Development of Persian version of the Spinal Cord Independence Measure III assessed by interview: a psychometric study

Changes in functional independence after inpatient rehabilitation in patients with spinal cord injury: A simultaneous evaluation of prognostic factors

OBJECTIVE

This study aimed to investigate the improvements of functional independence following inpatient rehabilitation and compare those improvements between different levels and severities of Spinal Cord Injury (SCI). Prognostic factors affecting the patient's outcomes were also studied.

SETTINGS

Rofeideh Rehabilitation Hospital.

OUTCOME MEASURES

Spinal Cord Independence Measure version III (SCIM III), and Functional Independence Measure (FIM).

METHOD

In this retrospective cohort study, 180 patients with SCI were enrolled to record their functional independence upon admission and discharge, and the changes were compared between different levels and severities of injury using non-parametric tests. The prognostic factors of outcomes were studied by generalized estimating equation (GEE) analysis.

RESULTS

The independence changes were significant for all the severities (American Spinal Injury Association Impairment Scale (AIS)) and levels of injury except for the patients with AIS A and B at upper cervical levels (P < 0.05). The level of injury, AIS, Length of Stay (LOS), and pressure ulcer had a significant prognostic value on patient's outcomes. Furthermore, there was a significant difference between different levels of injury with the same AIS grade in functional improvement (P < 0.05), while there was a significant difference between AIS groups with the same level of injury only at upper and middle cervical lesions (P < 0.05).

CONCLUSION

Recording the values of functional independence before and after rehabilitation in individuals with SCI can help clinicians approximately expect the outcomes of future patients. Moreover, a deeper study of the prognostic factors can provide a more logical expectation of rehabilitation outcomes.

Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran

STUDY DESIGN

A retrospective study.

OBJECTIVES

The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs).

METHODS

The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase.

RESULTS

In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1 hour and <8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%).

CONCLUSION

These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.

Standardized administration and scoring guidelines for the Spinal Cord Independence Measure Version 3.0 (SCIM-III)

STUDY DESIGN

Qualitative studies.

OBJECTIVE

To develop clear and specific administration and scoring procedures for the Spinal Cord Independence Measure Version 3.0 as a performance-based and interview assessment.

SETTING

Research lab.

METHODS

Modified Delphi Technique survey methods were used in this study. Previously developed SCIM-III administration and scoring procedures for performance-based and interview versions were presented to clinicians experienced in SCI and SCIM-III using the Qualtrix (Qualtrics, Provo, UT) online survey platform. Summary and descriptive statistics were used to assess the percent agreement survey responses.

RESULTS

Three survey rounds were necessary to achieve 80% agreement or above for the performance-based version. Two survey rounds were necessary to achieve 80% agreement or above on the interview version.

CONCLUSIONS

This study describes the development of standardized administration and scoring procedures for the self-care and mobility sub-scales of the SCIM-III as a performance-based and interview version.

Practical approach to the native distal femur fractures in the elderly: A rapid review over the recent trends

Significant work has been done in recent years on treatment strategies for distal femur fractures. Inclusive reviews on periprosthetic fractures of distal femur have been carried out recently, but there is a lack of such reviews on the subject of native distal femur fractures in the recent literature. In this narrative review, we are set out to address the latest updates on geriatric non-periprosthetic distal femur fractures, and perform a rapid review over different treatment options, arriving at a summarized proposed treatment algorithm.

Langenskiöld classification of tibia vara: a multicenter study on interrater reliability

Since 1952, when Langenskiöld introduced his six-stage classification on roentgenographic morphologies of tibia vara, this method has been used extensively in Orthopaedic studies. Different studies have tried to determine the reliability of this method. Although there are scarce reports of major variability in using Langenskiöld classification, but the question still remains, as to whether using expert subspecialists and MRI would improve its reliability. The aim of this study is to evaluate inter-rater reliability of Langenskiöld classification using simple radiograph and MRI, by expert raters. This is a cross-sectional multicenter study, involving patients from 4 tertiary pediatric orthopedic centers in France and Iran. Radiograph and MRI (T1, T2, fat saturation) of the affected knees were independently classified by 12 academy members from France and Iran: six pediatric fellowship orthopedic surgeons and six musculoskeletal radiologists. All data were analyzed afterwards by an independent researcher. Mean weighted kappa for agreement based on radiograph and MRI was 0.47 and 0.45, respectively. Mean percent of total agreement was 46.6 and 40.8% in the same order. Kappa statistics for the new grouping were 0.53 and 0.46 for roentgenograms and MRIs, respectively. The new regrouping was proposed so that each group would need a different treatment strategy. Fleiss kappa statistics for group B (stages 2 and 3), rose from (0.33 and 0.09) to 0.44. These values for group C (stages 4 and 5) rose from (0.42 and 0.11) to 0.54. This study concludes that Langenskiöld's classification when used by experts, still has a moderate inter-rater reliability at best. This variability is most at stages 2, 3, and 4; and can cause different treatment approaches. Use of MRI does not have a significant effect on its reliability. Regrouping the stages improved the inter-rater reliability. Level of evidence: III.

Reliability validity and responsiveness of the spinal cord independence measure 4th version in a multicultural setup

OBJECTIVE

To examine the fourth version of the Spinal Cord Independence Measure for reliability and validity.

DESIGN

Partly blinded comparison with the criterion standard Spinal Cord Independence Measure III, and between examiners and examinations.

SETTING

A multicultural cohort from 19 spinal cord injury units in 11 countries.

PARTICIPANTS

Six hundred and forty-eight patients with spinal cord injury.

INTERVENTION

Assessment with Spinal Cord Independence Measure (SCIM IV) and Spinal Cord Independence Measure (SCIM III) on admission to inpatient rehabilitation and before discharge.

MAIN OUTCOME MEASURES

SCIM IV interrater reliability, internal consistency, correlation with and difference from SCIM III, and responsiveness.

RESULTS

Total agreement between examiners was above 80% on most SCIM IV tasks. All Kappa coefficients were above 0.70 and statistically significant (p<0.001). Pearson's coefficients of the correlation between the examiners were above 0.90, and intraclass correlation coefficients were above 0.90. Cronbach's alpha was above 0.96 for the entire SCIM IV, above 0.66 for the subscales, and usually decreased when an item was eliminated. Reliability values were lower for the subscale of respiration and sphincter management, and on admission than at discharge. SCIM IV and SCIM III mean values were very close, and the coefficients of Pearson correlation between them were 0.91-0.96 (p<0.001). The responsiveness of SCIM IV was not significantly different from that of SCIM III in most of the comparisons.

CONCLUSIONS

The validity, reliability, and responsiveness of SCIM IV, which was adjusted to assess specific patient conditions or situations that SCIM III does not address, and which includes more accurate definitions of certain scoring criteria, are very good and quite similar to those of SCIM III. SCIM IV can be used for clinical and research trials, including international multi-center studies, and its group scores can be compared with those of SCIM III.

Translation and validation of the Chinese version of the Spinal Cord Independence Measure (SCIM III) Self-Report

STUDY DESIGN

A cross-sectional psychometric study.

OBJECTIVE

To translate, culturally adapt and validate the Chinese version of the Spinal Cord Independence Measure III-Self Report (SCIM-SR).

SETTING

Four rehabilitation centers in Guangzhou, Chengdu, and Shiyan, China.

METHODS

Translation and cultural adaptation of the Chinese version of the SCIM-SR was conducted according to Brislin guidelines. A total of 147 spinal cord injury patients self-rated their functional independence using translated instrument. The psychometric properties of content validity, criterion-related validity, internal consistency reliability, and test-retest reliability were examined.

RESULTS

The content validity index of the new scale was 0.99. The intraclass correlation coefficient between the total SCIM-SR and SCIM III scores was 0.935, and the coefficients for its three subscales were 0.899, 0.760, and 0.942. Bland-Altman analysis showed that the mean difference between the total SCIM-SR and SCIM III scores was 2.35 (95% confidence interval -0.58 to 5.28), and differences for the three subscales were 0.75 (-0.51-2.01), 1.30 (-0.63-3.23), and 0.30 (-0.80-1.40). The Cronbach's α coefficients for the total scale, the self-care subscale, and the mobility subscale were 0.908, 0.913, and 0.895, respectively. The α for the respiration and sphincter management subscale was 0.581. Test-retest reliability after 2 weeks yielded a Spearman coefficient for the total scale of and subscale values all above 0.73.

CONCLUSIONS

Our results indicate acceptable validity and reliability of the Chinese version of SCIM-SR. It may facilitate long-term evaluations of independence in Chinese spinal cord injury patients in the community and at home.

Cross-cultural adaptation and psychometric testing of the Thai version of the Spinal Cord Independence Measure III-Self Report

STUDY DESIGN

Cross-sectional reliability and validation study.

OBJECTIVE

To translate and assess the psychometric properties of the Thai version of the Spinal Cord Independence Measure III-Self Report (TH-SCIM-SR) in Thai spinal cord injury (SCI) patients.

SETTING

Faculty of Medicine Siriraj Hospital, Mahidol University.

METHODS

A cross-cultural forward and backward translation of the original Spinal Cord Independence Measure III-Self Report (SCIM-SR) was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, to create the TH-SCIM-SR. The inclusion criteria were Thai patients with SCI duration of ≥3 months. Patients were evaluated by a team of healthcare professionals using the Thai version of the Spinal Cord Independence Measure Version III (TH-SCIM III). Study patients subsequently completed the TH-SCIM-SR two times with a 3-day interval between evaluations. Cronbach's Alpha, Pearson's correlation coefficient, and intraclass correlation coefficient (ICC) were used to examine internal consistency, concurrent validity, and reliability, respectively. Bland-Altman plot was used to compare scoring results between the TH-SCIM III and the TH-SCIM-SR.

RESULTS

Thirty-two patients were included. Cronbach's alpha of total score, self-care subscale, respiration/sphincter management, and mobility subscale were 0.91, 0.94, 0.75, and 0.90, respectively. The reliability analysis showed good reliability. The test-retest ICC of total score, self-care subscale, respiration/sphincter management, and mobility subscale were 0.95, 0.95, 0.78, and 0.96, respectively. Regarding construct validity, the subscales of TH-SCIM-SR demonstrated a strong correlation with those of the TH-SCIM III (0.85-0.96).

CONCLUSIONS

TH-SCIM-SR showed good reliability and validity for assessing functional independence in Thai patients with SCI.

Advanced weight-bearing mat exercises combined with functional electrical stimulation to improve the ability of wheelchair-dependent people with spinal cord injury to transfer and attain independence in activities of daily living: a randomized controlled trial

STUDY DESIGN

Randomized controlled trial.

OBJECTIVE

To determine the effects of advanced weight-bearing mat exercises (AWMEs) with/without functional electrical stimulation (FES) of the quadriceps and gastrocnemius muscles on the ability of wheelchair-dependent people with spinal cord injury (SCI) to transfer and attain independence in activities of daily living (ADLs).

SETTING

An outpatient clinic, Iran.

METHODS

People with traumatic chronic paraplegia (N = 16) were randomly allocated to three groups. The exercise group (EX; N = 5) performed AWMEs of quadruped unilateral reaching and tall-kneeling for 24 weeks (3 days/week). Sessions were increased from 10 min to 54 min over the 24-week period. The exercise-FES group (EX + FES; N = 5) performed AWMEs simultaneously with FES of the quadriceps and gastrocnemius muscles. The control group performed no exercise and no FES (N = 6). The primary outcomes were the total Spinal Cord Independence Measure-III (SCIM-III) to reflect independence with ADL, and the sum of the four SCIM-III transfer items to reflect ability to transfer. There were six other outcomes.

RESULTS

The mean (95% CI) between-group differences of the four transfer items of the SCIM-III for the EX vs. control group was 1.8 points (0.2-3.4), and for the EX + FES vs. control group was 2 points (0.4-3.6). The equivalent differences for the total SCIM-III scores were 2.7 points (-0.6-6.0) and 4.1 points (0.8-7.4), respectively. There were no significant between-group differences for any other outcomes.

CONCLUSIONS

Advanced weight-bearing mat exercises improve the ability of wheelchair-dependent people with SCI to transfer and attain independence in ADL.