Development of the SCI-BodyMap—Measuring Mental Body Representations in Adults With Spinal Cord Injury: Protocol for Item Generation, Reliability, and Validity Testing

Background Approximately 69% of Americans with spinal cord injury (SCI) have neuropathic pain. Research suggests that impairments in mental body representations (MBRs; ie, representations of the body in the brain) likely contribute to neuropathic pain. Clinical trials in adults with SCI, focused on restoring MBR, led to improvements in sensation and movement as well as neuropathic pain relief. Scales measuring aspects of MBR exist, but none of them assess SCI-related MBR impairments. Objective As our first aim, we will generate items for a new MBR scale for adults with SCI (the SCI-BodyMap). As our second aim, we will assess the interrater reliability, test-retest reliability, concurrent validity, face validity, and utility of the SCI-BodyMap. Methods Our preliminary work will encompass initial item generation by SB, an Italian physical therapist (PT) specialized in cognitive multisensory rehabilitation, which is a therapeutic approach that focuses on restoring MBR in adults with neurological disorders and chronic pain. Further item refinements will be carried out by Italian PTs (n=7) and Brazilian PTs (n=3) specialized in cognitive multisensory rehabilitation. In aim 1, American PTs or occupational therapists (n=8) and adults with SCI (n=8) will provide feedback on the SCI-BodyMap. Next, American PTs or occupational therapists (n=3) will administer the SCI-BodyMap to adults with SCI (n=3) and provide more feedback during an in-person visit. In aim 2, four assessors will administer the SCI-BodyMap to adults with SCI (n=30) for interrater reliability. The self-report items will be administered at 2 separate time points to assess test-retest reliability. We will also administer the SCI-BodyMap to uninjured adults (n=30) to identify whether healthy adults score statistically different on the scale than adults with SCI. We will assess concurrent validity through correlations between the MBR scale, the Revised Body Awareness Rating Questionnaire, and the Multidimensional Assessment of Interoceptive Awareness-2. Results As of August 2025, we have enrolled 8 PTs or occupational therapists and 8 adults with SCI for aim 1 as well as 29 adults with SCI and 13 uninjured adults for aim 2. Conclusions A reliable and valid MBR scale is needed to identify MBR deficits and evaluate intervention effects on MBR outcomes in adults with SCI. Improving MBR can lead to safer, more efficient day-to-day activities (eg, transfers); promote functional independence and quality of life; reduce neuropathic pain and spasms; and improve sensorimotor function. International Registered Report Identifier (IRRID) DERR1-10.2196/72370