Citation Mellick, D. (2000).
The Craig Handicap Assessment and Reporting Technique. The
Center for Outcome Measurement in Brain Injury. http://www.tbims.org/
combi/chart ( accessed
This citation is for the COMBI web material. Mr. Mellick is
not the scale author for the CHART.
to the Craig Handicap Assessment and Reporting Technique
World Health Organization (WHO) describes a conceptual model of
disablement which includes impairment at the organ level, disability
describing functional status, and "handicap," or more recently,
"participation, " encompassing the roles one plays in the world
and society. Despite its importance as a rehabilitation goal, handicap
(absence of social participation) is the least often measured of
all rehabilitation outcomes. Although decades of research and numerous
instruments have been developed devoted to the assessment of impairment
and disability, equal efforts have not been directed towards the
comprehensive assessment of handicap.
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.
original CHART consisted of 27 questions and employed up to seven
questions in each of five domains to quantify the extent to which
individuals fulfill various social roles. Items focus on observable
criteria and have been worded to minimize ambiguity and promote
a consistent interpretation.
WHO model includes a sixth dimension of handicap called "Orientation"
(ability to orient oneself to his/her surroundings). Although not
addressed in the original CHART, the revised CHART contains a sixth
domain designed to assess "orientation", entitled "Cognitive Independence"
(Mellick et al, 1999). In 1995, this new five question domain was
added to the CHART, now adding up to a total of 32 questions in
the overall instrument.
of the domains or subscales of the CHART have a maximum score of
100 points, which is considered 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. High subscale
scores indicate less handicap, or higher social and community participation.
instrument was designed to be administered by interview, either
in person or by telephone and takes approximately 15 minutes to
administer. Participant-proxy agreement across disability groups
on the CHART has provided evidence in support of the use of proxy
data for persons with various types of disabilities. 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.
initially developed for use with persons with spinal cord injury,
the revised CHART has since been found to be an appropriate measure
of handicap that can be used with individuals having a range of
physical or cognitive impairments. 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.
regarding the CHART was provided by Craig
Hospital. Please contact Dave Mellick, MA, at
you find the information in the COMBI useful, please mention it
when citing sources of information. The information on the Craig
Handicap Assessment and Reporting Technique may be cited as:
Mellick, D. (2000). The Craig Handicap Assessment and Reporting
Technique. The Center for Outcome Measurement in Brain Injury.
http://www.tbims.org/combi/chart ( accessed
This citation is for the COMBI web material. Mr. Mellick is not
the scale author for the CHART.