The Spinal Cord Independence Measure (SCIM) version III: Reliability and validity in a multi-center international study

Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel.
Disability and Rehabilitation (Impact Factor: 1.99). 12/2007; 29(24):1926-33. DOI: 10.1080/09638280601046302
Source: PubMed


To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study.
Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge.
Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors.
The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.

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    • "The ASIA scale is used internationally to determine the neurologic level of impairment for sensation and motor power [5]. The SCIM II is a 16-domain disability scale covering self-care, respiratory and sphincter management and mobility with a possible total of 100 points [6-8]. A higher SCIM score correlates with a higher level of functional independence. "
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    ABSTRACT: The final months of the conflict in Sri Lanka in 2009 resulted in massive displacement of the civilian population and a high volume of orthopedic trauma including spinal cord injury. In response to this need, Medecins Sans Frontieres implemented a multidisciplinary rehabilitation program. Patients were admitted to the program if they had a spinal cord injury, a stable spine and absence of a high-grade pressure ulcer. All patients were assessed on admission with a standardized functional scale the Spinal Cord Independence Measure II (SCIM) and the American Spinal Injury Association Impairment Scale (ASIA). A multidisciplinary team provided nursing care, physiotherapy, bowel and bladder training, mental health care, and vocational rehabilitation. Patients were discharged from the program when medically stable and able to perform activities of daily living independently or with assistance of a caregiver. The primary outcome measures were discharge to the community, and change in SCIM score on discharge. Secondary outcome measures were measured at 6-12 weeks post-discharge, and included SCIM score and presence of complications (pressure ulcers, urinary tract infections and bowel problems). 89 patients were admitted. The majority of injuries were to the thoracic region or higher (89%). The injuries were classified as ASIA grade A in 37 (43%), grade B in 17(20%), grade C in 15 (17%) and grade D in 17(20%). 83.2% met the criteria for discharge, with a further 7.9% patients requiring transfer to hospital for surgical care of pressure ulcers. There was a significant change in SCIM score from 55 on admission to 71 on discharge (p < 0.01). 79.8% and 66.7% achieved a clinically significant and substantially significant SCIM score improvement, respectively. Amongst those with follow up data, there was a reduction in post spinal cord injury complications from those experienced either at or during admission. A further 79% of SCIM scores were stable or improved compared to the score on discharge. Provision of effective rehabilitation for spinal cord injury is possible in complex humanitarian emergency situations. A multidisciplinary approach, including psychological support along with partnerships with local and international organizations with specialized expertise, was key to the program's success.
    Full-text · Article · Mar 2014 · Conflict and Health
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    • "The motor level of the lesion was between C4 and T11 to exclude patients with peripheral lesions. Furthermore, participants had to walk with at most moderate assistance at the time of inclusion (i.e. a score of <6 in the “mobility outdoors” item of the Spinal Cord Independence Measure [SCIM] [25]). Cognitive capacity to follow verbal instructions was tested with the Mini Mental State Examination (required score: ≥26) [26]. "
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    ABSTRACT: Task-specific locomotor training has been promoted to improve walking-related outcome after incomplete spinal cord injury (iSCI). However, there is also evidence that lower extremity strength training might lead to such improvements. The aim of this randomized cross-over pilot study was to compare changes in a broad spectrum of walking-related outcome measures and pain between robot-assisted gait training (RAGT) and strength training in patients with chronic iSCI, who depended on walking assistance. We hypothesized that task-specific locomotor training would result in better improvements compared to strength training. Nine participants with a chronic iSCI were randomized to group 1 or 2. Group 1 received 16 sessions of RAGT (45 min each) within 4 weeks followed by 16 sessions of strength training (45 min each) within 4 weeks. Group 2 received the same interventions in reversed order. Main outcome measures were the 10 m Walk Test (10MWT) at preferred and maximal speed. Furthermore, we assessed several measures such as walking speed under different conditions, balance, strength, and 2 questionnaires that evaluate risk of falling and pain. Data were collected at baseline, between interventions after 4 weeks, directly after the interventions and at follow-up 6 months after the interventions. Pain was assessed repeatedly throughout the study. There were no significant differences in changes in scores between the 2 interventions, except for maximal walking speed (10MWT), which improved significantly more after strength training than after RAGT. Pain reduced after both interventions. In patients with chronic iSCI dependent on walking assistance, RAGT was not more effective in improving walking-related outcome compared to lower extremity strength training. However, the low sample size limits generalizability and precision of data interpretation.Trial registration: This study was registered at (NCT01087918).
    Full-text · Article · Jan 2014 · Journal of NeuroEngineering and Rehabilitation
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    • "The spinal cord independence measure (SCIM-III) consists of 17 items from two sub-scales, Self Care and Mobility (9). The most independent persons would have scored 20 in the Self Care sub-scale and 40 for the Mobility sub-scale. "
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    ABSTRACT: Study Design: Prospective cohort study. Objective: This study examined the relationship between motor control and clinical function outcomes after spinal cord injury (SCI). Setting: University of Louisville, Louisville, KY, USA. Materials: Eleven persons with SCI and 5 non-injured subjects were included in this study. Methods: The ASIA Impairment Scale (AIS) was used to categorize injury level and severity. Multi-muscle, surface EMG (sEMG) recording, was carried out using a protocol of reflex and volitional motor tasks and was analyzed using a vector-based tool that calculates index values that relate a distribution of multi-muscle activation pattern of each SCI subject to the prototype obtained from non-injured subject group and presents overall magnitude as a separate value. Functional Independence Measure motor sub-scale, Spinal Cord Injury Independence Measure (SCIM-III), and Walking Index for Spinal Cord Injury (WISCI) scale scores were compared to neurophysiological parameters. Results: AIS category and injury level correlated significantly with the WISCI and SCIM mobility sub-scales. sEMG-derived parameters were significantly correlated with SCIM and WISCI scores but only for examinations carried out 48 or more days post-injury. Conclusion: These results supported the hypothesis that clinically relevant function after SCI is related to the degree to which functional organization within the central nervous system is disrupted. Further, due likely to the constraints placed on the expression of functional ability by early post-injury immobilization and hospitalization, neurophysiological assessment of motor function may provide better sensitivity and reliability than can be obtained using the clinical function scales examined here within the early period after injury.
    Full-text · Article · Nov 2013 · Frontiers in Neurology
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