Introduction to the Craig Handicap Assessment and Reporting Technique

The 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.

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.

The 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.

The 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.

Each 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.

The 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.

While 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.

Information regarding the CHART was provided by Craig Hospital. Please contact Dave Mellick, MA, at for more information.

If 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 ).*

*Note: This citation is for the COMBI web material. Mr. Mellick is not the scale author for the CHART.