title: Psychometric Properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for Pressure Ulcer Risk Assessment During Inpatient Rehabilitation.
abstract: OBJECTIVE
  To assess the psychometric properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for pressure ulcer (PU) risk assessment during inpatient rehabilitation.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Tertiary rehabilitation centers.
  
  
  METHODS
  Individuals (N=759) participating in inpatient spinal cord injury rehabilitation between January 3, 2012, and April 23, 2014.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Admission SCIPUS scores and the corresponding risk stratification, PU incidence, intraclass correlation coefficient (ICC) for interrater reliability, sensitivity, specificity, and likelihood ratios (LRs). Receiver operating characteristic analysis was performed to calculate the area under the curve (AUC).
  
  
  RESULTS
  Mean SCIPUS scores were higher for individuals who developed PUs than for those who did not (mean SCIPUS score, 9.8±2.5 vs 8.5±2.6). Interrater reliability was excellent for SCIPUS composite scores (ICC=.91) and very good for risk stratification (ICC=.86). Using the existing cutoff value of ≥6 for "high risk" category, sensitivity and specificity were estimated to be .97 and .12, respectively, with an LR of 1.1. A cutoff value of ≥8 yielded a better balance between sensitivity and specificity (.85 and .38, respectively). The AUC equaled .64 with an LR of 1.4. Results were similar when the analysis was confined to PUs of stage II or greater.
  
  
  CONCLUSIONS
  The psychometric properties of the SCIPUS do not currently support its routine use as a measure of PU risk in individuals with spinal cord injury undergoing inpatient rehabilitation. LRs of <2 indicate that stratification as high risk or very high risk does not substantially increase the likelihood of identifying individuals who develop PUs beyond chance alone. AUCs were also below the desired cutoff value of 0.7.
authors.affiliation: Brain and Spinal Cord Rehabilitation Program, Lyndhurst Center, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada. Electronic address: jude.delparte@uhn.ca.
authors.forename: Jude J
authors.initials: JJ
authors.lastname: Delparte
authors.affiliation: Brain and Spinal Cord Rehabilitation Program, Lyndhurst Center, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Scovil
authors.affiliation: Brain and Spinal Cord Rehabilitation Program, Lyndhurst Center, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Flett
authors.affiliation: School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Center for interdisciplinary research in rehabilitation of greater Montreal, Montreal, Quebec, Canada; Research, Institut de réadaptation Gingras-Lindsay-de-Montréal du CIUSSS Centre-est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
authors.forename: Johanne
authors.initials: J
authors.lastname: Higgins
authors.affiliation: Center for interdisciplinary research in rehabilitation of greater Montreal, Montreal, Quebec, Canada; Spinal cord injury program, Institut de réadaptation Gingras-Lindsay-de-Montréal du CIUSSS Centre-est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Laramée
authors.affiliation: Brain and Spinal Cord Rehabilitation Program, Lyndhurst Center, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Burns
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000453:epidemiology*; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods* / Q000592:standards*; D012372:ROC Curve; D012047:Rehabilitation Centers; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000534:rehabilitation*
keywords: Pressure ulcer; Rehabilitation; Reproducibility of results; Risk assessment; Sensitivity and specificity; Spinal cord injuries