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.

     

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。     

Translation into Greek and initial validity and reliability testing of a modified version of the SCIM III,in both English and Greek,for self-use

Purpose: To translate and culturally adapt the Spinal Cord Injury Measure version III (SCIM III) into Greek (GR-SCIM III). To conduct initial testing of psychometric properties of both measures by self-report. Method: Forward–backward translation was conducted to produce the GR-SCIM III. Participants completed the English or Greek versions in 2008–2009. Both versions were examined for multidimensionality, internal consistency and concurrent/criterion validity with the EQ-5D. Results: Forty-five Greek adults with spinal cord injury (SCI) (23 males), mean age 61 (SD17) years; mean time since injury 11 (SD9) years, completed the GR-SCIM III. One hundred and seventy four English-speaking adults with SCI (111 males), mean age 47 (SD12) years; mean time since injury 12 (SD11) years, completed the SCIM III. Unidimensionality was confirmed for both versions. Internal consistency was acceptable (α?=?0.78 for both). Validity was strong for the “self-care” subscale (GR-SCIM III ρ?=??0.78, SCIM III ρ?=??0.75) and moderate for the “mobility” subscale (GR-SCIM III ρ?=??0.58, SCIM III ρ?=??0.45). Conclusions: This has been the first function scale translated and validated in Greek for people with SCI. Both the GR-SCIM III and SCIM III are reliable for use by self-report. More studies are needed to further examine their psychometric properties and compare with observation or interview.

• Implications for Rehabilitation

• The Greek version of the Spinal Cord Independence Measure version III (SCIM) is valid and reliable for self-report. Further testing is needed to assess psychometric qualities not assessed in the present study.

• Researchers and therapists in Greece can use a specific measure to assess functional independence in people with Spinal Cord Injury (SCI).

• Consideration needs to be given to the participants’ type of injury, which may affect the results of SCIM III.

     

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。     

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.     

Effects of Epidural Spinal Cord Stimulation and Treadmill Training on Locomotion Function and Ultrastructure of Spinal Cord Anterior Horn after Moderate Spinal Cord Injury in Rats

Objective:To investigate the effects of epidural spinal cord stimulation (ESCS) and treadmill training on the locomotion function and ultrastructure of spinal cord anterior horn after moderate spinal cord injury in rats.Method:Nine adult female Sprague-Dawley rats were randomly distributed into three groups: ①spinal cord injury group (SI, n=3). ②spinal cord injury plus ESCS group (SE, n=3). ③spinal cord injury plus treadmill training group (TT, n=3). All rats received a moderate spinal cord injury surgery. Four weeks after surgery, rats in SE group received an electrode implantation procedure, with the electrode field covering spinal cord segments L2—S1. Four weeks after electrode implantation, rats received subthreshold ESCS for 30 min/d. Rats in TT group received 4cm/s treadmill training for 30min/d. Rats in SI group received no intervention, as a control group. All procedures in these three groups lasted four weeks.The open field Basso,Beattie and Bresnahan(BBB) scale was used before and after intervention to evaluate rats′ hindlimb motor function. Result:After four weeks intervention, rats in TT group improved their open field locomotion scores to 20. In contrast, no significant improvement was observed in groups SI and SE. The morphology of synapses and neurons were similar regardless of whether rats had undergone ESCS, treadmill training or not. Conclusion:ESCS alone was not sufficient to improve the walking ability of spinal cord injured rats. ESCS or treadmill training alone might not contribute to the changes of ultrastructure in anterior horn of spinal cord that underlie the recovery of walking ability. Further research is needed to understand the contributions of combination of ESCS and treadmill training to the rehabilitation of spinal cord injured rats.     

脊髓独立性评定量表Ⅲ中文版的适用性研究

目的:评价脊髓独立性评定(SCIM)量表Ⅲ中文版的适用性。方法:利用功能独立性评定量表(FIM)和SCIMⅢ中文版对79例急性和27例慢性脊髓损伤患者的功能能力进行评定,通过内部一致信度、重测信度和评定者间信度评价SCIMⅢ中文版的信度,通过效标效度和结构效度评价SCIMⅢ中文版的效度。结果:①中文版SCIMⅢCronbachα系数为0.816,重测相关系数为0.9,总量表评定者间相关系数为0.92;②SCIMⅢ中文版各维度与FIM相对应维度相关系数均在0.806—0.845;SCIMⅢ中文版各维度间相关系数在0.56—0.714,各维度与总量表相关系数在0.732—0.848(P<0.01)。结论:SCIMⅢ中文版具有良好的信度、效度及可行性,适于中国脊髓损伤患者的功能结局评定;但是,呼吸和一些具体活动项目的记分结构或记分标准需要调整以进一步提高其信度、效度和临床应用。     

Spinal Cord Stimulation and Motor Disorders

Spinal cord stimulation has been investigated by us during the past 10 years in the treatment of various disorders of the motor system. The effectiveness was studied in 735 cases, including cerebral palsy (212), dystonia (129), torticollis (66), spinal cord injury (169), and degenerative diseases (159). Our resuits indicate that in properly selected patients, stimulating the spinal neural axis is therapeutically effective in the majority of the cases treated. Our data demonstrate that the level stimulated, the pattern and the polarity of the applied field, and the frequency of the stimulation are critical to achieve a satisfactory therapeutic result and must be individualized in each patient.     

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。     

医源性脊髓损伤患者流行病学特征分析

目的:分析医源性脊髓损伤(ISCI)的流行病学特征.方法:对纳入患者的临床资料进行回顾性分析,分析患者年龄段、性别、损伤脊柱节段、初始疾病及损伤原因的构成比及其差异.结果:≤50岁人群中,ISCI的危险性随年龄而增加;男性的罹患危险性高于女性;病变发生于上胸椎及初始疾病为脊柱退变性疾病者罹患ISCI的危险性高;置钉失误...     

外伤性与非外伤性脊髓损伤发病及康复特点

目的比较外伤性与非外伤性脊髓损伤的发病及康复特点。方法对226例脊髓损伤患者进行回顾性分析。结果外伤性脊髓损伤占73.4%,平均年龄(33.96±12.18)岁,低于非外伤性脊髓损伤(43.98±11.4)岁;完全性损伤占65.4%,高于非外伤性38.7%;住院时间(189.74±157.88)d,长于非外伤性损伤(142.53±85.72)d;住院费用(55270.39±47967.59)元,高于非外伤性(40838.94±34786.85)元;出院日常生活能力评分(54.25±24.16),低于非外伤性损伤(74.88±25.61)。结论外伤性脊髓损伤在本院收治的脊髓损伤患者中占多数,与非外伤性相比,年龄偏低,住院时间长,费用偏高,出院日常生活能力评分偏低。     

脊髓损伤后脊髓内神经递质含量的变化及其作用

脊髓损伤后脊髓内神经递质分泌量的变化在一定程度上影响脊髓损伤模型动物或患者神经功能恢复,近年来有关神经递质的研究在脊髓神经恢复中越来越受关注,本文对脊髓损伤后脊髓内主要神经递质及其在不同措施干预下含量的变化进行综述。     

神经营养素-3修复脊髓损伤的研究进展

脊髓损伤的修复是神经科学研究领域的一大难题,原因之一是损伤脊髓的再生能力极其有限。近年来大量实验证明神经营养素－3（NT－3）对脊髓损伤的再生修复具有至关重要的作用,其中又以其基因移植效果为佳。本文就NT－3对脊髓损伤的修复研究进展作一综述。     

颈髓损伤早期急诊手术的可行性及疗效评价

目的:探讨颈髓损伤早期急诊减压内固定手术的可行性及疗效。方法:回顾性分析2000年6月～2007年6月我科治疗的颈髓损伤患者68例,按是否进行急诊手术分为急诊手术组22例和非急诊手术组46例。所有患者均采集一般资料、神经功能状况(入院时和最后一次随访时)、术后并发症、重症监护时间和住院时间等临床资料,并进行统计学分析。结果:2组患者在一般资料、受伤节段、手术方式、随访时间及入院时神经功能状况等方面均无统计学差异;最后一次随访时2组相比神经功能无显著性差异,但急诊手术组的并发症发生率、重症监护时间和住院时间均低于非急诊手术组。结论:颈髓损伤后早期急诊手术可行、安全,有利于减少术后并发症,但对神经功能的恢复无明显帮助。     

胞磷胆碱对大鼠脊髓损伤的神经保护性作用

目的:观察胞磷胆碱对大鼠脊髓损伤(SCI)的神经保护作用。方法:成年SD大鼠72只随机分为对照组、甲基强的松龙(MP)组、胞磷胆碱组及联合组,各组18只;造模后即刻腹腔注射给药1次,对照组给予等量生理盐水,MP组给予30mg/kg MP,胞磷胆碱组给予40mg/kg胞磷胆碱,联合组给予30mg/kg MP及40mg/kg胞磷胆碱;伤后8、24及72h每组各处死6只大鼠取材;HE染色观察脊髓组织的病理学变化,免疫组织化学方法观察半胱天冬氨酸酶(Caspase)-3和环氧化酶(COX)-2表达变化情况,DNA原位末端缺口标记法(TUNEL)检测神经细胞凋亡。结果:与对照组相比,MP组、胞磷胆碱组及联合组脊髓组织病理学改变明显减轻,Caspase-3和COX-2表达降低(P<0.05),凋亡细胞减少(P<0.05),MP组、胞磷胆碱组及联合组各组之间差异无统计学意义。结论:胞磷胆碱对大鼠SCI有神经保护性作用,与MP疗效相似,两者的联合应用与单独用药相比未见明显优势。     

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-Itzkovich 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.