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Spinal Cord Independence Measure
Availability
The SCIM III is freely available in the following publication: Catz A et al. SCIM--spinal cord independence measure: a new disability scale for patients with spinal cord lesions.  Spinal Cord. 1997;35(12):850–856.
Classification
Supplemental-Highly Recommended: Spinal Cord Injury (SCI)
Exploratory: SCI-Pediatric (up to 18 years)
Short Description of Instrument
Construct measured: Function, Activities of Daily Living
Generic vs. disease specific: Disease specific
Intended respondent: The measure was developed as a performance measure but has also been used in an interview (with participant) and self-report format.
# of items: 19
Comments/Special Instructions
Scoring: The most recent version of the SCIM (SCIM III) is comprised of 19 items in three sub-scales: 1) self-care (6 items, sub-score 0–20), 2) respiration and sphincter management (4 items, sub-score 0–40), and 3) mobility (9 items, sub-score 0–40). The total score ranges from 0–100. Mobility is sub-divided into “room and toilet” and “indoors and outdoors”. The items are weighted in terms of their assumed clinical relevance.
 
Background: The SCIM is an SCI specific measure of basic functional independence. The SCIM III is scored by observation or interview. A self-report version (SCIM-SR) of the SCIM III has been validated in German (Fekete et al. 2013). There is no training manual as instructions are on the worksheet. However, it has been recommended that a reference manual be developed to describe how to score variable situations.
 
SCI-Pediatric-specific:
 
There are no reported psychometric studies of the SCIM-III with youth with SCI. A current multi-center study is under way.
At this time, it is not recommended for children but the SCIM self-report youth is Exploratory for ages >8.
Rationale/Justification
Psychometric Properties: This test has undergone extensive psychometric testing in SCI.
 
Reliability: Internal consistency (Cronbach’s a=0.77 – 0.91); Inter-rater reliability for SCIM total (ICC=0.956), for the subscales: self-care (ICC=0.941), respiration/sphincter (ICC=0.844), mobility in the room (ICC=0.961), mobility indoors/outdoors (ICC=0.945).  
 
Validity: Correlation of the SCIM III with the FIM (Pearson’s r=0.779 – 0.91).
 
Responsiveness: When comparing the ability to detect a 1-point change from admission to discharge, the SCIM-III detected more numerous changes than FIMTM in 3 of the 4 areas; self-care, respiration and sphincter management, and mobility indoors and outdoors, but NOT mobility in the room and toilet. The differences between the 2 scales’ responsiveness to changes are not statistically significant. Floor/ceiling effects: Ceiling effects have been observed in 3 items, floor effects have been observed in 11 items.
References
Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM--spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord. 1997;35(12):850–856.
 
Reliability and Validity:  
 
Anderson KD, Acuff ME, Arp BG, Backus D, Chun S, Fisher K, Fjerstad JE, Graves DE, Greenwald K, Groah SL, Harkema SJ, Horton JA 3rd, Huang MN, Jennings M, Kelley KS, Kessler SM, Kirshblum S, Koltenuk S, Linke M, Ljungberg I, Nagy J, Nicolini L, Roach MJ, Salles S, Scelza WM, Read MS, Reeves RK, Scott MD, Tansey KE, Theis JL, Tolfo CZ, Whitney M, Williams CD, Winter CM, Zanca JM. United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2011;49(8):880–885.
 
Bluvshtein V, Front L, Itzkovich M, Aidinoff E, Gelernter I, Hart J, Biering-Soerensen F, Weeks C, Laramee MT, Craven C, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Catz A. SCIM III is reliable and valid in a separate analysis for traumatic spinal cord lesions. Spinal Cord. 2011;49(2):292–296.
 
Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V, Ronen J. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord. 2007;45(4):275–291.
 
Fekete C, Eriks-Hoogland I, Baumberger M, Catz A, Itzkovich M, Lüthi H, Post MW, von Elm E, Wyss A, Brinkhof MW. Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2013;51(1):40–47.
 
Glass CA, Tesio L, Itzkovich M, Soni BM, Silva P, Mecci M, Chadwick R, el Masry W, Osman A, Savic G, Gardner B, Bergström E, Catz A. Spinal Cord Independence Measure, version III: applicability to the UK spinal cord injured population. J Rehabil Med. 2009;41(9):723–728.
 
Invernizzi M, Carda S, Milani P, Mattana F, Fletzer D, Iolascon G, Gimigliano F, Cisari C. Development and validation of the Italian version of the Spinal Cord Independence Measure III. Disabil Rehabil. 2010;32(14):1194–1203.
 
Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V, Ronen J, Catz A. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil. 2007;29(24):1926–1933.
 
Responsiveness:
 
Anderson KD, Acuff ME, Arp BG, Backus D, Chun S, Fisher K, Fjerstad JE, Graves DE, Greenwald K, Groah SL, Harkema SJ, Horton JA 3rd, Huang MN, Jennings M, Kelley KS, Kessler SM, Kirshblum S, Koltenuk S, Linke M, Ljungberg I, Nagy J, Nicolini L, Roach MJ, Salles S, Scelza WM, Read MS, Reeves RK, Scott MD, Tansey KE, Theis JL, Tolfo CZ, Whitney M, Williams CD, Winter CM, Zanca JM. United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2011;49(8):880–885.
 
Bluvshtein V, Front L, Itzkovich M, Aidinoff E, Gelernter I, Hart J, Biering-Soerensen F, Weeks C, Laramee MT, Craven C, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Catz A. SCIM III is reliable and valid in a separate analysis for traumatic spinal cord lesions. Spinal Cord. 2011;49(2):292–296.
 
Glass CA, Tesio L, Itzkovich M, Soni BM, Silva P, Mecci M, Chadwick R, el Masry W, Osman A, Savic G, Gardner B, Bergström E, Catz A. Spinal Cord Independence Measure, version III: applicability to the UK spinal cord injured population. J Rehabil Med. 2009;41(9):723–728.
 
Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V, Ronen J, Catz A. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil. 2007;29(24):1926–1933.
 
Floor/Ceiling effects:
 
Ackerman P, Morrison SA, McDowell S, Vazquez L. Using the Spinal Cord Independence Measure III to measure functional recovery in a post-acute spinal cord injury program. Spinal Cord. 2010;48(5):380–387.
 
Anderson KD, Acuff ME, Arp BG, Backus D, Chun S, Fisher K, Fjerstad JE, Graves DE, Greenwald K, Groah SL, Harkema SJ, Horton JA 3rd, Huang MN, Jennings M, Kelley KS, Kessler SM, Kirshblum S, Koltenuk S, Linke M, Ljungberg I, Nagy J, Nicolini L, Roach MJ, Salles S, Scelza WM, Read MS, Reeves RK, Scott MD, Tansey KE, Theis JL, Tolfo CZ, Whitney M, Williams CD, Winter CM, Zanca JM. United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2011;49(8):880–885.
 
Glass CA, Tesio L, Itzkovich M, Soni BM, Silva P, Mecci M, Chadwick R, el Masry W, Osman A, Savic G, Gardner B, Bergström E, Catz A. Spinal Cord Independence Measure, version III: applicability to the UK spinal cord injured population. J Rehabil Med. 2009;41(9):723–728.
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