Enhancement of Rehabilitation Outcome Measures for Patients with Spinal Cord Injury (SCI)

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Authors (including presenting author) :
Yam YWA(1), Ng HK(1), Wan KYK(1)
Affiliation :
(1)Occupational Therapy Department, MacLehose Medical Rehabilitation Centre (MMRC)
Introduction :
Improving functional outcome is one of the major goals in rehabilitation, and hence relevant and sensitive outcome measures are always in demand. Functional Independence Measure (FIM) has been used for over 20 years as a generic outcome measure for various impairment categories in MMRC. However, some argued that FIM was designed to assess burden of care and might not specifically reflect the functional recovery for SCI patients. Spinal Cord Independence Measure (SCIM) was developed since 1997 and was refined to SCIM III in 2007. SCIM III included items specifically designed for SCI patients, and was proved to be valid for patients with traumatic SCI and non-traumatic SCI.
Objectives :
To review and update the use of functional outcome measures for SCI patients who went through in-patient rehabilitation
Methodology :
FIM motor subscales of 46 subjects (20 females (43%), mean age=59.5) were rated by the case therapist, while SCIM III were charted by the case therapist and another Occupational Therapist (OT), upon admission and before discharge. The inter-rater reliability of SCIM III and correlation between SCIM III and FIM motor subscale were evaluated for SCI patients with rehabilitation received from January to December 2017.
Result & Outcome :
SCIM III was shown to be a valid and reliable functional outcome measure for SCI patients, supported by the significant results of criterion validity and inter-rater reliability. For criterion validity, strong correlation was found between SCIM III and FIM motor subscale with all Spearman coefficients obtained ≥0.900 (p< .001, n=22 and n=24) for admission and discharge. For inter-rater reliability of SCIM III, intra-class correlation coefficients (ICC) were 0.971 (Admission) with 95% confident interval=0.948-0.984 (F(45,45)=68.1, p< .001) and 0.987 (Discharge) with 95% confident interval=0.976-0.993 (F(45,45)=158.0, p< .001). SCIM III included specific items which were very relevant to the life expectancy and quality of life for SCI patients. The scores also reflected the impact of rehabilitation inputs such as adaptive methods and use of assistive technology. Furthermore, rating FIM enabled us to compare the rehabilitation outcomes of SCI patients with international benchmarking information. In conclusion, using both SCIM III and FIM motor subscale allows a more comprehensive review of SCI rehabilitation outcomes for patients’ progress monitoring and program evaluation without taking extra efforts of test administration.

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