Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research.
OBJECTIVE
The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome measures designed to assess functional status relevant to SCI are important to develop.


METHODS
Evaluation of currently available SCI functional outcome measures by a multinational work group.


RESULTS
The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel Index (MBI), the Functional Independence Measure (FIM), the Quadriplegia Index of Function (QIF), and the Spinal Cord Independence Measure (SCIM). The MBI and the QIF were found to have minimal evidence for validity, whereas the FIM and the SCIM were found to be reliable and valid. The MBI has little clinical utility for use in the SCI population. Likewise, the FIM applies mainly when measuring burden of care, which is not necessarily a reflection of functional recovery. The QIF is useful for measuring functional recovery but only in a subpopulation of people with SCI, and substantial validity data are still required. The SCIM is the only functional recovery outcome measure designed specifically for SCI.


CONCLUSIONS
The multinational work group recommends that the latest version of the SCIM (SCIM III) continue to be refined and validated and subsequently implemented worldwide as the primary functional recovery outcome measure for SCI. The QIF may continue to be developed and validated for use as a supplemental tool for the nonambulatory tetraplegic population.
Anderson
Kim
K
Reeve-Irvine Research Center, Department of Neurological Surgery, University of California, Irvine, CA 92697-1385, USA. kanderso@uci.edu
Aito
Sergio
S
Atkins
Michal
M
Biering-Sørensen
Fin
F
Charlifue
Susan
S
Curt
Armin
A
Ditunno
John
J
Glass
Clive
C
Marino
Ralph
R
Marshall
Ruth
R
Mulcahey
Mary Jane
MJ
Post
Marcel
M
Savic
Gordana
G
Scivoletto
Giorgio
G
Catz
Amiram
A
D000203:Activities of Daily Living; D004185:Disability Evaluation; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards; D006801:Humans; D007391:International Cooperation; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards; D011782:Quadriplegia / Q000534:rehabilitation; D020127:Recovery of Function; D015203:Reproducibility of Results; D013119:Spinal Cord Injuries / Q000534:rehabilitation*