Clinical interpretation of the Spinal Cord Injury Functional Index (SCI-FI)

The Journal of Spinal Cord Medicine, 2016 · DOI: 10.1080/10790268.2015.1133483 · Published: May 1, 2016

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

The Spinal Cord Injury-Functional Index (SCI-FI) is a new series of PRO measures of physical functioning, specifically developed for persons with SCI. SCI-FI items were generated based on focus group discussions with persons living with SCI and SCI rehabilitation specialists to ensure that items assessed key functional activities that are important to individuals with SCI and consistent with common data elements found in other scales Cluster analyses were run to identify clusters of individuals where the groupings were not pre-determined and to sort cases (or variables) into a small number of groups such that members in the same group were as similar as possible, while members of different groups were as dissimilar as possible on a specific metric.

Study Duration

2006-2011

Participants

855 individuals with traumatic spinal cord injury

Evidence Level

Cross-sectional study

Key Findings

1
Cluster analyses identified three distinct groups that represent low, mid-range and high SCI-FI functional ability levels.
2
Participants in Cluster 1 (n = 300; 42.4%) were characterized by high functional ability levels, which represents perceived ability to be able to do most SCI-FI activities across domains without any difficulty.
3
Participants in Cluster 3 (low functional ability levels) were newly injured, living with cervical complete injuries and most likely to use a power wheelchair some or most of the time.

Research Summary

SCI-FI functional ability levels provide clinicians and patients with score ranges that distinguish important functional abilities and assign clinical meaning to SCI-FI scores. Three distinct clusters of SCI-FI functional ability level scores were identified: Cluster 1 included participants with high SCI-FI functional ability levels; Cluster 2 included participants with mid-range SCI-FI functional ability levels; Cluster 3 included participants with low SCI-FI functional ability levels. These findings provide further validation for the derivation of SCI-FI functional ability levels that are based on patient’s self-reported perceived ability to complete functional activities

Practical Implications

Clinical Utility

The SCI-FI can be administered in inpatient and outpatient settings, prior to rehabilitative care visits and can provide clinicians with assessment results that can be used alongside more traditional clinical information to facilitate patient-provider communication.

Pattern Identification

Cluster membership can provide information that is similar to the functional ability levels which can be used by clinicians as they identify patterns of functional ability on the basis of injury characteristics at key time-points in rehabilitation.

Goal Setting

Administering the SCI-FI while a patient with SCI is waiting for his/her first outpatient visit can provide both the patient and clinician with a baseline assessment of functional ability levels that might have occurred since discharge and can be used to discuss goals during the clinical encounter.

Study Limitations

1
The final clusters of functional ability levels should be validated in different samples of individuals with traumatic SCI.
2
Domains with 5 functional ability levels may be less clinically meaningful for distinguishing between individuals with SCI who are able to complete all and most activities in a domain
3
A degree of subjectivity is inherent in the qualitative review of results

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