Original research| Volume 99, ISSUE 9, P1783-1788, September 2018

Sensitivity of the SCI-FI/AT in Individuals With Traumatic Spinal Cord Injury

Published:March 30, 2018DOI:



      To examine the ability of the Spinal Cord Injury-Functional Index/Assistive Technology (SCI-FI/AT) measure to detect change in persons with spinal cord injury (SCI).


      Multisite longitudinal (12-mo follow-up) study.


      Nine SCI Model Systems programs.


      Adults (N=165) with SCI enrolled in the SCI Model Systems database.


      Not applicable.

      Main Outcome Measures

      SCI-FI/AT computerized adaptive test (CAT) (Basic Mobility, Self-Care, Fine Motor Function, Wheelchair Mobility, and/or Ambulation domains) completed at discharge from rehabilitation and 12 months after SCI. For each domain, effect size estimates and 95% confidence intervals were calculated for subgroups with paraplegia and tetraplegia.


      The demographic characteristics of the sample were as follows: 46% (n=76) individuals with paraplegia, 76% (n=125) male participants, 57% (n=94) used a manual wheelchair, 38% (n=63) used a power wheelchair, 30% (n=50) were ambulatory. For individuals with paraplegia, the Basic Mobility, Self-Care, and Ambulation domains of the SCI-FI/AT detected a significantly large amount of change; in contrast, the Fine Motor Function and Wheelchair Mobility domains detected only a small amount of change. For those with tetraplegia, the Basic Mobility, Fine Motor Function, and Self-Care domains detected a small amount of change whereas the Ambulation item domain detected a medium amount of change. The Wheelchair Mobility domain for people with tetraplegia was the only SCI-FI/AT domain that did not detect significant change.


      SCI-FI/AT CAT item banks detected an increase in function from discharge to 12 months after SCI. The effect size estimates for the SCI-FI/AT CAT vary by domain and level of lesion. Findings support the use of the SCI-FI/AT CAT in the population with SCI and highlight the importance of multidimensional functional measures.


      List of abbreviations:

      ASIA (American Spinal Injury Association), AT (assistive technology), CAT (computerized adaptive test), ES (effect size), MDC90 (minimal detectable change at the 90% confidence level), SCI (spinal cord injury), SCI-FI/AT (Spinal Cord Injury-Functional Index/Assistive Technology), SCI-FI/C (Spinal Cord Injury-Functional Index/Capacity), SCIMS (Spinal Cord Injury Model Systems), SRFM (Self-Reported Functional Measure)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Slavin M.D.
        • Kisala P.
        • Jette A.M.
        • Tulsky D.
        Developing a contemporary functional outcome measure for spinal cord injury research.
        Spinal Cord. 2010; 48: 262-267
        • Jette A.M.
        • Slavin M.D.
        • Ni P.
        • et al.
        Development and initial evaluation of the SCI-FI/AT.
        J Spinal Cord Med. 2015; 38: 409-418
        • Jette A.M.
        • Tulsky D.
        • Ni P.
        • et al.
        Development and initial evaluation of the Spinal Cord Injury-Functional Index.
        Arch Phys Med Rehabil. 2012; 93: 1735-1750
        • Tulsky D.
        • Kisala P.
        • Victorson D.
        • et al.
        Overview of the spinal cord injury–quality of life (SCI-QOL) measurement system.
        J Spinal Cord Med. 2015; 38: 257-269
        • Wu X.
        • Liu J.
        • Tanadini L.
        • et al.
        Challenges for defining minimal clinically important difference (MCID) after spinal cord injury.
        Spinal Cord. 2015; 53: 84-91
        • Hall K.M.
        • Cohen M.E.
        • Wright J.
        • Call M.
        • Werner P.
        Characteristics of the Functional Independence Measure in traumatic spinal cord injury.
        Arch Phys Med Rehabil. 1999; 80: 1471-1476
        • Tooth L.
        • McKenna K.
        • Geraghty T.
        Rehabilitation outcomes in traumatic spinal cord injury in Australia: functional status, length of stay and discharge setting.
        Spinal Cord. 2003; 41: 220-230
        • Catz A.
        • Itzkovich M.
        • Tesio L.
        • et al.
        A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation.
        Spinal Cord. 2007; 45: 275-291
        • Cook K.F.
        • O’Malley K.J.
        • Roddey T.S.
        Dynamic assessment of health outcomes: time to let the CAT out of the bag?.
        Health Serv Res J. 2005; 40: 1694-1711
        • Slavin M.D.
        • Ni P.
        • Tulsky D.
        • et al.
        Spinal Cord Injury-Functional Index/Assistive Technology short forms.
        Arch Phys Med Rehabil. 2016; 97: 1745-1752.e7
        • Tao W.
        • Haley S.M.
        • Coster W.J.
        • Ni P.
        • Jette A.M.
        An exploratory analysis of functional staging using an item response theory approach.
        Arch Phys Med Rehabil. 2008; 89: 1046-1053
        • Lai J.
        • Cella D.
        • Choi S.
        • et al.
        How item banks and their application can influence measurement practice in rehabilitation medicine: a PROMIS fatigue item bank example.
        Arch Phys Med Rehabil. 2011; 92: S20-S27
        • Haley S.M.
        • Siebens H.
        • Black-Schaffer R.M.
        • et al.
        Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation. II. Participation outcomes.
        Arch Phys Med Rehabil. 2008; 89: 275-283
        • Chaves E.
        • Boninger M.
        • Cooper R.
        • Fitzgerald S.
        • Gray D.
        • Cooper R.
        Assessing the influence of wheelchair technology on perception of participation in spinal cord injury.
        Arch Phys Med Rehabil. 2004; 85: 1854-1858
        • Marino R.
        • Huang M.
        • Knight P.
        • Herbison G.
        • Ditunno J.
        • Segal M.
        Assessing selfcare status in quadriplegia: comparison of the Quadriplegia Index of Function (QIF) and the Functional Independence Measure (FIM).
        Paraplegia. 1993; 31: 225-233
        • Rust K.
        • Smith R.
        Assistive technology in the measurement of rehabilitation and health outcomes.
        Am J Phys Med Rehabil. 2005; 84: 780-793
        • Tulsky D.
        • Jette A.
        • Kisala P.
        • et al.
        Spinal Cord Injury-Functional Index: item banks to measure physical functioning in individuals with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 1722-1732
        • Spinal Cord Injury Research Evidence Professional
        American Spinal Injury Association Impairment Scale (AIS): International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).
        (Available at:)
        • Hoenig H.
        • McIntyre L.
        • Sloane R.
        • Branch L.
        • Truncali A.
        • Horner R.
        The reliability of a self-reported measure of disease, impairment, and function in persons with spinal cord dysfunction.
        Arch Phys Med Rehabil. 1998; 79: 378-387
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        Routledge, Hillsdale, NJ1988
        • Donoghue D.
        • Stokes E.
        How much change is true change? The minimum detectable change of the BERG balance scale in elderly people.
        J Rehabil Med. 2009; 41: 343-346