Assessment of Disability in Patients with Acute Traumatic Spinal Cord Injury: A Systematic Review of the Literature

JOURNAL OF NEUROTRAUMA, 2011 · DOI: 10.1089/neu.2009.1148 · Published: August 1, 2011

Spinal Cord Injury Disability Research Methodology & Design

Simple Explanation

This study systematically reviews outcome measures used to assess disability in patients with acute spinal cord injury (SCI). It focuses on the reliability, validity, and responsiveness of these measures to identify the most suitable tool for clinical trials. The review analyzed eight different outcome measures, including the Functional Independence Measure (FIM) and Spinal Cord Injury Measure (SCIM), to evaluate their psychometric properties. The expert panel of the Spinal Cord Injury Solutions Network (SCISN) that participated in the modiﬁed Delphi process endorsed these conclusions.

Study Duration

Not specified

Participants

36 full articles reviewed

Evidence Level

Level 2b and 4

Key Findings

1
Criterion validity was not examined due to the lack a gold standard for the assessment of disability.
2
All instruments were tested in the rehabilitation and/or community setting, but only FIM was examined in the acute care setting.
3
Based on the quality assessment, the SCIM has the most appropriate performance regarding its psychometric properties.

Research Summary

This systematic review assessed the psychometric properties of various disability assessment tools used in spinal cord injury (SCI) patients. The study aimed to identify the most reliable, valid, and responsive measure for acute traumatic SCI. Eight different outcome measures were analyzed, including FIM, SCIM, WISCI, and others. The review found that most instruments demonstrated convergent construct validity, but criterion validity was lacking due to the absence of a gold standard. The Spinal Cord Injury Measure (SCIM) was identified as having the most appropriate psychometric properties, although further research is needed to confirm its performance in acute care settings.

Practical Implications

Clinical Trials

The study helps identify suitable outcome measures for future clinical trials of therapeutic strategies in acute SCI.

Functional Recovery Assessment

The review supports the use of SCIM for assessing functional recovery in SCI patients, particularly in rehabilitation settings.

Acute Care Research

The study highlights the need for further research to validate disability assessment tools like SCIM in acute care settings for SCI patients.

Study Limitations

1
Lack of a gold standard for assessing disability, limiting criterion validity assessment.
2
Paucity of studies on validity, agreement, responsiveness, and interpretability in the setting of acute care.
3
All instruments were mostly tested in the rehabilitation and/or community setting.

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