Measurement Characteristics and Clinical Utility of the Reintegration to Normal Living Index Among Persons With Spinal Cord Injuries

Community reintegration is an important aspect of rehabilitation for people with spinal cord injuries (SCIs). The Reintegration to Normal Living Index (RNLI) is a patient-reported outcomes measure that assesses an individual’s ability to resume activities of daily living within the community after a debilitating illness or injury. The RNLI consists of 11 questions, which clinicians or researchers administer via paper and pencil in 5-10 minutes.¹ Patients respond to each question using a visual analog scale numbered 1-10, with 1 being “does not describe my situation” and 10 being “fully describes my situation.”^1(p1969) The measure is scored as the sum of the patient’s answers to all 11 items, with a minimum score of 0 and a maximum score of 110 (100 after score adjustment),² with higher scores indicating a greater amount of patient satisfaction. The RNLI has been shown to be a reliable and valid measure when used in a wide array of patient populations (eg, stroke and cancer).³ In addition, the RNLI has also been demonstrated to have adequate to excellent construct validity,^{2.,  3.,  4.,  5.} excellent internal consistency,^3,4 excellent content validity,⁴ and excellent item convergent and discriminant validity⁴ for the SCI patient population. SCI-EDGE, a taskforce by the Academy of Neurologic Physical Therapy that uses the Evidence Database to Guide Effectiveness, recommends use of the RNLI with the chronic SCI population and use with any ASIA Impairment Scale classification. In addition, they state that it is appropriate for use with intervention research studies to measure changes.⁶