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.

     

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.     

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。     

功能独立性测量的信度与效度研究

探讨功能独立性测量在残疾评测中的信度与效度。方法：检测２９例住院康复患者中风９例，脊髓损伤１３例，外伤性脑损伤７例。     

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.     

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.

     

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。     

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.     

Translation,cross-cultural adaptation and validity of the Brazilian version of the Foot and Ankle Ability Measure questionnaire

Purpose: To translate and cross-culturally adapt the Foot and Ankle Ability Measure (FAAM) questionnaire and verify the psychometric properties of the Brazilian–Portuguese version of this instrument.

Methods: Analysis of validity was carried out by applying the Rasch model and evaluating correlations with the Short Form-36 (SF-36) Physical Function (PF) subscale. Test–retest reliability and internal consistency were analyzed with the intraclass correlation coefficient (ICC_2,1) and Cronbach’s alpha tests, respectively.

Results: Ninety subjects with various foot and ankle musculoskeletal disorders (age 37.05 SD 10.49 years) were included. The ICC_2,1 was 0.88 and 0.82 with Cronbach’s alphas of 0.93 and 0.90 for the “Activities of Daily Living” (ADL) and “Sports” subscales, respectively. Correlations with the SF-36 PF were 0.78 (p?95: 0.62–0.87) and 0.65 (p?95: 0.45–0.79) for the ADL and Sports subscales, respectively. Item reliability indices in Rasch analysis were 0.91 (ADL) and 0.84 (Sports). Three items from the ADL subscale (14.2%) did not match the expectations of the model. All items from the Sports subscale fit the model.

Conclusions: There is evidence of validity and reliability of the FAAM-Brazil. Rasch analysis indicated that three items of the ADL subscale did not fit the model in the sample studied.

• Implications for Rehabilitation

• Self-report questionnaires are commonly used in both clinical practice and research because of their ability to efficiently collect information. If the instrument is created properly, the information collected can be used to interpret the effect of clinical conditions on physical function.

• The Foot and Ankle Ability Measure (FAAM) is an evaluative instrument that assesses functional limitations for those with foot- and ankle-related disorders. It was translated into four languages and has evidence of validity, reliability, and responsiveness.

• Evidence of validity and reliability is provided for the FAAM-Brazil when applied to subjects with a wide range of foot and ankle musculoskeletal disorders.

     

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。     

Clinical Assessment of Spasticity in People With Spinal Cord Damage: Recommendations From the Ability Network,an International Initiative

A thorough assessment of the extent and severity of spasticity, and its effect on functioning, is central to the effective management of spasticity in persons with spinal cord damage (SCD). These individuals however do not always receive adequate assessment of their spasticity. Inadequate assessment compromises management when the effect of spasticity and/or need for intervention are not fully recognized. Assessment is also central to determining treatment efficacy. A barrier to spasticity assessment has been the lack of consensus on clinical and functional measures suitable for routine clinical practice. To extend on existing work, a working group of the Ability Network identified and consolidated information on possible measures, and then synthesized and formulated findings into practical recommendations for assessing spasticity and its effect on function in persons with SCD. Sixteen clinical and functional measures that have been used for this purpose were identified using a targeted literature review. These were mapped to the relevant domains of the International Classification of Functioning, Disability and Health to assess the breadth of their coverage; coverage of many domains was found to be lacking, suggesting a focus for future work. The advantages, disadvantages, and usefulness of the measures were assessed using a range of criteria, with a focus on usefulness and feasibility in routine clinical practice. Based on this evaluation, a selection of measures suitable for initial and follow-up assessments are recommended. The recommendations are intended to have broad applicability to a variety of health care settings where people with SCD are managed.     

The Activities-specific Balance Confidence scale: reliability and validity in Spanish patients with vestibular disorders

Purpose: To examine the reliability and validity of the Spanish version of the Activities-specific Balance Confidence scale (ABC-S), and its ability to discriminate between patients with and without a history of falls among a Spanish population with vestibular disorders. Method: A total of 84 participants completed the ABC-S. Internal consistency, test–retest reliability and construct validity (exploratory factor analysis) were analysed. Concurrent validity was evaluated using the 12-item Short Form Health Survey (SF-12) and the Dizziness Handicap Inventory (DHI). To determine the accuracy of the ABC total score in discriminating patients with and without a history of falls, a receiver operating characteristic (ROC) curve analysis was performed. Results: The ABC-S showed excellent internal consistency (Cronbach’s α?=?0.916) and substantial test–retest reliability (ICC?=?0.86, 95% CI: 0.74–0.93), with standard error and minimal detectable change values of 8.64 and 16.94, respectively. Factor analyses suggested a three-factor structure (explained variance was 62.24%). The ABC total score significantly correlated with the physical component summary score of the SF-12 and with the DHI-P, DHI-E, DHI-F and DHI total scores (p?p?Conclusions: The ABC-S is a valid and reliable instrument, suitable to assess balance confidence in Spanish patients with vestibular disorders.

• Implications for Rehabilitation

• The Spanish version of the ABC scale is a valid and reliable measure of balance confidence in patients with vestibular disorders.

• In persons with vestibular disorders, the Spanish version of the ABC scale has shown the ability to discriminate between patients with and without a history of falls in the last year.

     

Validation and cross-cultural adaptation of the Persian version of Craig Handicap Assessment and Reporting Technique (CHART) short form

Abstract

Objective: To test the psychometric specifications of the Persian version of the Craig Handicap Assessment and Reporting Technique (CHART) short form in an Iranian population. Design: Cross-sectional study. Subjects: Fifty-two individuals with a mean age of 49.3 years (SD 7.9, minimum 38 years and maximum 80 years), who had chronic spinal cord lesions, were included in this study. Most of them were paraplegic (88.5%) and unemployed (76.9%). Methods: Reliability (internal consistency) of the measure was examined by applying Cronbach’s alpha. In addition, validity (construct) was tested by Pearson’s correlation. Results: Overall, the internal consistency of the questionnaire was found to be satisfactory (Cronbach’s alpha 0.613). Regarding construct validity, the minimum and maximum significant correlations were among Physical Component Summery and Cognitive Independence (r?=?0.267, p?<?0.05), Vitality and Social Integration (r?=??0.429, p?<?0.01) respectively. Conclusion: By analyzing data regarding the psychometric specifications of the Persian version of CHART, we can conclude that this version is a valid, reliable and unique measure that can be used for spinal cord–injured individuals. As demonstrated in our preliminary study, it is easy to be filled out and is not confusing.

• Implications for Rehabilitation

• The Persian version of the CHART has been successfully validated.

• It can be used by those working specifically in the field of spinal cord injury and also more generally.

• It will enable both initial assessment and follow-up for people in Persian-speaking areas of the world.

     

Cross-cultural adaptation,reliability, and validity of the Japanese version of the Cumberland ankle instability tool

Purpose To study validity and reliability of a Japanese version of the Cumberland Ankle Instability Tool and to determine the optimal cutoff score. Methods In this study, the questionnaire was cross-culturally adapted into Japanese. The psychometric properties tested in the Japanese version of the CAIT were measured for criteria validity, internal consistency and test–retest reliability in 111 collegiate soccer athletes. We also established the questionnaire cutoff score for discriminating between individuals with and without CAI. Results There was a significant correlation between the Japanese version of the CAIT and the Karlsson score (r?=?0.604, p?α?=?0.833) and reliability [intraclass correlation coefficient (ICC)?=?0.826, 95% confidence interval (CI): 0.732–0.888]. The optimal cutoff score was?≤25, which was consistent with previous reports. Conclusions The Japanese version of the CAIT has been shown to be a valid and reliable questionnaire for determining the presence of CAI. We expect that researchers and clinicians will use the Japanese version of the CAIT in Japan.

• Implications for Rehabilitation

• Chronic Ankle Instability (CAI), which not only increases recurrence rate of ankle sprain but also decreases athletic performance, is a residual symptom after ankle sprain.

• Cumberland Ankle Instability Tool, which has the reliability and validity to assess CAI, will be critically useful in assessment procedure for CAI.

• It is preferable for clinicians and researchers to use the native language version of the CAIT.

     

国内应用脊髓损伤神经学分类标准(ASIA)现状初步分析

目的了解国内应用美国脊柱损伤委员会脊髓损伤神经学分类标准（简称“ASIA”）使用现状。方法登陆“中国知网”网站（http：／／www．cnki．net），在1979～2006全部中国期刊全文数据库，模糊匹配检索词为“脊髓损伤”与“ASIA”进行检索。结果共检索到164篇，去除不相关及重复文献，共检索到与本研究相关文献共140篇。结论ASIA标准在国内得到广泛应用，国内学者的研究为ASIA标准的完善提出了自己的见解；国内在对ASIA标准的使用上也存在一定程度的混乱及滞后。     

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.     

Optimizing the Management of Spasticity in People With Spinal Cord Damage: A Clinical Care Pathway for Assessment and Treatment Decision Making From the Ability Network,an International Initiative

The recognition, evaluation, and management of disabling spasticity in persons with spinal cord damage (SCD) is a challenge for health care professionals, institutions, health systems, and patients. To guide the assessment and management of disabling spasticity in individuals with SCD, the Ability Network, an international panel of clinical experts, developed a clinical care pathway. The aim of this pathway is to facilitate treatment decisions that take into account the effect of disabling spasticity on health status, individual preferences and treatment goals, tolerance for adverse events, and burden on caregivers. The pathway emphasizes a patient-centered, individualized approach and the need for interdisciplinary coordination of care, patient involvement in goal setting, and the use of assessment and outcome measures that lend themselves to practical application in the clinic. The clinical care pathway is intended for use by health care professionals who provide care for persons with SCD and disabling spasticity in various settings. Barriers to optimal spasticity management in these people are also discussed. There is an urgent need for the clinical community to clarify and overcome barriers (knowledge-based, organizational, health system) to optimizing the management of spasticity in people with SCD.     

用ASIA2000标准评估脊髓损伤神经功能恢复的初步研究

目的探索ASIA2000标准对评定脊髓损伤后神经功能变化的指导作用。方法对42例脊髓损伤患者进行连续性临床观察。使用ASIA2000标准对伤后1个月、3个月和12个月的脊髓神经功能进行检查。结果对于不完全脊髓损伤，运动评分、针刺觉评分和触觉评分在伤后1个月和3个月对比有明显变化，伤后3个月和12个月对比则无明显变化；对完全脊髓损伤来说，运动评分、针刺觉评分和触觉评分在伤后无明显变化；量化残损分级测定所有脊髓损伤的神经功能均无明显改善。结论ASIA评分灵敏度高于ASIA残损分级；脊髓损伤后3个月内神经功能改善较3个月后明显；不完全性脊髓损伤神经功能预后可能优于完全性脊髓损伤。