Applying a Bookmarking Approach to Setting Clinically Relevant Interpretive Standards for the Spinal Cord Injury–Functional Index/Capacity Basic Mobility and Self-Care Item Bank Scores

Published:November 24, 2020DOI:



      To develop clinically relevant interpretive standards for the Spinal Cord Injury–Functional Index/Capacity (SCI-FI/C) Basic Mobility and Self-Care item bank scores.


      Modified “bookmarking” standard-setting methodology, including 2 stakeholder consensus meetings with individuals with spinal cord injury (SCI) and SCI clinicians, respectively, and a final, combined (consumers and clinicians) “convergence” meeting.


      Two SCI Model System centers in the United States.


      Fourteen adults who work with individuals with traumatic SCI and 14 clinicians who work with individuals with SCI.

      Main Outcome Measures

      Placement of bookmarks between vignettes based on SCI-FI Basic Mobility and Self-Care T scores. Bookmarks were placed between vignettes representing “No Problems,” “Mild Problems,” “Moderate Problems,” and “Severe Problems” for each item bank.


      Each consensus group resulted in a single set of scoring cut points for the SCI-FI/C Basic Mobility and Self-Care item banks. The cut points were similar but not identical between the consumer and clinician groups, necessitating a final convergence meeting. For SCI-FI/C Basic Mobility, the convergence group agreed on cut scores of 61.25 (no problems/mild problems), 51.25 (mild problems/moderate problems), and 41.25 (moderate problems/severe problems). For SCI-FI/C Self-Care, the convergence group agreed on cut scores of 56.25 (no/mild), 51.25 (mild/moderate), and 38.75 (moderate/severe).


      The results of this study provide straightforward interpretive guidelines for SCI researchers and clinicians using the SCI-FI/C Basic Mobility and Self-Care instruments. These results are appropriate for the full bank, computer adaptive test, and short-form versions of the SCI-FI/C Basic Mobility and Self-Care item banks.


      List of abbreviations:

      CAT (computerized adaptive test), IRT (item response theory), PRO (patient-reported outcome), PROMIS (Patient Reported Outcomes Measurement Information System), SCI (spinal cord injury), SCI-FI (Spinal Cord Injury–Functional Index), SCI-FI/C (Spinal Cord Injury–Functional Index/Capacity), SCI-QOL (Spinal Cord Injury–Quality of Life), SF (Short Form)
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