Spinal Cord Injury – Functional Index/Capacity (SCI-FI/C): Responsiveness to Change over Time

Arch Phys Med Rehabil, 2022 · DOI: 10.1016/j.apmr.2021.10.005 · Published: February 1, 2022

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

Individuals with spinal cord injuries (SCI) often experience significant functional improvements within the first year after their injury. Outcome measures are needed to accurately capture these changes in functional capacity, which directly impacts their independence and overall well-being. Responsiveness of an outcome measure indicates its ability to detect clinically meaningful change over time. Valid and responsive measures are essential for providing tailored, high-quality rehabilitative care and making informed treatment decisions. The Spinal Cord Injury – Functional Index (SCI-FI) is a tool designed to improve the measurement of physical function in individuals with SCI. It includes item banks assessing various aspects of physical function, such as Basic Mobility, Self-Care, and Fine Motor skills, both with and without assistive technology.

Study Duration

6 months and 1 year follow-up

Participants

Study 1: 184 recent SCI, 221 community-dwelling SCI; Study 2: 418 recent SCI

Evidence Level

Longitudinal patient-reported outcomes assessment

Key Findings

1
The SCI-FI Basic Mobility/C and Self-Care/C item banks demonstrated sensitivity to change at both 6 months and 1 year post-injury for individuals with SCI.
2
The SCI-FI Fine Motor/C item bank was found to be sensitive to change specifically in individuals with tetraplegia or incomplete paraplegia, indicating its relevance for assessing fine motor skill improvements in these subgroups.
3
All SCI-FI/C banks demonstrated stability in community-dwelling individuals with SCI, indicating that these measures can also be used to monitor function over time.

Research Summary

This study evaluated the responsiveness of the SCI-FI/C Basic Mobility, Self-Care, and Fine Motor item banks in individuals with SCI during the first year post-injury. Responsiveness was examined by comparing changes in SCI-FI scores in recently injured individuals versus community-dwelling individuals and cross-validated in a second sample. The results showed that the SCI-FI/C Basic Mobility and Self-Care item banks are sensitive to change for all individuals with SCI, while the Fine Motor item bank is sensitive to change only for individuals with tetraplegia or incomplete paraplegia. The study also demonstrated the stability of these measures in community-dwelling adults with SCI. The study supports the use of the SCI-FI/C measures in clinical and research settings to monitor functional changes in individuals with SCI, particularly in the first year post-injury or during interventions aimed at improving function.

Practical Implications

Clinical Monitoring

The SCI-FI/C measures can be used to monitor changes in physical function during inpatient rehabilitation and outpatient encounters, potentially justifying continued stay or alerting clinicians to potential problems.

Intervention Assessment

The SCI-FI/C measures can be used in research to assess changes following interventions aimed at improving body function, both with and without assistive technology.

Community Dwelling Monitoring

The SCI-FI/C item banks can monitor function over time in community-dwelling individuals and decreases in scores could indicate problem areas in need of clinical discussion and potential intervention.

Study Limitations

1
The convenience sample of SCI Model Systems sites may not be representative of all persons with SCI.
2
Due to the low frequency of individuals who ambulate, we were unable to compute responsiveness for the SCI-FI/C Ambulation measure.
3
The SRFM was the only available criterion measure for comparison to SCI-FI/C scores.

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