The spinal cord independence measure (SCIM): Sensitivity to functional changes in subgroups of spinal cord lesion patients

Background: The spinal cord independence measure (SCIM) is a newly developed disability scale specific to patients with spinal cord lesions (SCL). Its sensitivity to functional changes in a whole cohort of SCL patients was found to be better than that of the functional independence measure (FIM). Objective: To compare the sensitivity to functional changes of the SCIM and the FIM in SCL subgroups. Design: A comparative self-controlled study. Setting: The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel. Subjects: 22 SCL inpatients. Interventions: Monthly SCIM and FIM assessments of the subgroups. Main outcome measures: Functional change detection rate (FDR) and mean differences between consecutive scores (DCS). Results: The outcome measures of the SCIM were higher than those of the FIM for tetraplegia and paraplegia, complete and incomplete lesions (the FIM missed 25-27% of the functional changes detected by the SCIM; DSC 8.2-11.4 vs 5.2-9; P<0.05 in most comparisons). The SCIM did not exhibit this advantage, however, in the functional areas of self-care and mobility in the room and toilet. Further subgrouping yielded similar results. Conclusions: The SCIM is more sensitive than the FIM to functional changes in the subgroups studied, and has the potential to serve as a universal tool for disability assessment of SCL patients.