Spinal Cord Injury-Functional Index/Capacity: Responsiveness to Change Over Time

Area of Science:

• Rehabilitation Medicine
• Neuroscience
• Clinical Assessment

Background:

• Assessing functional recovery after spinal cord injury (SCI) is crucial for patient outcomes.
• Existing functional outcome measures require validation for responsiveness to change in the early post-injury period.
• The Spinal Cord Injury-Functional Index/Capacity (SCI-FI/C) is a patient-reported outcome measure designed to capture functional status.

Purpose of the Study:

• To establish the responsiveness of three SCI-FI/C item banks (Basic Mobility/C, Self-care/C, Fine Motor/C) within the first year after SCI.
• To validate these SCI-FI/C measures in independent datasets representing different stages of recovery.
• To compare the responsiveness of SCI-FI/C measures with the Self-reported Functional Measure (SRFM).

Main Methods:

• Secondary analysis of longitudinal data from 8 SCI Model Systems rehabilitation hospitals.
• Study 1: Compared SCI-FI/C scores at baseline and 6 months in recently injured (≤4 months) and community-dwelling (>1 year) adults.
• Study 2: Cross-validated findings in a new cohort of recently injured individuals and compared SCI-FI/C with SRFM, stratifying by injury type.

Main Results:

• SCI-FI/C Basic Mobility/C and Self-care/C item banks showed statistically significant changes (P<.01) with small to medium effect sizes in recently injured individuals.
• SCI-FI Fine Motor/C was responsive in recently injured individuals with tetraplegia and incomplete paraplegia.
• Results were consistent across both studies, with SCI-FI/C demonstrating stability in the community-dwelling sample.

Conclusions:

• The SCI-FI Basic Mobility/C and Self-care/C item banks are sensitive to functional changes at 6 months and 1 year post-SCI for all individuals.
• The SCI-FI Fine Motor/C item bank is sensitive to change in specific SCI populations (tetraplegia, incomplete paraplegia).
• These findings support the use of SCI-FI/C item banks for research and clinical assessment of functional status in SCI.