Abstract
Objective
To evaluate the psychometric properties of the Spinal Cord Injury Spasticity Evaluation
Tool (SCI-SET) and Patient-Reported Impact of Spasticity Measure (PRISM) using Rasch
analysis to optimize their validity and efficiency.
Design
Rasch analysis of the SCI-SET and PRISM represents a secondary analysis of data collected
as part of a collaborative research project of the SCI Model Systems Centers. The
overall survey was organized into 4 sections: (1) participant demographics and injury
characteristics, (2) participant experiences of spasticity, (3) SCI-SET, and (4) PRISM.
Participants were recruited from the community via multiple avenues. Data were collected
and managed via an online survey tool using a secure web-based data management application.
Setting
Participating Spinal Cord Injury Model Systems Centers.
Participants
Most participants (N=1239) had lived with their injury for more than 2 years and used
a wheelchair as their primary mode of mobility. The majority of the sample (58%) sustained
cervical injuries.
Interventions
None.
Main Outcome Measures
SCI-SET and PRISM.
Results
The SCI-SET demonstrated strong measurement properties with acceptably high reliability
and point-measure correlations and no evidence of multidimensionality. However, respondents
underused some rating scale categories. Analyses of the PRISM demonstrated 3 distinct
subscales relating to the physical, psychological, and social influences of spasticity;
respondents underused some rating scale categories. Combining underused rating scale
categories for both spasticity instruments resulted in increased reliability and reduced
respondent burden compared with the original versions. Both the Modified SCI-SET (person
separation reliability=0.93) and Modified PRISM (person separation reliability=0.85,
0.89, 0.83 for physical, psychological, and social subscores, respectively) display
strong measurement properties.
Conclusions
Measurement properties of the SCI-SET and PRISM improved from use of Rasch model methods.
The SCI-SET required minor revisions, whereas the PRISM required definition of subscores.
Both modified spasticity measures demonstrated adequate psychometric properties, and
correlations among the modified measures were high, providing evidence of convergent
validity. We recommend use of the Modified SCI-SET and Modified PRISM measures in
future studies.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), IRB (Institutional Review Board), PRISM (Patient-Reported Impact of Spasticity Measure), SCI (spinal cord injury), SCI-SET (Spinal Cord Injury Spasticity Evaluation Tool)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 accessOne-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:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
National Spinal Cord Injury Statistical Center. 2020 Spinal cord injury facts and figures at a glance. Available at: https://www.nscisc.uab.edu/Public/Facts%20and%20Figures%202020.pdf. Accessed May 30, 2020.
- Spasticity after traumatic spinal cord injury: nature, severity, and location.Arch Phys Med Rehabil. 1999; 80: 1548-1557
- Epidemiology of spasticity following traumatic spinal cord injury.Arch Phys Med Rehabil. 1990; 71: 566-569
- Contracture management for people with spinal cord injuries.NeuroRehabilitation. 2011; 28: 17-20
- Restoration of walking function in an individual with chronic complete (AIS A) spinal cord injury.J Rehabil Med. 2010; 42: 795-798
- Priming neural circuits to modulate spinal reflex excitability.Front Neurol. 2017; 8: 17
- Adherence associated with oral medications in the treatment of spasticity.PM R. 2013; 5: 747-756
- Treatment of spasticity in spinal cord injury with botulinum toxin.J Spinal Cord Med. 2019; 42: 281-287
- Symposium synopsis.in: Feldman R.G. Young R.R. Koella W.P. Spasticity: disordered motor control. Symposia Specialists, Miami1980
- The experience of spasticity after spinal cord injury: perceived characteristics and impact on daily life.Spinal Cord. 2018; 56: 478
- Spasticity: clinical perceptions, neurological realities and meaningful measurement.Disabil Rehabil. 2005; 27: 2-6
- Spasticity after spinal cord injury.Spinal Cord. 2005; 43: 577
- Firing patterns of spontaneously active motor units in spinal cord-injured subjects.J Physiol. 2012; 590: 1683-1697
- Treatment patterns of in-patient spasticity medication use after traumatic spinal cord injury: a prospective cohort study.Spinal Cord. 2018; 56: 1176-1183
- Stop using the Ashworth Scale for the assessment of spasticity.J Neurol Neurosurg Psychiatry. 2010; 81: 46-52
- The spinal cord injury spasticity evaluation tool: development and evaluation.Arch Phys Med Rehabil. 2007; 88: 1185-1192
- Development and validation of Patient Reported Impact of Spasticity Measure (PRISM).J Rehabil Res Dev. 2007; 44: 363-371
- Person-first language: are we practicing what we preach?.J Multidiscip Healthc. 2019; 12: 125
- Identifying and classifying quality of life tools for assessing spasticity after spinal cord injury.Top Spinal Cord Inj Rehabil. 2014; 20: 208-224
- Applying the Rasch model: fundamental measurement in the human sciences.3rd ed. Taylor & Francis, Hoboken2015
- A metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inf. 2009; 42: 377-381
- Risk of mortality after spinal cord injury: an 8-year prospective study.Arch Phys Med Rehabil. 2009; 90: 1708-1715
- The troublesome trio of spasticity: clonus, spasms, stiffness - characteristics and impact. Program No. 747.07. 2019 Neuroscience Meeting Planner.Society for Neuroscience, Chicago2019
- Rating scale analysis.MESA Press, Chicago1982
- Rating scale instrument quality criteria.Rasch Meas Trans. 2007; 21: 1095
- Sample size and item calibration stability.Rasch Mes Trans. 1994; 7: 328
- Number of person or item strata (4G+1)/3.Rasch Meas Trans. 2002; 16: 888
- Guidelines to statistical evaluation of data from rating scales and questionnaires.J Rehabil Med. 2001; 33: 47-48
Article info
Publication history
Published online: June 01, 2020
Footnotes
Supported by the National Institute on Disability Independent Living and Rehabilitation Research (grant no. 90SI5016 to ECF).
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
