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

Published:December 18, 2019DOI:
      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
      This abbreviated summary provides a review of the psychometric properties of the Reintegration to Normal Living Index (RNLI) among persons with SCIs. A full review of the RNLI and reviews of over 440 other instruments for patients with various health conditions can be found at:
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      This instrument summary is designed to facilitate the selection of outcome measures by clinicians. The information contained in this summary represents a sample of the peer-reviewed research available at the time of this summary’s publication. The information contained in this summary does not constitute an endorsement of this instrument for clinical practice. The views expressed are those of the summary authors and do not represent those of authors’ employers, instrument owner(s), the Archives of Physical Medicine and Rehabilitation, the Rehabilitation Measures Database, or the United States Department of Health and Human Services. The information contained in this summary has not been reviewed externally.
      The Rehabilitation Measures Database and Instrument Summary Tear-sheets were initially funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Administration for Community Living, United States Department of Health and Human Services, through the Rehabilitation Research and Training Center on Improving Measurement of Medical Rehabilitation Outcomes (H133B090024). Current funding for the Rehabilitation Measures Database comes from the Shirley Ryan AbilityLab, the first-ever translational research hospital where clinicians, scientists, innovators, and technologists work together in the same space, applying research in real time to physical medicine and rehabilitation and by NIDILRR through the Rehabilitation Research and Training Center on Employment for People with Physical Disabilities (90RTEM0001).
      • 1.
        Miller A, Clemson L, Lannin N. Measurement properties of a modified Reintegration to Normal Living Index in a community-dwelling adult rehabilitation population. Disabil Rehabil 2011;33:1968-78.
      • 2.
        May LA, Warren S. Measuring quality of life of persons with spinal cord injury: external and structural validity. Spinal Cord 2002;40:341-50.
      • 3.
        Hitzig SL, Romero Escobar EM, Noreau L, Craven BC. Validation of the Reintegration to Normal Living Index for community-dwelling persons with chronic spinal cord injury. Arch Phys Med Rehabil 2012;93:108-14.
      • 4.
        Mothabeng DJ, Eksteen CA, Westaway M. Psychometric validation of the Reintegration to Normal Living Index in people with spinal cord injuries. S Afr J Physiother 2012;68:32-6.
      • 5.
        Harker WF, Dawson DR, Boschen KA, Stuss DT. A comparison of independent living outcomes following traumatic brain injury and spinal cord injury. Int J Rehabil Res 2002;25:93-102.
      • 6.
        Kahn JN, Christopher, Palma P, et al. Spinal cord injury EDGE task force outcome measures recommendations. Minneapolis: Academy of Neurologic Physical Therapy; 2013.