Objectives The purpose of this study was to determine which stratification (anatomical versus functional) forms a better construct for classification of para surfers with spinal cord injury; to assess the groupings of these para surfers; and to evaluate the strength of association between manual muscle testing and surfing performance. Design Cross-sectional. Methods Archived data from classification records including demographics, spinal cord injury levels, trunk strength, and limb strength were compared to judged wave scores and competition rankings. Results Participants (n=70, male n=56; female n=14) met inclusion criteria and were classified into Para Surfing Kneeling (n=9); Sit (n=11); Prone 1 (n=25); and Prone 2 (n=25) sport classes. Reliability statistics showed that functional grouping (Cronbach's a=0.759) is better grouped with strength testing and rankings compared to anatomical grouping (Cronbach's a=0.721). Under exploratory factor analysis with 2 fixed components, based on the factor loadings (rank and strength) functional stratification (0.978) is better aligned compared to anatomical stratification (0.785) for grouping of surfers. Further, the association and impact of strength with functional spinal cord level stratification were confirmed using regression analysis (chi-square of 74.06 with p-value < .0001). Conclusions Trunk and limb strengths have been shown to influence wave riding performance in surfers with spinal cord injury. Surfers with spinal cord injury can equitably be classified into one of the four para surfing sport classes. The use of functional stratification of spinal cord injury with trunk and limb strengths should be considered as an integral component in para surfing athlete sport classification.
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