The Spinal Cord Independence Measure (SCIM) is a new disability scale developed speci®cally for patients with spinal cord lesions in order to make the functional assessments of patients with paraplegia or tetraplegia more sensitive to changes. The SCIM includes the following areas of function: self-care (subscore 0 ± 20), respiration and sphincter management (0 ± 40) and mobility (0 ± 40). Each area is scored according to its proportional weight in these patients' general activity. The ®nal score ranges from 0 to 100. This study was performed to evaluate the reliability of the SCIM and its sensitivity to functional changes in spinal cord lesion patients compared with the Functional Independence Measure (FIM). Thirty patients were included. Scores were recorded one week after admission and thereafter every month during hospitalization. Each area of function was assessed by a pair of sta members from the relevant discipline. The comparison of scores between each pair of raters revealed a remarkable consistency (r=0.91 ± 0.99; P50.0001; slope&1; constant&0). The total SCIM score (mean=51, SD=21) was lower than the total FIM score (mean=87, SD=23) owing to the di erence in scale range structure and the relatively high cognitive scores of our patients; however, a relationship was noted between the scores of both scales (r=0.85, P50.01). The SCIM was more sensitive than the FIM to changes in function of spinal cord lesion patients: the SCIM detected all the functional changes detected by the FIM total scoring, but the FIM missed 26% of the changes detected by the SCIM total scoring. The mean di erence between consecutive scores was higher for the SCIM (P50.01). We conclude that the SCIM is a reliable disability scale and is more sensitive to changes in function in spinal cord lesion patients than the FIM. The SCIM when administered by a multidisciplinary team, may be a useful instrument for assessing changes in everyday performance in patients with spinal cord lesion.

Where data are to be pooled for international studies, analysis of DIF by culture is essential. Where DIF is observed, adjustments can be made to allow for cultural differences in outcome measurement.

No abstract