Abstract
Tulsky DS, Jette AM, Kisala PA, Kalpakjian C, Dijkers MP, Whiteneck G, Ni P, Kirshblum
S, Charlifue S, Heinemann AW, Forchheimer M, Slavin MD, Houlihan B, Tate DG, Dyson-Hudson
T, Fyffe D, Williams S, Zanca J. Spinal Cord Injury-Functional Index: item banks to
measure physical functioning in individuals with spinal cord injury.
Objectives
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 individuals (N=855) with traumatic SCI stratified by diagnosis, severity,
and time since injury.
Interventions
None.
Main Outcome Measure
Spinal Cord Injury-Functional Index (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 function, 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 indicated strong support for a unidimensional
model. Similar results were demonstrated for each of the other 4 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.
Key Words
List of Abbreviations:
AM-PAC (Activity Measure for Post-Acute Care), CAT (computer adaptive test), CFA (confirmatory factor analysis), CFI (comparative fit index), IRT (item response theory), Neuro-QOL (Neurology Quality of Life Measurement System), PROMIS (Patient-Reported Outcomes Measurement Information System), PRO (patient-reported outcome), QIF (Quadriplegia Index of Function), RMSEA (root mean square error of approximation), SCI (spinal cord injury), SCI-FI (Spinal Cord Injury-Functional Index), SCIMS (Spinal Cord Injury Model System), TLI (Tucker-Lewis Index)To read this article in full you will need to make a payment
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References
- Research from the model spinal cord injury systems: findings from the current 5-year grant cycle.Arch Phys Med Rehab. 2004; 85: 1737-1739
- Outcome measures: evolution in clinical trials of neurological/functional recovery in spinal cord injury.Spinal Cord. 2010; 48: 674-684
- Review of treatment trials in human spinal cord injury: issues, difficulties, and recommendations.Neurosurgery. 2006; 59: 957-982
- Clinical Guide for the Uniform Data Set for Medical Rehabilitation (including the FIM™ instrument).State University of New York at Buffalo, Buffalo1997
- The Functional Independence Measure: a new tool for rehabilitation.Adv Clin Rehabil. 1987; 1: 6-18
- The Catz-Itzkovich SCIM: a revised version of the Spinal Cord Independence Measure.Disabil Rehabil. 2001; 23: 263-268
- Outcome measures in spinal cord injury: recent assessments and recommendations for future directions.Spinal Cord. 2009; 47: 582-591
- A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation.Spinal Cord. 2007; 45: 275-291
- Walking Index for Spinal Cord injury (WISCI II): scale revision.Spinal Cord. 2001; 39: 654-656
- The reproducibility and convergent validity of the Walking Index for Spinal Cord Injury (WISCI) in chronic spinal cord injury.Neurorehabil Neural Repair. 2011; 25: 149-157
- Functional evaluation: the Barthel Index.Md Med State J. 1965; 14: 61-65
- Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index.Arch Phys Med Rehabil. 1979; 60: 145-154
- The Quadriplegia Index of Function (QIF)–sensivitiy and reliability demonstrated in a study of 30 quadriplegic patients.Paraplegia. 1986; 24: 38-44
- The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study.Disabil Rehabil. 2007; 29: 1926-1933
- Developing a contemporary functional outcome measure for spinal cord injury research.Spinal Cord. 2010; 48: 262-267
- Guidance for industry patient-reported outcome measures: use in medical product development to support labeling claims.U.S. Department of Health and Human Services, Food and Drug Administration, Silver Spring2009
- The PROMIS Initiative: involvement of rehabilitation stakeholders in development and examples of applications in rehabilitation research.Arch Phys Med Rehabil. 2011; 92: S12-S19
- Patient-reported outcomes measurement and management with innovative methodologies and technologies.Qual Life Res. 2007; 16: 157-166
- Incorporating the patient's perspective into drug development and communication: an ad hoc task force report of the patient-reported outcomes (PRO) harmonization group meeting at the Food and Drug Administration, February 16, 2001.Value Health. 2003; 6: 522-531
- The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008.J Clin Epidemiol. 2010; 63: 1179-1194
- The Neurology Quality-of-Life Measurement Initiative.Arch Phys Med Rehabil. 2011; 92: S28-S36
- Evaluation of a preliminary physical function item bank supported the expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS).J Clin Epidemiol. 2008; 61: 17-33
- Neuro-QOL: quality of life item banks for adults with neurological disorders: item development and calibrations based upon clinical and general population testing.Qual Life Res. 2012; 21: 475-486
- Development and initial evaluation of the Spinal Cord Injury-Functional Index.Arch Phys Med Rehabil. 2012; 93: 1733-1750
- Opportunities for CAT applications in medical rehabilitation: development of targeted item banks.J Appl Meas. 2010; 11: 315-330
- Linking the activity measure for post acute care and the quality of life outcomes in neurological disorders.Arch Phys Med Rehabil. 2011; 92: S37-S43
- Activity outcome measurement for postacute care.Med Care. 2004; 42: I49-I61
- Development of items designed to evaluate activity performance and participation in children and adolescents with spinal cord injury.Int J Pediatr. 2009; 2009: 854904
- Children's and parents' perspectives about activity performance and participation after spinal cord injury: initial development of a patient-reported outcome measure.Am J Occup Ther. 2010; 64: 605-613
- Evaluation of item candidates: the PROMIS qualitative item review.Med Care. 2007; 45: S12-S21
- Spinal cord injury: facts and figures at a glance.University of Alabama, Birmingham2011
- International Classification of Functioning, Disability and Health.World Health Organization, Geneva2008
- Structural equations with latent variables.Wiley, New York1989
- Introduction.in: Bollen K.A. Long J.S. Testing structural equation models. Sage, Newbury Park1993: 1-9
- Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives.Struct Equation Model. 1999; 6: 1-55
- Goodness-of-fit indexes in confirmatory factor analysis: the effect of sample size.Psychol Bull. 1988; 103: 391-401
- A reliability coefficient for maximum likelihood factor analysis.Psychometrika. 1973; 38: 1-10
- Comparative fit indexes in structural models.Psychol Bull. 1990; 107: 238-246
- Alternative ways of assessing model fit.in: Bollen K.A. Long J.S. Testing structural equation models. Sage, Newbury Park1993: 136-162
- Use of item response theory and the testlet concept in the measurement of psychopathology.Psychol Methods. 1996; 1: 81-97
- Confirmatory factor analysis of the Wechsler Memory Scale-III.J Clin Exp Neuropsychol. 1999; 21: 87-93
Article info
Publication history
Published online: May 18, 2012
Footnotes
Supported by the U.S. Department of Education, National Institute of Disability and Rehabilitation Research (grant nos. H133N060022, H133N060024, H133N060014, H133N060005, H133N060027, and H133N060032) and by the National Institutes of Health, National Institute of Child Health & Human Development, National Center for Medical Rehabilitation Research, and National Institute of Neurological Disorders and Stroke (grant no. 5R01HD054659).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on Jul 30, 2012, at www.archives-pmr.org.
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© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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