Applying a Bookmarking Approach to Setting Clinically Relevant Interpretive Standards for the Spinal Cord...

Area of Science:

• Rehabilitation Medicine
• Neuroscience
• Clinical Measurement

Background:

• The Spinal Cord Injury-Functional Index/Capacity (SCI-FI/C) is a crucial tool for assessing functional status in individuals with spinal cord injury (SCI).
• Clinically relevant interpretive standards are needed to translate SCI-FI/C scores into meaningful functional capacity levels.
• Existing scoring lacks clear benchmarks for Basic Mobility and Self-Care domains, hindering consistent interpretation.

Purpose of the Study:

• To establish clinically relevant interpretive standards for the SCI-FI/C Basic Mobility and Self-Care item bank scores.
• To provide clear cut points for classifying functional capacity in individuals with SCI.
• To ensure consistent and accurate application of SCI-FI/C across different versions (full bank, CAT, short-form).

Main Methods:

• A modified "bookmarking" standard-setting methodology was employed.
• Two consensus meetings were conducted with individuals with SCI (consumers) and SCI clinicians.
• A final "convergence" meeting integrated consumer and clinician perspectives to establish final cut scores.

Main Results:

• Consensus was reached on scoring cut points for both SCI-FI/C Basic Mobility and Self-Care item banks.
• For Basic Mobility, agreed cut scores were 61.25 (no/mild), 51.25 (mild/moderate), and 41.25 (moderate/severe problems).
• For Self-Care, agreed cut scores were 56.25 (no/mild), 51.25 (mild/moderate), and 38.75 (moderate/severe problems).

Conclusions:

• Straightforward interpretive guidelines for SCI-FI/C Basic Mobility and Self-Care instruments have been developed.
• These standards facilitate consistent interpretation of functional capacity for researchers and clinicians.
• The established cut points are applicable to all SCI-FI/C Basic Mobility and Self-Care instrument versions.