ORIGINAL RESEARCH| Volume 103, ISSUE 2, P199-206, February 2022

Spinal Cord Injury–Functional Index/Capacity: Responsiveness to Change Over Time

Published:October 27, 2021DOI:



      To establish responsiveness of 3 Spinal Cord Injury–Functional Index/Capacity (SCI-FI/C) item banks in the first year after spinal cord injury (SCI).


      Longitudinal patient-reported outcomes assessment replicated through secondary analysis of an independent data set.


      A total of 8 SCI Model Systems rehabilitation hospitals in the United States.


      Study 1 participants included 184 adults with recent (≤4 months) traumatic SCI and 221 community-dwelling adults (>1 year post injury) (N=405). Study 2 participants were 418 individuals with recent SCI (≤4 months) (N=418).


      In study 1, SCI-FI/C computer adaptive tests were presented in a standardized interview format either in person or by phone call at baseline and 6-month follow-up. Responsiveness was examined by comparing 6-month changes in SCI-FI scores within and across samples (recently injured vs community-dwelling) because only the recent injury sample was expected to exhibit change over time. Effect sizes were also computed. In study 2, the study 1 results were cross-validated in a second sample with recent SCI 1 year after baseline measurement. Study 2 also compared the SCI-FI/C measures’ responsiveness to that of the Self-reported Functional Measure (SRFM) and stratified results by injury diagnosis and completeness.

      Main Outcome Measures

      The SCI-FI Basic Mobility/C, Self-care/C and Fine Motor/C item banks (study 1 and study 2); Self-reported Functional Measure SRFM (study 2 only).


      In study 1, changes in SCI-FI/C scores between baseline and 6-month follow-up were statistically significant (P<.01) for recently injured individuals. SCI-FI Basic Mobility/C, Self-care/C, and Fine Motor/C item banks demonstrated small to medium effect sizes in the recently injured sample. In the community-dwelling sample, all SCI-FI/C effects were negligible (ie, effect size<0.08). Study 2 results were similar to study 1. As expected, SCI-FI Basic Mobility/C and Self-care/C were responsive to change for all individuals in study 2, whereas the SCI-FI Fine Motor/C was responsive only for individuals with tetraplegia and incomplete paraplegia. The SRFM demonstrated a medium effect size for responsiveness (effect size=0.65).


      The SCI-FI Basic Mobility/C and Self-care/C banks demonstrate adequate sensitivity to change at 6 months and 1 year for all individuals with SCI, while the SCI-FI/C Fine Motor item bank is sensitive to change in individuals with tetraplegia or incomplete paraplegia. All SCI-FI/C banks demonstrate stability in a sample not expected to change. Results provide support for the use of these measures for research or clinical use.


      List of abbreviations:

      ANCOVA (analysis of covariance), AT (assistive technology), C (capacity), CAT (computer adaptive test), SCI (spinal cord injury), SCI-FI (Spinal Cord Injury–Functional Index), QOL (quality of life), SRFM (Self-reported Functional Measure)
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        • Steeves JD
        • Kramer JK
        • Fawcett JW
        • et al.
        Extent of spontaneous motor recovery after traumatic cervical sensorimotor complete spinal cord injury.
        Spinal Cord. 2011; 49: 257-265
        • Bracken MB
        • Holford TR.
        Neurological and functional status 1 year after acute spinal cord injury: estimates of functional recovery in National Acute Spinal Cord Injury Study II from results modeled in National Acute Spinal Cord Injury Study III.
        J Neurosurg. 2002; 96 (Suppl): 259-266
      1. World Health Organization. International classification of functioning, disability, and health. Geneva: World Health Organization; 2008.

        • Revicki DA
        • Cella D
        • Hays RD
        • Sloan JA
        • Lenderking WR
        • Aaronson NK.
        Responsiveness and minimal important differences for patient reported outcomes.
        Health Qual Life Outcomes. 2006; 4: 70
        • Liang MH.
        Longitudinal construct validity: establishment of clinical meaning in patient evaluative instruments.
        Med Care. 2000; 38 (Suppl): II84-II90
        • Terwee C
        • Dekker F
        • Wiersinga W
        • Prummel M
        • Bossuyt P.
        On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation.
        Qual Life Res. 2003; 12: 349-362
        • King MT.
        A point of minimal important difference (MID): a critique of terminology and methods.
        Expert Rev Pharmacoecon Outcomes Res. 2011; 11: 171-184
        • Jette AM
        • Tulsky DS
        • Ni P
        • et al.
        Development and initial evaluation of the spinal cord injury-functional index.
        Arch Phys Med Rehabil. 2012; 93: 1733-1750
        • Tulsky DS
        • Jette AM
        • Kisala PA
        • 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
        • Tulsky D
        • Kisala P
        • et al.
        E. SCI-FI structure and recent advances [e-pub ahead of print].
        Arch Phys Med Rehabil. 2021;
        • Tulsky DS
        • Kisala PA
        • Victorson D
        • et al.
        Overview of the spinal cord injury - quality of life (SCI-QOL) measurement system.
        J Spinal Cord Med. 2015; 38: 257-269
      2. World Health Organization. International classification of functioning, disability and health: ICF. Geneva: World Health Organization; 2001.

        • Gittler MS
        • McKinley WO
        • Stiens SA
        • Groah SL
        • Kirshblum SC.
        Spinal cord injury medicine. 3. Rehabilitation outcomes.
        Arch Phys Med Rehabil. 2002; 83 (Suppl 1S90-8): S65-S71
        • Kozlowski AJ
        • Heinemann AW.
        Using individual growth curve models to predict recovery and activities of daily living after spinal cord injury: an SCIRehab project study.
        Arch Phys Med Rehabil. 2013; 94 (Suppl): S154-S164
        • Pretz C
        • Kozlowski A
        • Charlifue S
        • Chen Y
        • Heinemann A.
        Using Rasch motor FIM individual growth curves to inform clinical decisions for persons with paraplegia.
        Spinal Cord. 2014; 52: 671-676
        • Warschausky S
        • Kay JB
        • Kewman DG.
        Hierarchical linear modeling of FIM instrument growth curve characteristics after spinal cord injury.
        Arch Phys Med Rehabil. 2001; 82: 329-334
        • Keeney T
        • Slavin M
        • Kisala P
        • et al.
        Sensitivity of the SCI-FI/AT in individuals with traumatic spinal cord injury.
        Arch Phys Med Rehabil. 2018; 99: 1783-1788
        • Kirshblum S
        • Millis S
        • McKinley W
        • Tulsky D.
        Late neurologic recovery after traumatic spinal cord injury1.
        Arch Phys Med Rehabil. 2004; 85: 1811-1817
        • Yilmaz F
        • Sahin F
        • Aktug S
        • Kuran B
        • Yilmaz A.
        Long-term follow-up of patients with spinal cord injury.
        Neurorehabil Neural Repair. 2005; 19: 332-337
        • Lee BA
        • Leiby BE
        • Marino RJ.
        Neurological and functional recovery after thoracic spinal cord injury.
        J Spinal Cord Med. 2016; 39: 67-76
        • Scivoletto G
        • Morganti B
        • Molinari M.
        Neurologic recovery of spinal cord injury patients in Italy.
        Arch Phys Med Rehabil. 2004; 85: 485-489
        • Gershon R
        • Rothrock NE
        • Hanrahan RT
        • Jansky LJ
        • Harniss M
        • Riley W.
        The development of a clinical outcomes survey research application: Assessment Center.
        Qual Life Res. 2010; 19: 677-685
        • Cella D
        • Chang CH.
        A discussion of item response theory and its applications in health status assessment.
        Med Care. 2000; 38: 66-72
        • Tulsky DS
        • Kisala PA
        • Victorson D
        • et al.
        Methodology for the development and calibration of the SCI-QOL item banks.
        J Spinal Cord Med. 2015; 38: 270-287
        • Guyatt G
        • Walter S
        • Norman G.
        Measuring change over time: assessing the usefulness of evaluative instruments.
        J Chronic Dis. 1987; 40: 171-178
        • Benjamini Y
        • Hochberg Y.
        Controlling the false discovery rate: a practical and powerful approach to multiple testing.
        J R Stat Soc Series B Stat Methodol. 1995; 57: 289-300
        • Bonett DG.
        Interval estimation of standardized mean differences in paired-samples designs.
        J Educ Behav Stat. 2015; 40: 366-376
      3. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

        • Hoenig H
        • McIntyre L
        • Sloane R
        • Branch LG
        • Truncali A
        • Horner RD.
        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
        • Hoenig H
        • Hoff J
        • McIntyre L
        • Branch LG.
        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
        • Branch LG
        • McIntyre L
        • Hoff J
        • Horner RD.
        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: 539-543
        • Bonett DG.
        Meta-analytic interval estimation for standardized and unstandardized mean differences.
        Psychol Methods. 2009; 14: 225-238
        • Anderson SF
        • Maxwell SE.
        There's more than one way to conduct a replication study: beyond statistical significance.
        Psychol Methods. 2016; 21: 1-12
        • Slavin MD
        • Kisala PA
        • Jette AM
        • Tulsky DS.
        Developing a contemporary functional outcome measure for spinal cord injury research.
        Spinal Cord. 2010; 48: 262-267
        • Kirshblum SC
        • Priebe MM
        • Ho CH
        • Scelza WM
        • Chiodo AE
        • Wuermser LA.
        Spinal cord injury medicine. 3. Rehabilitation phase after acute spinal cord injury.
        Arch Phys Med Rehabil. 2007; 88 (Suppl 1): S62-S70
        • Mokkink LB
        • Prinsen C
        • Patrick DL
        • et al.
        COSMIN methodology for systematic reviews of patient-reported outcome measures.
        User Manual. 2018; 78: 63