Development & Validation of a Sitting-Balance Confidence Scale for Non-Ambulatory Persons with Physical Impairments: Application to Sport and Physical Activity

Background/Objectives: Participation in sport and daily activities among individuals with spinal cord injury (SCI) is influenced not only by physical capacity but also by psychological factors such as balance confidence. Existing measures primarily assess performance or fear of falling, leaving a gap in evaluating perceived sitting balance ability. This study aimed to (1) develop a Patient-Reported Sitting Balance Confidence (PR-SBC) scale for non-ambulatory individuals with SCI, (2) incorporate participation-based activities relevant to community and sport, and (3) evaluate its psychometric properties. Methods: Scale development used a Delphi process with clinicians, researchers, individuals with SCI, and care partners to refine items. The final 19-item PR-SBC was administered to 31 individuals with SCI (inpatient and outpatient). Inter-rater reliability was assessed using intraclass correlation coefficients (ICC), internal consistency via Cronbach’s alpha, and criterion validity through correlation with the SCI Falls Concern Scale (SCI-FCS). Exploratory regression analyses examined demographic and clinical predictors of PR-SBC scores. Results: The PR-SBC demonstrated excellent inter-rater reliability (ICC = 0.953) and strong internal consistency (α = 0.931). Criterion-related validity showed a moderate inverse correlation with SCI-FCS scores (r = −0.512). Outpatient setting and manual wheelchair use were associated with higher balance confidence, while injury-related variables were not significant predictors. Conclusions: The PR-SBC is a reliable and valid instrument for assessing sitting balance confidence in individuals with SCI. By capturing perceived balance across functional and participation contexts, it complements existing measures and may support improved clinical decision-making, targeted interventions, and enhanced participation outcomes.