the CHART Short Form (SF). To reduce the number of questions in CHART a multi-dimensional analysis plan was designed. First, using data already gathered from a previous study, item-scale and item-total correlation coefficients were calculated for each scale. Second, regression analysis was performed on each subscale with the dependent measure being the scale score and the variables contributing to the subscale acting as the predictor variables. It was hypothesized that each subscale score could be accurately be predicted by fewer items. With two exceptions, the only variables that were selected to be in a subscale were those that entered into a stepwise regression model together explaining over 90% of the variance. Third, once the items had been selected for each subscale, the items were re-scored. Each subscale was computed to have a maximum score of 100, which indicates no handicap in that domain. Furthermore, efforts were made to keep all of the score weightings of the variables proportionate to the original weightings. Fourth, the CHART Short Form items and scoring were evaluated on 1800 persons that contributed to the Behavioral Risk Factor Surveillance System's survey of Colorado residents. As a result, the CHART SF has 19 items that yield the same subscales as the original CHART (32 items). 1. The instrument was designed to be administered by interview, either in person or by telephone. It is possible to use the instrument as a mailed or self-administered questionnaire, although some valuable data potentially would be lost in the absence of interaction with an interviewer providing consistent prompts. 2. It takes approximately 15 minutes to administer. 3. It can be administered to a proxy in the absence of the primary respondent. 4. It can be used with individuals having a range of physical or cognitive impairments. 5. There is no set time period for administering the CHART; however, it is recommended that multiple measurements be taken over the course of a person's lifetime to assess changes with adaptation to the disability and to gain insight into changes in handicap which may occur over time. Each of the domains or subscales of the CHART have a maximum score of 100 points, which is considered at the level of performance typical of the average non-disabled person. Achieving the maximum score indicates that roles within the domain are fulfilled at a level equivalent to that of the norm: an able-bodied person. Subscale scores have routinely been added together to obtain a CHART total score, reflecting overall handicap level. High subscale and total scores (100 and 500, respectively) indicate less handicap, or higher social and community participation. A major asset of the CHART is that it produces an index of handicap. There are a number of ways for a person with a disability to demonstrate the absence of handicap, and the scoring procedures of the CHART give credit to these various behaviors. However, the instrument is designed to measure handicap, not to identify the characteristics shared by 'super-achievers.' Therefore, although it is possible to score more than 100 on most of the sub-scales, a maximum of 100 points has been allowed, as a score of 100 would indicate no handicap in that dimension. It is recognized that value judgments are critical to the actual scoring of many items. These value judgments reflect the expectations of society for non-disabled persons, and a pilot test of the CHART on non-disabled persons was used to calibrate the scoring. The vast majority of non-disabled persons received a score of 100 on each dimension. There are a variety of pre-morbid or post-rehabilitation factors that might explain CHART scores which deviate from the scores of other persons with similar impairments and disabilities. It has been suggested in the literature that certain pre-morbid behaviors, attitudes, and prior life experiences have been found to be correlates of successful rehabilitation outcomes. In addition to pre-existing individual characteristics, post-rehabilitation constraints and limitations may influence CHART scores. These factors include such things as family interference, alcohol or drug use, and awareness of vocational options. While CHART does not isolate any of these causes, it measures the combined consequences to the individual from these various factors. The following guidelines provide detailed instructions on how to compute each CHART dimension score and the total CHART score. It is very simple to calculate these scores manually; however, you may choose to utilize your own computerized data analysis systems. Following the description of the scoring procedures, a series of suggestions and conventions are listed to assist in the interpretation and coding of responses from the CHART. Source Material provided by Craig Hospital. For more information, contact Dave Mellick, MA. Mellick, D. (2000). The Craig Handicap Assessment and Reporting Technique. The Center for Outcome Measurement in Brain Injury. Mellick, D. (2000). The Craig Handicap Assessment and Reporting Technique - Short Form. The Center for Outcome Measurement in Brain Injury. Whiteneck, G.G., Mellick, D., Walker, N., Brooks, C.A., Gerhart, K. Measuring handicap across impairment groups using CHART. World Health Organization. (1980) International Classification of Impairments, Disabilities and Handicaps: A Manual of Classification Relating to the Consequences of Disease. Geneva: World Health Organization. World Health Organization. (1997) International Classification of Impairments, Activities, and Participation: A Manual of Dimensions of Disablement and Functioning, Beta-1 Draft. Geneva: World Health Organization. 
Craig Handicap Assessment and Reporting Technique (CHART Form)
Craig Handicap Assessment and Reporting Short Form (CHART-SF Form)Rater's Instructions
Scoring
Factors Influencing CHART Scores
CHART Scoring Guidelines and Instructions
Contact
References