Developing a Measure to Assess the Functional Abilities of Persons with Spinal Cord Injury (SCI-FI)
For people with spinal cord injuries (SCI), research helps identify the best treatments to improve a person’s level of function. However, the only way to know if a treatment works is to be able to measure function accurately.
A good example to help understand the importance of measurement is to think of a scale that gives you your weight. For instance what if a scale could only tell you that you weighed 150, 160, or 170 pounds, and nothing in between? If you weighed 160 pounds and wanted to lose weight, you would have no idea if your diet and exercise were working until your weight dropped from 160 to 150 pounds. There’s a lot of change that you would miss! And if you only wanted to lose 5 pounds, you wouldn’t be able to tell if you achieved your goal. Similarly, it is important to have an accurate way to measure function in SCI so we can document that change has occurred and better understand what has contributed to the change.
Functional measures currently used in SCI evaluate a limited number of activities or have a specific focus, such as only looking at one diagnosis (for example, tetraplegia) or only measuring one type of activity (for example, only wheelchair use OR walking ability, but not both). There is a need for a single functional measure that can assess different types of activities at all levels and degrees of injury.
For the last several years, NERSCIC researchers have been developing a way to easily assess function using a computerized adaptive test (CAT) approach. With a CAT approach, a computer program asks a question, and then uses the answer to select the next best question for that individual. This approach eliminates the need to ask questions that do not apply because they are either too easy or too difficult for someone to accomplish. CATs can be used to assess a wide range of functional ability while dramatically reducing the amount of time needed to complete the assessment.
The new functional measure developed by NERSCIC researchers is called the Spinal Cord Injury Functional Index, or SCI-FI. The SCI-FI includes questions in five functional areas or domains: basic mobility, self-care, fine motor function, ambulation, and wheelchair mobility and related issues. Finally, we developed the CAT component, where a computer program selects the SCI-FI questions that match each person’s ability level. Using the SCI-FI CAT, a person’s functional score can be estimated in a few minutes by answering no more than 10 questions in each domain. Since all questions a person could be asked are part of a single scale, the SCI-FI CAT can be given to individuals with a wide range of functional abilities, and it can track changes in function accurately for anyone no matter their level of functioning.
In the next phase of our research, individuals with SCI who are newly injured will complete the SCI-FI CAT both before discharge from inpatient rehabilitation and one-year later. This will allow us to examine how well the SCI-FI CAT detects changes in function during the first year post-injury, when people are likely to see some improvement in functioning. The SCI-FI is a better ‘scale’ that helps us detect when even small changes have occurred. Ultimately, the SCI-FI helps us to better understand the impact of treatment approaches that are intended to maximize the functional abilities of people with SCI.