title: Determining the most robust dimensional structure of categories from the international classification of functioning, disability and health across subgroups of persons with spinal cord injury to build the basis for future clinical measures.
abstract: OBJECTIVE
  To determine the most robust dimensional structure of the International Classification of Functioning, Disability and Health (ICF) categories relevant to spinal cord injury (SCI) across subgroups of lesion level, health care context, sex, age, and resources of the country.
  
  
  METHODS
  A multidimensional between-item response Rasch model was used. The choice of the dimensions was conceptually driven using the ICF components from the functioning chapters and splits of the activity and participation component described in the ICF.
  
  
  METHODS
  Secondary analysis of data from an international, cross-sectional, multicentric study for the Development of ICF Core Sets for Spinal Cord Injury.
  
  
  METHODS
  Persons with SCI (N=1048) from the early postacute and long-term living context from 14 middle/low- and high-resource countries.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Ratings of categories of the ICF relevant for SCI were analyzed.
  
  
  RESULTS
  Five models were tested on the complete sample and 5 subgroups. The overall reliability of all models and reliability within dimensions of the unidimensional and 2-dimensional models were good to excellent. The ICF categories spread well along the disability scale. The model fit improvement from the unidimensional to the 2-dimensional and from the 2-dimensional to the 3-dimensional model was significant in all groups (P<.0001). The improvement, however, from a unidimensional to a 2-dimensional structure was markedly better than from a 2-dimensional to a 3-dimensional one.
  
  
  CONCLUSIONS
  We propose that a 2-dimensional structure separating body functions and body structures from the activity and participation categories should serve as a basis for developing clinical measures in SCI in the future.
authors: Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland; ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Nottwil, Switzerland.
authors: Carolina S
authors: CS
authors: Ballert
authors: Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland; ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Nottwil, Switzerland.
authors: Gerold
authors: G
authors: Stucki
authors: Department for Spinal Cord Injuries, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Fin
authors: F
authors: Biering-Sørensen
authors: Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton, UK; Department of Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, Research Unit for Biopsychosocial Health, Ludwig-Maximilians University of Munich, Munich, Germany. Electronic address: A.Cieza@soton.ac.uk.
authors: Alarcos
authors: A
authors: Cieza
mesh_terms: D001208:Asia; D001315:Australia; D001938:Brazil; D002170:Canada; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000145:classification*; D005060:Europe; D005260:Female; D006295:Health Resources; D006304:Health Status; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D007557:Israel; D008297:Male; D008962:Models, Theoretical; D009520:New Zealand; D010264:Paraplegia / Q000209:etiology; D011594:Psychometrics; D011782:Quadriplegia / Q000209:etiology; D013119:Spinal Cord Injuries / Q000145:classification* / Q000150:complications / Q000503:physiopathology; D014481:United States
keywords: International Classification of Functioning, Disability and Health; Paraplegia; Rehabilitation; Spinal cord injuries