The Catz-Itzkovich SCIM: a revised version of the Spinal Cord Independence Measure

PURPOSE: To examine the suitability of the revised Spinal Cord Independence Measure, the Catz-ltzkovich SCIM, for evaluation of patients with spinal cord lesions, as compared to the original SCIM and to the Functional Independence Measure (FIM). METHOD: The revised SCIM was applied by paired independent teams of occupational therapists, physiotherapists and nurses and the FIM by a single nurse. The examiners assigned scores to the functional capabilities of 28 patients with spinal cord lesions. The scores by the revised SCIM were analysed for reproducibility as between the two teams of examiners (interrater reliability) and for their correlation with the FIM scores. RESULTS: The frequency of identical scoring by two independent examiners (total agreement) was 80% or higher for 13/18 individual functions listed in the revised SCIM. In the self-care category it was 80-99%, as compared to 75-87% before revision. In neither bowel management nor bed mobility was there an increase over the original SCIM in the frequency of identical scores, despite rephrasing and restructuring of the scoring criteria. A high correlation was noted between the paired scores for all functions listed as well as for those comprising each of the four functional categories (r = 0.90-0.96, p <0.001). The total revised-SCIM scores were significantly correlated with those derived by the FIM (r = 0.835, p < 0.001). CONCLUSIONS: The findings indicate that the newly revised SCIM (Catz-Itzkovich) is a valid and highly reproducible measure of daily function in patients with spinal cord lesions, and is superior to the original SCIM. We recommend that it supersede the original SCIM.     

The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study

PURPOSE: To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. METHOD: Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge. RESULTS: Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors. CONCLUSIONS: The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.     

The Spinal Cord Independence Measure (SCIM) version III: Reliability and validity in a multi-center international study

Purpose. To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study.

Method. Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge.

Results. Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P < 0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's α was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P < 0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors.

Conclusions. The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.     

Reliability of the Catz-Itzkovich Spinal Cord Independence Measure assessment by interview and comparison with observation

OBJECTIVE: To examine the reliability of assessment with the Catz-Itzkovich Spinal Cord Independence Measure II (SCIM II) by interview and compare the findings with assessment by observation. DESIGN: In a cohort, comparative study, 28 inpatients with spinal cord lesions were assessed by two nurses using the Catz-Itzkovich SCIM II (interview) and by a multidisciplinary team (observation). RESULTS: Total agreement between interviewers ranged from 50% to 80% (Kappa coefficients 0.40-0.60). Pearson's coefficients of the correlation between scores obtained for the various SCIM subscales by interview or observation were 0.765-0.940 (P < 0.0001). The differences in mean scores obtained between the interview and observation methods were small and not statistically significant for most of the subscales. CONCLUSIONS: The results support the reliability of the Catz-Itzkovich SCIM assessment by interview and show it to be comparable with assessment by observation. The SCIM II interview may serve as an accurate measure of daily function in patients with spinal cord injury. However, with the sample of the study being relatively small, a larger scale examination is needed to generalize the results.     

脊髓独立测量量表Ⅱ中文版的开发及信度和效度研究

目的：脊髓独立测量量表第2版（Spinal Cord Independence MeasureⅡ,SCIM-Ⅱ）是由劳温斯坦康复医院研制并用于脊髓损伤患者的功能评估的专用量表。研制脊髓独立测量量表Ⅱ中文版并检验其信度和效度。方法：完成量表的汉化,对87例脊髓损伤的患者进行测试,评价SCIM-Ⅱ中文版内部一致性信度、重测信度和测量者间的信度,检验量表的标准效度、内容效度和结构效度。其中标准效度以功能独立测量（FIM）为效标。结果：量表的4个领域中Cronbach′s系数为0.829-0.943;重测信度和测量者间的信度系数均大于0.9。因子分析显示4个公共因子累计方差贡献率为86.1%;各领域与总量表得分的相关系数0.728-0.871;与FIM中文版相比,各领域间有着高度的相关性（r〉0.808;P〈0.01）。结论：SCIM-Ⅱ中文版具有较好的信度和效度,适用于脊髓损伤患者的功能评估。     

Development and validation of the Italian version of the Spinal Cord Independence Measure III

Purpose.?To provide a translation and cultural adaptation of the Spinal Cord Independence Measure version III scale for Italy (i-SCIM3) and to validate this version of the scale.

Method.?i-SCIM3 was developed involving a forward–backward translation and administered to patients with spinal cord lesions (SCL) admitted to two centers. Two raters for each center evaluated patients at admission and discharge. Psychometric testing included reliability by internal consistency (Cronbach's α) and test–retest reliability. The validity of i-SCIM3 was assessed by comparing it with the Italian version of Functional Independence Measure? (FIM?).

Results.?One hundred three adult patients with SCL (84 males) with a mean age of 50.33?±?15.35 years were recruited. Seventy-four patients were paraplegic and 29 patients were tetraplegic. The median time elapsed between the two evaluations was 77.5 days (interquartile range, 53–144 days). Internal consistency, inter-rater reliability, and test–retest reliability were satisfactory overall, showing values higher than 0.90. The validity of i-SCIM3 was confirmed by the close correlation with FIM results both at admission and discharge (r?=?0.91, p?<?0.01). The sensitivity to change of i-SCIM3 was similar to that of FIM.

Conclusion.?i-SCIM3 was found to be a consistent, reliable, and valid scale for use in the clinical setting. It is the first validated scale in Italian for patients with SCL.     

Applicability,validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions

Purpose: To verify the applicability, reproducibility and validity of the SCIM III patients with non-traumatic spinal cord injury.

Method: The cross-sectional study included 30 patients (66% females; 41.5?±?14.7 yo) with non-traumatic spinal cord injury of any etiology. Subjects were subjected by computerized gait analysis and answered the Brazilian versions of SCIM III (0–100 points) and FIM? (18–126 points) by two raters (A and B) at the same day and 1 week later (A).

Results: The intraclass correlation coefficient for the use of SCIM III indicated appropriated intra- and inter-evaluator reproducibility (ICC?=?0.9). Correlation between the SCIM III and the motor FIM? was appropriate (r?=?0.6; p?=?0.0). SCIM III subscales and FIM? domains correlated strongly for self-care (r?=?0.8; p?≤?0.001), moderately for transfers (r?=?0.6; p?=?0.0005) and locomotion (r?=?0.6; p?=?0.0006). SCIM III mobility subscale positively correlated with the cadence (r?=?0.8; p?≤?0.01), gait speed (r?=?0.7; p?≤?0.01) and step length (r?=?0.6; p?≤?0.01).

Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with non-traumatic spinal cord injury. The SCIM III is more sensitive than the MIF? for non-traumatic spastic paraplegic patients with higher levels of independence, particularly if they can walk independently. Linear gait parameters correlated with its mobility subscale.

• Implications for Rehabilitation

• Applicability, validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions.

• There are not many studies focused on patients with non-traumatic spinal cord lesion.

• Disability varies in severity, but frequently contributes to limitations in the activities of daily living (ADL) and participation.

• We do not find in the literature studies that assess the functionality of these individuals as comprehensive as ours.

     

脊髓独立性评定及其第3版介绍

功能能力评定是脊髓损伤患者功能结局评定的主要项目之一。目前常用评定脊髓损伤患者功能能力的量表有Bar-thel指数、修订Barthel指数、功能独立性评定、脊髓独立性评定、脊髓损伤步行指数等。其中,脊髓独立性评定是为评价脊髓损伤患者的功能能力而专门设计的量表,已经过两次修订和国际多中心试验验证,具有良好的信度、效度和灵敏性,可适用于不同文化背景下的脊髓损伤患者的功能能力评定。但该评定方法也存在一定的局限性,需要进一步完善。     

Development of the Spanish version of the Spinal Cord Independence Measure version III: cross-cultural adaptation and reliability and validity study

Abstract

Purpose: To provide a translation and cross-cultural adaptation of the Spinal Cord Independence Measure (SCIM) version III for Spain and to validate the Spanish version of the SCIM III (eSCIM III). Patients and methods: Development of eSCIM III has involved translation, back-translation and assessment of cultural equivalence procedures. eSCIM version III, was administered to 64 patients with spinal cord injury, admitted to our hospital. Investigation of the psychometric characteristics included: (1) study of the inter-rater reliability, (2) internal consistency (Cronbach’s α), (3) validation and confirmation of the correlation between eSCIM III and Functional Independence Measure (FIM), and (4) sensitivity to change. Results: The reliability of eSCIM III showed an intra-class coefficient value >0.97 in the different subscales assessed. Internal consistency of eSCIM III was shown by a Cronbach’s α value of 0.93. The validity of eSCIM III was confirmed by the close correlation with FIM (r?=?0.94, p?<?0.0001). The sensitivity to change of eSCIM III was also confirmed. Conclusions: eSCIM III was found to be culturally equivalent to the original version, as reliability and validity of this tool were demonstrated. It can be used in Spain for functional assessment of patients with spinal cord injury.

• Implications for Rehabilitation

• Development of the Spanish version of the Spinal Cord Independence Measure version III.

• The importance of the adaptation of Spinal Cord Independence Measure (SCIM) is that it guarantees the possibility of measuring the same concept in different cultures and countries.

• The eSCIM III is the first, specific assessment tool in patients with spinal cord injury adapted for its use in Spain.

• The eSCIM III is a tool conceptually equivalent to the original version. It has the reliability and validity of SCIM III in order to be used by clinicians.

     

313例脊髓损伤患者FIM评定结果分析

目的探讨不同损伤平面、不同损伤程度的脊髓损伤(SCI)患者日常生活活动(ADL)状况的特点。方法对313例SCI住院患者进行功能独立性评定(FIM)评分,根据损伤平面和损伤程度的不同,将FIM评定的得分情况进行统计学分析。结果颈、胸、腰髓损伤患者的得分差异有显著性意义(P<0.05~0.01);随损伤平面的降低,FIM评分升高;同一损伤平面不同损伤程度的SCI患者的FIM评分差异有显著性意义(P<0.05~0.01),但腰髓完全性和不完全性SCI患者的FIM评分差异无显著性意义(P>0.05)。结论FIM评分可客观反映不同损伤平面、不同损伤程度SCI患者的ADL状况。     

Reference Values and Cutoff Scores of the Spinal Cord Independence Measure III to Determine Independence for Wheelchair Users and Ambulatory Individuals With Spinal Cord Injury

ObjectiveTo establish the reference values and optimal cutoff scores of the Spinal Cord Independence Measure Version III (SCIM III) to indicate independence of wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI).DesignA cross-sectional study.SettingTertiary rehabilitation center and communities.ParticipantsA total of 309 (168 WU and 141 AM) participants with SCI.InterventionsNot applicable.Main Outcome Measure(s)SCIM III scores.ResultsParticipants with greater levels of independence had significantly higher SCIM III scores, both total and subitem scores (P<.05). The SCIM III scores of ≥55 and ≥75 were optimal indicators of modified independence in WU and AM individuals, respectively (sensitivity and specificity >93%, AUC>.95). In addition, scores of 90 were proved to be excellent indicators for independence of AM individuals (sensitivity 94%, specificity 100%, AUC=.99).ConclusionsThe present findings provide the reference values of SCIM III scores covering WU and AM individuals with SCI at various levels of independence as well as optimal cutoff scores to indicate independence of these individuals. These data can be used as standard criteria for data comparison with patients’ ability, and target functional values for individuals with SCI in clinical-, community-, and home-based settings.     

Spinal Cord Independence Measure: comprehensive ability rating scale for the spinal cord lesion patient

The Spinal Cord Independence Measure (SCIM) is, at present, the only comprehensive rating scale that measures the ability of patients with spinal cord lesions (SCL) to perform everyday tasks according to their value for the patient. This article describes the scale and its scoring techniques, presents the purposes for which SCIM is used, and details its advantages for patients with SCL. Findings of an international multicenter study supported the validity and reliability of its third version, despite intercultural differences, and demonstrated its superior sensitivity to changes in function compared with the Functional Independence Measure. SCIM can be used in patients with SCL for ability assessment, as a compact guide for determining certain treatment goals, and for outcome assessment following interventions designed to promote recovery.     

脊髓独立性评定(第3版)

自我照顾(0-20分) 1进食(切、打开罐装食物、倒、把食物送进嘴、握住装液体的杯子)     

Reliability Validity and Responsiveness of the Spinal Cord Independence Measure 4th Version in a Multicultural Setup

ObjectiveTo examine the fourth version of the Spinal Cord Independence Measure for reliability and validity.DesignPartly blinded comparison with the criterion standard Spinal Cord Independence Measure III, and between examiners and examinations.SettingA multicultural cohort from 19 spinal cord injury units in 11 countries.ParticipantsA total of 648 patients with spinal cord injury.InterventionAssessment with Spinal Cord Independence Measure (SCIM IV) and Spinal Cord Independence Measure (SCIM III) on admission to inpatient rehabilitation and before discharge.Main outcome measuresSCIM IV interrater reliability, internal consistency, correlation with and difference from SCIM III, and responsiveness.ResultsTotal agreement between examiners was above 80% on most SCIM IV tasks. All Kappa coefficients were above 0.70 and statistically significant (P<.001). Pearson's coefficients of the correlation between the examiners were above 0.90, and intraclass correlation coefficients were above 0.90. Cronbach's alpha was above 0.96 for the entire SCIM IV, above 0.66 for the subscales, and usually decreased when an item was eliminated. Reliability values were lower for the subscale of respiration and sphincter management, and on admission than at discharge. SCIM IV and SCIM III mean values were very close, and the coefficients of Pearson correlation between them were 0.91-0.96 (P<.001). The responsiveness of SCIM IV was not significantly different from that of SCIM III in most of the comparisons.ConclusionsThe validity, reliability, and responsiveness of SCIM IV, which was adjusted to assess specific patient conditions or situations that SCIM III does not address, and which includes more accurate definitions of certain scoring criteria, are very good and quite similar to those of SCIM III. SCIM IV can be used for clinical and research trials, including international multi-center studies, and its group scores can be compared with those of SCIM III.     

脊髓独立性评定量表Ⅲ与功能独立量表灵敏度的比较

目的：观察和比较脊髓独立性评定量表Ⅲ（SCIM-Ⅲ）中文版的灵敏度,探讨其在中国推广的价值。方法：利用现有的汉化版SCIM-Ⅲ对20例脊髓损伤（SCI）患者进行2次测评,间隔1个月。通过数据的统计学处理分析SCIM-Ⅲ中文版的灵敏度,并与已被广泛认可的功能独立量表（FIM）比较。结果：20例患者SCIM-Ⅲ中的4个领域以及总分评分1个月前后差异均有统计学意义（P〈0.05）,由统计量反映出SCIM-Ⅲ的敏感度高于FIM（P〈0.05）。结论：FIM和SCIM-Ⅲ均可反映SCI患者的功能变化,但SCIM-Ⅲ的灵敏度反应高于FIM量表。     

Turkish adaptation of Spinal Cord Independence Measure--version III

Various rating scales have been used to assess ability in individuals with spinal cord injury. There is no specific functional assessment scale for Turkish patients with spinal cord injury. The Spinal Cord Independence Measure (SCIM) is a specific test, which has become popular in the last decade. A study was conducted to validate and evaluate the Turkish adaptation of the SCIM III (T-SCIM III). The SCIM III was translated into Turkish. Reliability, (internal consistency, interrater reliability, and test-retest reliability), validity (with Functional Independence Measurement), and sensitivity (changes in 8-week exercise program) were studied. Internal consistency for total score was sufficient (Cronbach α=0.79). The interrater reliability was moderate to high (Cohen κ between 0.72 and 1). Convergent validity was high (r=0.89, P<0.01). The T-SCIM III was found to be more sensitive than the Functional Independence Measurement to changes in function. Hence, we recommend the use of T-SCIM III in clinical practice as a reliable, valid, and easy-to-use tool.     

Transforming a Traumatic Brain Injury Measure of Participation Into a Psychometrically Sound Spinal Cord Injury Participation Measure

ObjectiveTo evaluate the use of Participation Assessment with Recombined Tools–Objective (PART-O) in spinal cord injury (SCI) and compare it with the Craig Handicap Assessment and Reporting Technique–Short Form (CHART-SF).DesignFollow-up survey of inception cohort.SettingCommunity.ParticipantsIndividuals with SCI, rehabilitated at 2 large SCI Model Systems and enrolled in the SCI Model Systems National Database, who were due for routine follow-up (N=468; median age at injury, 29; median time post injury, 5 years).InterventionsNot applicable.Main Outcome MeasuresPART-O and CHART-SF.ResultsUse of Rasch analysis identified an SCI-specific scoring of PART-O that demonstrated unidimensionality (first contrast eigenvalue of 1.76) with no misfitting items or disordered steps in any response categories. Person separation and reliability were 2.00 and .80, respectively. Unlike CHART-SF, PART-O had a relatively normal distribution with no floor or ceiling effects. Test-retest reliability PART-O administered 2-4 weeks apart was 0.97, with a reliable change index of 3.1 points on a 100-point scale. PART-O correlated 0.79 with the sum of 3 CHART-SF domains with similar content. The PART-O scoring was initially validated on a second data set.ConclusionsPART-O can be used successfully to measure participation in a population of people with SCI. A new method of scoring PART-O in SCI provides an initially validated, univariate interval measure of participation with good psychometric properties that has advantages over the CHART-SF legacy measure of participation.     

Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke

Purpose: To translate and cross-culturally adapt the Functional Independence Measure (FIM) into the Persian language and to test the reliability and validity of the Persian FIM (PFIM) in patients with stroke. Method: In this cross-sectional study carried out in an outpatient stroke rehabilitation center, 40 patients with stroke (mean age 60 years) were participated. A standard forward–backward translation method and expert panel validation was followed to develop the PFIM. Two experienced occupational therapists (OTs) assessed the patients independently in all items of the PFIM in a single session for inter-rater reliability. One of the OTs reassessed the patients after 1 week for intra-rater reliability. Results: There were no floor or ceiling effects for the PFIM. Excellent inter-rater and intra-rater reliability was noted for the PFIM total score, motor and cognitive subscales (ICC_agreement 0.88–0.98). According to the Bland–Altman agreement analysis, there was no systematic bias between raters and within raters. The internal consistency of the PFIM was with Cronbach's alpha from 0.70 to 0.96. The principal component analysis with varimax rotation indicated a three-factor structure: (1) self-care and mobility; (2) sphincter control and (3) cognitive that jointly accounted for 74.8% of the total variance. Construct validity was supported by a significant Pearson correlation between the PFIM and the Persian Barthel Index (r?=?0.95; p?Conclusions: The PFIM is a highly reliable and valid instrument for measuring functional status of Persian patients with stroke.

• Implications for Rehabilitation

• The Functional Independence Measure (FIM) is an outcome measure for disability based on the International Classification of Functioning, Disability and Health (ICF).

• The FIM was cross-culturally adapted and validated into Persian language.

• The Persian version of the FIM (PFIM) is reliable and valid for assessing functional status of patients with stroke.

• The PFIM can be used in Persian speaking countries to assess the limitations in activities of daily living of patients with stroke.

     

PIM2: a revised version of the Paediatric Index of Mortality

OBJECTIVE: To revise the Paediatric Index of Mortality (PIM) to adjust for improvement in the outcome of paediatric intensive care. DESIGN: International, multi-centre, prospective, observational study. SETTING: Twelve specialist paediatric intensive care units and two combined adult and paediatric units in Australia, New Zealand and the United Kingdom. PATIENTS: All children admitted during the study period. In the analysis, 20787 patient admissions of children less than 16 years were included after 220 patients transferred to other ICUs and one patient still in ICU had been excluded. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: A revised model was developed by forward and backward logistic regression. Variable selection was based on the effect of including or dropping variables on discrimination and fit. The addition of three variables, all derived from the main reason for ICU admission, improved the fit across diagnostic groups. Data from seven units were used to derive a learning model that was tested using data from seven other units. The model fitted the test data well (deciles of risk goodness-of-fit chi(2 )8.14, p=0.42) and discriminated between death and survival well [area under the receiver operating characteristic (ROC) plot 0.90 (0.89-0.92)]. The final PIM2 model, derived from the entire sample of 19638 survivors and 1104 children who died, also fitted and discriminated well [chi(2 )11.56, p=0.17; area 0.90 (0.89-0.91)]. CONCLUSIONS: PIM2 has been re-calibrated to reflect the improvement that has occurred in intensive care outcome. PIM2 estimates mortality risk from data readily available at the time of ICU admission and is therefore suitable for continuous monitoring of the quality of paediatric intensive care.