Study design: Cross-sectional validation study. Objectives: To develop and validate a self-report version of the Spinal Cord Independence Measure (SCIM III). Setting: Two SCI rehabilitation facilities in Switzerland. Methods: SCIM III comprises 19 questions on daily tasks with a total score between 0 and 100 and subscales for 'self-care', 'respiration & sphincter management' and 'mobility'. A self-report version (SCIM-SR) was developed by expert discussions and pretests in individuals with spinal cord injury (SCI) using a German translation. A convenience sample of 99 inpatients with SCI was recruited. SCIM-SR data were analyzed together with SCIM III data obtained from attending health professionals. Results: High correlations between SCIM III and SCIM-SR were observed. Pearson's r for the total score was 0.87 (95% confidence interval ( INTRODUCTIONThe Spinal Cord Independence Measure (SCIM), which was first published in 1997, 1 has become a widely used instrument to measure functioning in activities of daily living in persons with spinal cord injury (SCI). 2 Its main advantages over other instruments used for functional assessment in rehabilitation medicine are its sensitivity to changes in performance of tasks that are relevant for SCI patients, and the fact that it measures not only the burden of care, but also achievements, which have medical, psychological or social relevance for the SCI patient. The third version of the instrument, SCIM III, has been tested for validity and reliability in multicenter studies with satisfying psychometric properties. [3][4][5] SCIM III comprises items on 19 daily tasks grouped into three subscales. Item scores are weighted according to their clinical relevance and are graded for increasing difficulty, that is, requiring higher ability of the person with SCI. Each item has between 2 and 9 grades. The total SCIM III score ranges between 0 and 100, higher scores reflecting higher levels of performance or independence of a person. 3 The three subscales assess the areas of 'self-care' (six items, range 0-20), 'respiration & sphincter management' (four items, range 0-40) and 'mobility' (nine items, range 0-40).SCIM III is scored in observation of persons with SCI by health professionals. Ideally, each subscale is scored by clinical staff experienced in the assessment of the activities covered by the subscale. Such observations are time consuming and mainly applicable in inpatient settings. 6 In the outpatient setting, SCIM III data were collected by a single rater or in interviews previously, although with slightly decreased precision. 7,8 For research purposes, SCIM data are obtained by interview as part of the regular follow-up of large international studies, such as the European Multicenter Study about Spinal Cord Injury (EMSCI). 9 Studies conducted in the SCI community usually rely on selfadministered questionnaires for data collection. This method requires comparatively few resources, provides fast data collection and is applicable independent of the setting. 6,10 Using...

Study design: To develop a computer program that supports the overview of a follow-up care process in people with spinal cord injury (SCI) in daily clinical practice. Objectives: To create a new electronic tool based on the International Classification of Functioning, Disability and Health (ICF) that enables information to be registered and visualized, including the use of a net-diagram ('spider') to show a patient's long-term development. This diagram helps the clinician to recognize predispositions over time, as well as making information accessible to the patient, so as to involve him as a participant in defining current and future treatment options. Furthermore, guidelines for the prevention of common diseases, based on the recommendations of internal medicine, rehabilitation medicine and findings in the SCI literature, were implemented to provide enhanced health coaching in the area of preventative care. Methods: In an outpatient setting, four perspectives were assessed: patient, physician, occupational therapist and physiotherapist for a comprehensive bio-psycho-social consideration. All categories were assessed and graphically visualized with the electronic tool, on the basis of the ICF domains: body function, activities/participation and environmental factors. Results: The assessed data were summarized and graphically represented using three spider charts. Conclusion: The tool facilitates the patient counselling and the interdisciplinary work in daily clinical practice. Such a visual report helps to recognize predispositions over time. Furthermore, it helps to explain the clinical and patient-related findings accessible to the patients, to involve them as participants in defining the goals and the treatment plan.

A broad range of the individual experiences of persons with SCI is covered by the ICF. A large number of experiences were related to Personal Factors.

Study design: Qualitative, multi-center study. Objectives: The objective of this study is to explore the aspects of functioning and disability that are relevant to individuals with spinal cord injury (SCI), using a comprehensive approach based on the International Classification of Functioning, Disability and Health (ICF). Methods: Forty-nine people with SCI from early post-acute and long-term rehabilitation settings participated in nine focus groups. Five open-ended questions based on the ICF were used to initiate discussion about relevant Body Functions and Structures, Activities and Participation, Environmental and Personal Factors. The focus groups were audiotaped and the recording was transcribed verbatim. Qualitative analyses included the identification, extraction and coding of meaningful concepts from the transcribed dialogue. Concepts were coded according to established rules using ICF categories and were summarized semi-quantitatively. Results: In the analysis, 1582 different concepts were identified. For coding one concept, an average of 1.4 ICF categories was used. This resulted in 2235 concept-ICF category links, 1068 in the early postacute and 1167 in the long-term context, respectively. For the coding, 274 out of the 1454 categories contained in the ICF were used. Conclusion: The ICF coding showed the broad range of relevant aspects in the functioning experience of persons with SCI. Besides body limitations (especially paralysis and pain), the most relevant concepts covered mainly barriers in physical environment, assistive devices and social support, as well as the impact on everyday life regarding leisure and work. The resulting list of ICF categories can be helpful in facilitating person-centered clinical care and research.

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