Validation of the Spinal Cord Injury–Functional Index for Use in Community-Dwelling Individuals With SCI

Published:January 12, 2021DOI:



      To evaluate the psychometric properties of the Spinal Cord Injury–Functional Index (SCI-FI) instruments in a community-dwelling sample.


      Cross-sectional study.


      Community setting.


      Individuals (N=269) recruited from 6 SCI Model Systems sites.


      Not applicable.

      Main Outcome Measures

      Participants completed computer adaptive test and short form versions of 4 SCI-FI/Capacity (C) banks (ie, Ambulation, Basic Mobility, Fine Motor, Self-Care) and 1 SCI-FI/Assistive Technology (AT) bank (Wheelchair Mobility) at baseline and after 2 weeks. The Self-Report Functional Measure (SRFM) and the clinician-rated motor FIM were used to evaluate evidence of convergent validity.


      Pearson correlations, intraclass correlation coefficients, minimal detectable change, and Bland-Altman plots supported the test-retest reliability of the SCI-FI instruments. Correlations were large with the SRFM (.69-.89) and moderate-to-large for the FIM instrument (.44-.64), supporting convergent validity. Known-groups validity was demonstrated by a significant main effect of injury level on all instruments and a main effect of injury completeness on the SCI-FI/C instruments. A ceiling effect was detected for individuals with incomplete paraplegia on the Fine Motor/C and Self-Care/C Short Forms.


      Findings support the test-retest reliability, convergent validity, and known-groups validity of the SCI-FI/C instruments and the SCI-FI/AT Wheelchair Mobility instruments for use by community-dwelling individuals.


      List of abbreviations:

      AT (assistive technology), CAT (computer adaptive test), ICC (intraclass correlation coefficient), IRT (item response theory), MDC (minimal detectable change), NIH (National Institutes of Health), QOL (quality of life), SCI (spinal cord injury), SCI-FI (Spinal Cord Injury–Functional Index), SCI-FI/AT (Spinal Cord Injury–Functional Index/Assistive Technology), SCI-FI/C (Spinal Cord Injury–Functional Index/Capacity), SEM (standard error of measurement), SRFM (Self-Report 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


        • Tulsky D.S.
        • Jette A.M.
        • Kisala P.A.
        • 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
        • Kisala P.A.
        • Tulsky D.S.
        Opportunities for CAT applications in medical rehabilitation: development of targeted item banks.
        J Appl Meas. 2010; 11: 315-330
        • Tulsky D.S.
        • Kisala P.A.
        The Spinal Cord Injury-Quality of Life (SCI-QOL) measurement system: development, psychometrics, and item bank calibration.
        J Spinal Cord Med. 2015; 38: 251-256
        • Slavin M.D.
        • Kisala P.A.
        • Jette A.M.
        • Tulsky D.S.
        Developing a contemporary functional outcome measure for spinal cord injury research.
        Spinal Cord. 2010; 48: 262-267
        • Tulsky D.
        • Kisala P.
        • et al.
        SCI-FI structure and recent advances.
        Arch Phys Med Rehabil. 2022; 103: 185-190
        • Kisala P.
        • Tate D.
        • Heinemann A.
        • et al.
        Spinal Cord Injury-Functional Index (SCI-FI): responsiveness to change over time.
        Arch Phys Med Rehabil. 2022; 103: 199-206
        • 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
        • Slavin M.D.
        • Ni P.
        • Tulsky D.S.
        • et al.
        Spinal Cord Injury-Functional Index/Assistive Technology Short Forms.
        Arch Phys Med Rehabil. 2016; 97: 1745-1752.e7
        • Messick S.
        Validity of psychological assessment: validation of inferences from persons' responses and performances as scientific inquiry into score meaning.
        Am Psychol. 1995; 50: 741-749
        • Jette A.M.
        • Tulsky D.S.
        • Ni P.
        • et al.
        Development and initial evaluation of the Spinal Cord Injury-Functional Index.
        Arch Phys Med Rehabil. 2012; 93: 1733-1750
        • Scivoletto G.
        • Tamburella F.
        • Laurenza L.
        • Torre M.
        • Molinari M.
        Who is going to walk? A review of the factors influencing walking recovery after spinal cord injury.
        Front Hum Neurosci. 2014; 8: 141
        • Deyo R.A.
        • Diehr P.
        • Patrick D.L.
        Reproducibility and responsiveness of health status measures; statistics and strategies for evaluation.
        Control Clin Trials. 1991; 12: 142S-158S
        • Mokkink L.B.
        • Prinsen C.A.C.
        • Patrick D.L.
        • et al.
        COSMIN methodology for systematic reviews of patient-reported outcome measures (PROMs); user manual. Version 1.0 dated February 2018.
        (Available at:)
        • Tulsky D.S.
        • Kisala P.A.
        • Victorson D.
        • et al.
        Developing a contemporary patient-reported outcomes measure for spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: S44-S51
        • Tulsky D.S.
        • Kisala P.A.
        • Victorson D.
        • et al.
        Methodology for the development and calibration of the SCI-QOL item banks.
        J Spinal Cord Med. 2015; 38: 270-287
        • 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
        • Ditunno Jr., J.F.
        • Barbeau H.
        • Dobkin B.H.
        • et al.
        Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial.
        Neurorehabil Neural Repair. 2007; 21: 539-550
        • Fujiwara T.
        • Hara Y.
        • Akaboshi K.
        • Chino N.
        Relationship between shoulder muscle strength and Functional Independence Measure (FIM) score among C6 tetraplegics.
        Spinal Cord. 1999; 37: 58-61
        • Saboe L.A.
        • Darrah J.M.
        • Pain K.S.
        • Guthrie J.
        Early predictors of functional independence 2 years after spinal cord injury.
        Arch Phys Med Rehabil. 1997; 78: 644-650
        • Kucukdeveci A.A.
        • Yavuzer G.
        • Elhan A.H.
        • Sonel B.
        • Tennant A.
        Adaptation of the Functional Independence Measure for use in Turkey.
        Clin Rehabil. 2001; 15: 311-319
        • Stineman M.G.
        • Shea J.A.
        • Jette A.
        • et al.
        The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories.
        Arch Phys Med Rehabil. 1996; 77: 1101-1108
        • Grey N.
        • Kennedy P.
        The Functional Independence Measure: a comparative study of clinician and self ratings.
        Paraplegia. 1993; 31: 457-461
        • Karamehmetoglu S.S.
        • Karacan I.
        • Elbasi N.
        • Demirel G.
        • Koyuncu H.
        • Dosoglu M.
        The Functional Independence Measure in spinal cord injured patients: comparison of questioning with observational rating.
        Spinal Cord. 1997; 35: 22-25
        • Segal M.E.
        • Ditunno J.F.
        • Staas W.E.
        Interinstitutional agreement of individual Functional Independence Measure (FIM) items measured at two sites on one sample of SCI patients.
        Paraplegia. 1993; 31: 622-631
        • Hoenig H.
        • Branch L.G.
        • McIntyre L.
        • Hoff J.
        • Horner R.D.
        The validity in persons with spinal cord injury of a self-reported functional measure derived from the Functional Independence Measure.
        Spine (Phila Pa 1976). 1999; 24 (discussion 543-4): 539-543
        • Hoenig H.
        • Hoff J.
        • McIntyre L.
        • Branch L.G.
        The Self-Reported Functional Measure: predictive validity for health care utilization in multiple sclerosis and spinal cord injury.
        Arch Phys Med Rehabil. 2001; 82: 613-618
        • Hoenig H.
        • McIntyre L.
        • Sloane R.
        • Branch L.G.
        • Truncali A.
        • Horner R.D.
        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
        • Terwee C.B.
        • Bot S.D.
        • de Boer M.R.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Weathington B.L.
        • Cunningham C.J.L.
        • Pittenger D.J.
        Research methods for the behavioral and social sciences.
        John Wiley & Sons, Inc, Hoboken, NJ2017
        • Cohen J.
        The statistical power of abnormal-social psychological research: a review.
        J Abnorm Soc Psychol. 1962; 65: 145-153
        • Post M.W.
        What to do with "moderate" reliability and validity coefficients?.
        Arch Phys Med Rehabil. 2016; 97: 1051-1052
        • Prinsen C.A.C.
        • Mokkink L.B.
        • Bouter L.M.
        • et al.
        COSMIN guideline for systematic reviews of patient-reported outcome measures.
        Qual Life Res. 2018; 27: 1147-1157
        • Bohannon R.W.
        • Wang Y.C.
        Four-Meter Gait Speed: normative values and reliability determined for adults participating in the NIH Toolbox study.
        Arch Phys Med Rehabil. 2019; 100: 509-513
        • Bland J.M.
        • Altman D.G.
        Agreement between methods of measurement with multiple observations per individual.
        J Biopharm Stat. 2007; 17: 571-582
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Lakens D.
        Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs.
        Front Psychol. 2013; 4: 863
        • Field A.
        Discovering statistics using SPSS. 3rd ed.
        Sage Publications, London2009
        • National Spinal Cord Injury Statistical Center
        Spinal cord injury facts and figures at a glance.
        (Available at:)
        • Heinemann A.W.
        • Dijkers M.P.
        • Ni P.
        • Tulsky D.S.
        • Jette A.
        Measurement properties of the Spinal Cord Injury-Functional Index (SCI-FI) short forms.
        Arch Phys Med Rehabil. 2014; 95: 1289-1297.e5