A multi-center international study on the spinal cord independence measure, version IV: Rasch psychometric validation.

CONTEXT: The Spinal Cord Independence Measure is a comprehensive functional rating scale for individuals with spinal cord lesion (SCL). OBJECTIVE: To validate the scores of the three subscales of SCIM IV, the fourth version of SCIM, using advanced statistical methods. STUDY DESIGN: Multi-center cohort study. SETTING: Nineteen SCL units in 11 countries. METHODS: SCIM developers created SCIM IV following comments by experts, included more accurate definitions of scoring criteria in the SCIM IV form, and adjusted it to assess specific conditions or situations that the third version, SCIM III, does not address. Professional staff members assessed 648 SCL inpatients, using SCIM IV and SCIM III, at admission to rehabilitation, and at discharge. The authors examined the validity and reliability of SCIM IV subscale scores using Rasch analysis. RESULTS: The study included inpatients aged 16-87 years old. SCIM IV subscale scores fit the Rasch model. All item infit and most item outfit mean-square indices were below 1.4; statistically distinct strata of abilities were 2.6-6; most categories were properly ordered; item hierarchy was stable across most clinical subgroups and countries. In a few items, however, we found misfit or category threshold disordering. We found SCIM III and SCIM IV Rasch properties to be comparable. CONCLUSIONS: Rasch analysis suggests that the scores of each SCIM IV subscale are reliable and valid. This reinforces the justification for using SCIM IV in clinical practice and research.

Reliability Validity and Responsiveness of the Spinal Cord Independence Measure 4th Version in a Multicultural Setup.

OBJECTIVE: To examine the fourth version of the Spinal Cord Independence Measure for reliability and validity. DESIGN: Partly blinded comparison with the criterion standard Spinal Cord Independence Measure III, and between examiners and examinations. SETTING: A multicultural cohort from 19 spinal cord injury units in 11 countries. PARTICIPANTS: A total of 648 patients with spinal cord injury. INTERVENTION: Assessment with Spinal Cord Independence Measure (SCIM IV) and Spinal Cord Independence Measure (SCIM III) on admission to inpatient rehabilitation and before discharge. MAIN OUTCOME MEASURES: SCIM IV interrater reliability, internal consistency, correlation with and difference from SCIM III, and responsiveness. RESULTS: Total agreement between examiners was above 80% on most SCIM IV tasks. All Kappa coefficients were above 0.70 and statistically significant (P<.001). Pearson's coefficients of the correlation between the examiners were above 0.90, and intraclass correlation coefficients were above 0.90. Cronbach's alpha was above 0.96 for the entire SCIM IV, above 0.66 for the subscales, and usually decreased when an item was eliminated. Reliability values were lower for the subscale of respiration and sphincter management, and on admission than at discharge. SCIM IV and SCIM III mean values were very close, and the coefficients of Pearson correlation between them were 0.91-0.96 (P<.001). The responsiveness of SCIM IV was not significantly different from that of SCIM III in most of the comparisons. CONCLUSIONS: The validity, reliability, and responsiveness of SCIM IV, which was adjusted to assess specific patient conditions or situations that SCIM III does not address, and which includes more accurate definitions of certain scoring criteria, are very good and quite similar to those of SCIM III. SCIM IV can be used for clinical and research trials, including international multi-center studies, and its group scores can be compared with those of SCIM III.

Illusion of arm movement evoked by tendon vibration in patients with spinal cord injury.

BACKGROUND: Studies in healthy people show that stimulation of muscle spindles through frequency-specific tendon vibration (TV) induces the illusory perception of movement. Following spinal cord injury (SCI), motor and sensory connections between the brain and parts of the body below-the-lesion level are partially or totally impaired. OBJECTIVE: The present investigation is a descriptive study aimed to investigate whether people living with SCI may experience movement illusions comparable to a control group. METHODS: Healthy and people with SCI were asked to report on three illusion-related features (Vividness, Duration, Illusory Extension) after receiving 70 Hz TV on the biceps brachii tendon of both arms. Two different forces of stimulation were applied: 2.4 N and 4.2 N. RESULTS: Both patients and controls were susceptible to the kinesthetic illusion. However patients presented lower sensitivity to TV than healthy subjects. Participants rated stronger illusions of movement after 4.2 N than 2.4 N stimulation in all the three illusion-related features. Further, patients reported atypical illusory experiences of movement (e.g. as if the arm wanted to extend, or a sensation of pushing against something) that may reflect different reorganization processes following spinal cord injury. CONCLUSION: The study provides a preliminary evidence of the possible use of the proprioceptive stimulation in the upper limbs of people living with SCI. Results are discussed in the light of recent advancements of brain-computer applications based on motor imagery for the control of neuroprosthetic and robotic devices in patients with severe sensorimotor deficits.

Italian version of Qualiveen-30: cultural adaptation of a neurogenic urinary disorder-specific instrument.

PURPOSE: Qualiveen-30 is a neurological urinary disorder (UD)-specific health-related quality of life (HRQL) instrument, recommended in the European Association of Urology guideline 2008. The objective is to complete the cultural adaptation of Qualiveen-30 into Italian. MATERIALS AND METHODS: One hundred and twenty eight Italian-speaking spinal cord injury (SCI) patients completed Qualiveen-30 and the SF-12 physical and mental component (PC and MC) at enrollment and 4 weeks later. At follow-up, patients also made global ratings of change (GRC) in urinary HRQL (GRC). RESULTS: Qualiveen-30 proved reliable (intraclass correlation coefficients of four domains: 0.77-0.90). Correlations with SF-12 and GRC were generally consistent with our a priori predictions. Qualiveen-30 domains showed weak-to-moderate cross-sectional correlations with SF-12 scores (0.31-0.45 PC and 0.28-0.45 MC). Correlations between changes in Qualiveen-30 scores and in SF-12-PC scores were weak or absent. Correlations between changes in Qualiveen-30 scores and in SF-12-MC scores were weak to moderate (0.25-0.38). Relationships between change in Qualiveen-30 and GRC were moderate to strong (0.48-0.56). The responsiveness was excellent, similar to the original form (SMR: 1.76-2.31). Minimally important difference values in the four domains varied from 0.34 to 0.47. CONCLUSIONS: Italian Qualiveen-30 is a reliable, valid, and responsive measure of UD-related HRQL in SPI patients. Investigators can be confident of the Qualiveen-30 questionnaire's ability in distinguishing between patients in a cross-sectional survey, as well as in measuring within-subject changes over time in clinical trials in French, English, and Italian.