Evaluating the modified spinal cord injury secondary conditions scale (SCI-SCS) combining severity and...

Cross-sectional study OBJECTIVE: To evaluate alternative scoring approaches for the modified Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) using severity- and mortality-based weights, and to examine their associations with functioning and self-reported health in individuals with SCI.

Community METHODS: We analyzed data from 10,347 participants in the International Spinal Cord Injury Survey (InSCI). Eight scoring approaches were constructed from 14 secondary health conditions and a depression item, varying by severity coding and by whether mortality weights were applied equally or condition-specifically. Associations with functioning (ICF-based composite score) and self-reported health were assessed using Pearson and Spearman correlations, with additional country-level analyses to explore variability.

All scoring approaches were negatively correlated with both outcomes, indicating that higher secondary health condition burden was associated with worse functioning and poorer health. The score combining the modified SCI-SCS with condition-specific mortality weights showed the highest correlations, though differences from the unweighted score were small. Both scores demonstrated moderate associations with the outcomes. Country-level analyses revealed variability, partly related to sample size, but overall patterns were consistent.

The modified SCI-SCS demonstrated moderate and robust associations with functioning and self-reported health, supporting its use as a pragmatic proxy of overall health status in individuals with SCI. Weighting by mortality risks yielded only marginal gains, suggesting that the unweighted score remains a suitable option for research and practice. These findings advance the use of self-reported measures to capture health burden in SCI and encourage further validation with independent outcomes and across diverse contexts.