Craig Handicap Assessment and Reporting Technique — Measuring Participation in Social Roles
Craig Handicap Assessment and Reporting Technique (CHART) · Also known as: CHART, CHART-SF
The Craig Handicap Assessment and Reporting Technique (CHART) is a comprehensive interview-based measure designed to quantify how much a disabling condition restricts participation in six key social roles: physical independence, mobility, occupation, social integration, economic self-sufficiency, and cognitive independence. Developed by Whiteneck and colleagues at the Craig Hospital (now national leader in spinal cord injury care), CHART has become the gold-standard outcome measure for long-term spinal cord injury and traumatic brain injury follow-up, extensively used in international outcomes research.
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When to use it
CHART is the standard outcome measure for (1) long-term spinal cord injury outcomes (1–20+ years post-injury); (2) long-term traumatic brain injury outcomes, particularly focus on work/social participation; (3) international comparative research on spinal cord injury (standardized across countries in studies like the International SCI Community Survey); (4) quality-of-life and participation research in severe disability populations (major amputation, ventilator-dependent, locked-in syndrome); (5) program evaluation in long-term disability services, vocational rehabilitation, and independent living programs. CHART is less applicable to acute phase (<1 year) or populations with expected rapid recovery. Most extensively validated in spinal cord injury; also used in TBI, spinal cord disease (MS, ALS), and traumatic amputation.
Strengths & limitations
- Gold standard for long-term participation outcomes: decades of spinal cord injury research establish CHART as the benchmark measure. Enables comparison across international studies and time periods.
- Measures actual performance, not capacity: asks 'How many hours did you work last week?' not 'Are you able to work?' Captures real-world engagement, not theoretical potential.
- Six comprehensive life-role domains: covers physical independence, mobility, work, social engagement, financial independence, and cognitive management—the full spectrum of participation.
- Naturally interpretable scores: respondents answer in familiar units (hours, people, dollars); researchers then convert to 0–100 scales. Transparent measurement.
- Sensitive to both improvements and declines: CHART can detect positive change (e.g., return to work) and negative change (e.g., loss of employment, social withdrawal) over decades.
- Validated across cultures and countries: used in international studies (U.S., Canada, Europe, Australia); culturally adapted versions available.
- Accommodates severe disability: no floor effect; persons who are non-ambulatory, non-communicative, or require 24-hour care can be assessed for occupational, social, and economic participation.
- Interview required for best accuracy: while self-report version exists, interview is preferred; requires trained assessor familiar with disability nuances. Cost/time barrier in some settings.
- Scoring complexity: converting natural units to domain scores requires published algorithms or software. Not as straightforward as summing Likert responses. Training needed.
- Relies on self/proxy report of past 12 months: retrospective recall bias. Someone may not accurately remember work hours, social frequency, or income. Extraneous life events may distort recall.
- Limited by environmental opportunity: a person's CHART score reflects both their ability and the opportunities available (job market, accessible housing, social connections). Identical impairment can yield very different CHART scores based on location and resources.
- Ceiling effects in high-functioning populations: someone already highly employed, socially engaged, and financially independent will score 500+ (near-maximum); little room to show further improvement.
- Floor effects in very severe cases: non-communicative, medically complex persons may be difficult to interview; proxy report may have limited validity.
- Long baseline assumption: assumes respondent can recall and accurately report 12-month pattern. Acute life changes or memory impairment complicate measurement.
Frequently asked
How is CHART different from WHODAS 2.0 or CIQ?
WHODAS measures functional limitation (difficulty with tasks); CIQ measures community participation in three domains (home, social, productive). CHART measures participation in six broader life roles (including economic self-sufficiency and cognitive independence) and is specifically designed for chronic long-term outcomes. CHART responses are in natural units (hours, people, dollars) converted to scores; WHODAS/CIQ use Likert scales. In TBI/SCI, CHART is standard for long-term (5+ years) outcomes; WHODAS or CIQ are quicker for acute/intermediate phases.
Can CHART be administered via telephone?
Yes, CHART can be administered via telephone interview. Telephone administration by trained interviewer is acceptable and used in longitudinal studies. In-person interview is preferred for greater detail and clarification, but telephone is feasible for follow-up assessment.
What is clinically meaningful change in CHART?
Approximately 50 points on the total CHART score (out of 0–600) or 10 points on an individual subscale (out of 0–100) represents clinically meaningful change. Larger changes (100+ points) are considered substantial improvement or decline. However, context matters: a person returning to work might gain 100+ points; someone maintaining current status but declining in one domain might lose 25–50 points.
Can CHART be used in acute rehabilitation (first months post-injury)?
CHART is not recommended for acute phase (0–3 months) when social roles are disrupted and person is in active rehabilitation. CHART is most valid 1 year post-injury onward, when a new baseline in work, living, and social patterns has been established. Use acute measures (FIM, NIHSS) in acute phase; transition to CHART for long-term follow-up.
How do I score CHART if someone doesn't work?
If someone is not employed, not in school, and not managing household tasks (all zero values for Occupation domain), their Occupation score is 0. This is accurate—they have no participation in occupational roles. However, context matters: retirement, full-time caregiving, or disability pension are valid reasons for zero Occupation score. Document the reason in narrative notes.
Is CHART free to use?
Yes, CHART is in the public domain and may be used without license fees. The full CHART interview form and CHART-SF are available through the Craig Hospital or published literature. Scoring algorithms are published in the original papers; some commercial software packages include CHART scoring. Always cite Whiteneck et al. (1992) when publishing CHART results.
How do I obtain CHART scoring software or conversion tables?
CHART scoring algorithms are published in the original Whiteneck et al. (1992) paper and in CHART user manuals available through Craig Hospital. Hand-calculation is possible but tedious; many research institutions have developed Excel spreadsheets or software for automated scoring. Contact Craig Hospital or CHART developers for current resources.
Can CHART be completed by proxy (caregiver or family member)?
CHART can be administered to a proxy respondent (family member, caregiver, clinician) when the person is non-communicative or cognitively unable to self-report. However, proxy-self agreement is moderate (r 0.60–0.75), particularly for occupation, social, and financial items where proxy may have limited exposure. Self-report is preferred when feasible. Always note whether score is self- or proxy-report.
Sources
- Whiteneck, G. G., Charlifue, S. W., Gerhart, K. A., Overholser, J. D., & Richardson, G. N. (1992). Quantifying handicap: a new measure of long-term rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 73(6), 519–526. link ↗
- Charlifue, S., Post, M. W., & Biering-Sørensen, F. (2012). International Spinal Cord Injury Community Survey: does the use of different outcome measures lead to different conclusions about quality of life after spinal cord injury? Spinal Cord, 50(6), 457–463. link ↗
How to cite this page
ScholarGate. (2026, June 3). Craig Handicap Assessment and Reporting Technique (CHART). ScholarGate. https://scholargate.app/en/rehabilitation-science/craig-handicap-assessment
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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