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

Published:October 27, 2021DOI:https://doi.org/10.1016/j.apmr.2021.10.005

      Abstract

      Objective

      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).

      Design

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

      Setting

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

      Participants

      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).

      Interventions

      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).

      Results

      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).

      Conclusions

      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.

      Keywords

      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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