Association Between SCIM III Total Scores and Individual Item Scores to Predict Independence With ADLs in Persons With Spinal Cord Injury

Kei Unai; Osamu Uemura; Ryo Takemura; Michiyuki Kawakami; Meigen Liu

doi:10.1016/j.arrct.2019.100029

Association Between SCIM III Total Scores and Individual Item Scores to Predict Independence With ADLs in Persons With Spinal Cord Injury

Arch Rehabil Res Clin Transl. 2019 Oct 23;1(3-4):100029. doi: 10.1016/j.arrct.2019.100029. eCollection 2019 Dec.

Authors

Kei Unai¹, Osamu Uemura¹, Ryo Takemura², Michiyuki Kawakami³, Meigen Liu³

Affiliations

¹ National Hospital Organization Murayama Medical Center, Gakuen, Musashimurayama, Tokyo, Japan.
² Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinanomachi, Shinjuku, Tokyo, Japan.
³ Department of Rehabilitation Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan.

Abstract

Objective: To clarify the activities of daily living (ADL) structure of persons with spinal cord injury (SCI) by analyzing the associations between the Spinal Cord Independence Measure III (SCIM III) total score and individual SCIM III item scores.

Design: A retrospective survey.

Setting: A national hospital with 2 SCI units in Japan.

Participants: Inpatients (N=81) within 60 days of SCI onset were included (men, 84%). The mean age was 62 years. Of these, 63 persons had incomplete SCI (47 persons had tetraplegia).

Interventions: Not applicable.

Main outcome measure: SCIM III was used to assess the ADL independence level on a monthly basis during hospitalization. SCIM III data were analyzed with ordinal logistic analyses.

Results: The analyses revealed that SCIM III total scores accounted for the probabilities of individual SCIM III item scores. Goodness-of-fit of each logistic model by Wald test was significant (P<.001, R ² _McFadden=0.183-0.598). Some items in the self-care domain showed a shallow (ie, less steep) logistic curve. Regarding the feeding item, a total score of 80 was needed to attain the complete independence level, while patients with a total score >10 attained modified independence level.

Conclusions: The SCIM III total score can provide information on the probability and degree of difficulty of attaining independence for each item. Therefore, the present total SCIM III scores could be the indication for ADL attainment. In addition, the higher total SCIM III score and the probability of individual items score are useful for planning efficient rehabilitative approaches, considering the degree of difficulty of attaining independence for each item. Moreover, our results show good generalizability across patients with complete and incomplete SCI.

Keywords: ADL, activities of daily living; AIS, American Spinal Injury Association Impairment Scale; Paraplegia; Probability; Prognosis; Rehabilitation; SCI, spinal cord injury; SCIM III, Spinal Cord Independence Measure version III; Tetraplegia.