Spinal Cord Injury-Functional Index: Item Banks to Measure Physical Functioning in Individuals With Spinal Cord Injury

Abstract

Objective To develop a comprehensive set of patient reported items to assess multiple aspects of physical functioning relevant to the lives of people with spinal cord injury (SCI) and to evaluate the underlying structure of physical functioning. Design Cross-sectional Setting Inpatient and community Participants Item pools of physical functioning were developed, refined and field tested in a large sample of 855 individuals with traumatic spinal cord injury stratified by diagnosis, severity, and time since injury Interventions None Main Outcome Measure SCI-FI measurement system Results Confirmatory factor analysis (CFA) indicated that a 5-factor model, including basic mobility, ambulation, wheelchair mobility, self care, and fine motor, had the best model fit and was most closely aligned conceptually with feedback received from individuals with SCI and SCI clinicians. When just the items making up basic mobility were tested in CFA, the fit statistics indicate strong support for a unidimensional model. Similar results were demonstrated for each of the other four factors indicating unidimensional models. Conclusions Though unidimensional or 2-factor (mobility and upper extremity) models of physical functioning make up outcomes measures in the general population, the underlying structure of physical function in SCI is more complex. A 5-factor solution allows for comprehensive assessment of key domain areas of physical functioning. These results informed the structure and development of the SCI-FI measurement system of physical functioning.

Tracking Functional Status Across the Spinal Cord Injury Lifespan: Linking Pediatric and Adult Patient-Reported Outcome Scores

“…12,13 One commonly used method to check this assumption is the factor analysis. 12,13 Since the unidimensionality of the SCI-FI domains has been documented previously, 8 dimensionality analyses were not conducted for the SCI-FI banks. In the pediatric sample, confirmatory factor analysis (CFA) was conducted with the mean-and variance-adjusted weighted least square estimator.…”

“…8,9 The aim of this study was to link the Pedi SCI and SCI-FI as a way to assess functional outcomes of children with SCI as they age into adulthood. The linking between the pediatric and adult outcomes instruments provides, for the first time ever, the capability to track the function of a child with SCI across the lifespan.…”

Self-reported effects of cold temperature exposure in persons with tetraplegia

“…26,27 The SCI-QOL includes medical (bowel and bladder issues, pressure ulcers), emotional (depression, anxiety, resilience, positive affect and well-being, grief and loss, self-esteem, stigma, and psychological trauma), and social ( participation, satisfaction, and independence) domains, along with the physical functioning items from the Spinal Cord Injury-Functional Index (SCI-FI), 28 and the sleep disturbance from the Patient-Reported Outcomes Measurement Information System (PROMIS). 29,30 However, although the SCI-QOL addresses the impact of many of the consequences of SCI on QoL, it too does not address the impact of thermal dysregulation on QoL.…”

Functional Ability Level Development and Validation: Providing Clinical Meaning for Spinal Cord Injury Functional Index Scores

“…1,3 Existing measures are limited in the range of activities being assessed, such as the Spinal Cord Independence Measure, 4,5 which is composed of 19 items that assess 3 domains of functioning (self-care, respiration and sphincter management, mobility), and the FIM, 6 composed of 13 items that assess motor function. The FIM was developed as a generic measure for use in individuals with chronic health conditions and has been shown to have high floor and ceiling effects, 2,7,8 whereas other currently available SCI measures can be used for 1 diagnosis or domain of function.…”