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Simplifying ICF Assessment for Individuals with Spinal Cord Injury with Lower Limb Dysfunction Using Item Response
Huifang He1, Wenjun Dai2, Min Su3
1Department of Rehabilitation Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China; School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China.
A new 38-item International Classification of Functioning, Disability and Health (ICF) tool effectively assesses lower limb dysfunction in spinal cord injury (SCI) patients. This validated tool aids in personalized intervention strategies for improved functional outcomes.
Area of Science:
- Rehabilitation Medicine
- Psychometrics
- Health Informatics
Background:
- Spinal cord injury (SCI) frequently results in lower limb dysfunction, necessitating precise functional assessment tools.
- The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework for describing health and disability.
- Developing a psychometrically sound ICF-based tool is crucial for guiding rehabilitation interventions in SCI populations.
Purpose of the Study:
- To develop and validate a parameterized assessment tool based on the ICF for individuals with SCI and lower limb dysfunction.
- To apply item response theory (IRT) and graphical modeling (GM) for robust tool development and analysis.
- To investigate the relationships among ICF functional items and their implications for intervention.
Main Methods:
- A cross-sectional, multicenter study involving 252 participants with SCI and lower limb dysfunction across rehabilitation centers in China.
- Utilized Mokken scale analysis, parametric and non-parametric IRT models (npIRT, pIRT) for item evaluation and model development.
- Applied Graphical Modeling (GM) to visualize functional item networks and computed the Overall Benefit Index.
Main Results:
- A 38-item four-parameter logistic model was identified as the optimal assessment tool, demonstrating high reliability (Cronbach's α = 0.9445, latent class reliability = 0.9708).
- The tool showed measurement equivalence across various demographic and clinical subgroups (gender, self-care, clinical stage, age).
- GM analysis indicated that interventions targeting specific functional items (e.g., d420 Transferring Oneself, d415 Maintaining a Body Position) could yield significant overall functional benefits.
Conclusions:
- The 38-item ICF-based assessment tool exhibits strong structural validity and internal consistency.
- This validated tool is a promising resource for functional assessment in individuals with SCI and lower limb dysfunction.
- The tool has significant potential to inform the development of individualized intervention strategies for this patient population.
