Five additional mobility and locomotor items to improve responsiveness of the FIM in wheelchair-dependent individuals with spinal cord injury

• Published in: Spinal cord 2006-08, Vol.44 (8), p.495-504
• Main Authors: Middleton, J W, Harvey, L A, Batty, J, Cameron, I, Quirk, R, Winstanley, J
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adult; Anatomy; Australia; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cerebrospinal fluid. Meninges. Spinal cord; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disability Evaluation; Female; Gait Disorders, Neurologic - classification; Gait Disorders, Neurologic - diagnosis; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - rehabilitation; Human Physiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Locomotion; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; original-article; Outcome Assessment (Health Care) - methods; Paraplegia - classification; Paraplegia - diagnosis; Paraplegia - etiology; Paraplegia - rehabilitation; Quadriplegia - classification; Quadriplegia - diagnosis; Quadriplegia - etiology; Quadriplegia - rehabilitation; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Spinal Cord Injuries - classification; Spinal Cord Injuries - complications; Spinal Cord Injuries - diagnosis; Spinal Cord Injuries - rehabilitation; Traumas. Diseases due to physical agents; Wheelchairs
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sj.sc.3101872

Study design: Repeated-measures design. Objectives: To assess the validity and responsiveness of five additional mobility and locomotor (5-AML) items when used in conjunction with the Functional Independence Measure (FIM) for assessing the mobility and locomotor function of individuals with spinal cord injury (SCI). Setting: Specialised acute spinal and rehabilitation units in Sydney, Australia. Methods: A previously published scale comprising five key mobility and locomotor skills was further refined. The five items included a bed mobility and vertical (floor-to-chair) transfer item and three wheelchair propulsion items (pushing 200 m over flat ground, pushing up a ramp and negotiating a kerb). A total of 43 eligible patients with SCI (ASIA A–C impairment) admitted consecutively to two acute SCI units in Sydney between 1999 and 2002 were recruited, with four being lost to follow-up. Locomotor and mobility outcomes were measured at regular intervals for up to 6 months with the FIM and the 5-AML. Construct validity of the 5-AML was assessed by testing ability of items to discriminate between different impairment groups (tetraplegia and paraplegia). Item responsiveness was assessed by analysing ability to detect changes in mobility and locomotor function over time. Factor analysis techniques were used to test the hypothesis that the 5-AML, when used in conjunction with the FIM, provides a more sensitive measure of mobility and locomotor function than the FIM alone. Results: The 5-AML items were shown to be valid and responsive, measuring aspects of ‘real world’ mobility and locomotor function not reflected by the FIM. The bed mobility item was highly responsive to change over time for the tetraplegic group, but quickly reached a ceiling in the paraplegic group. The vertical (floor-to-chair) transfer item showed greater responsiveness over time and less ceiling effect for the paraplegic group than any of the FIM locomotor or mobility items. The three wheelchair propulsion items better discriminated between people with tetraplegia and paraplegia, and were more sensitive to changes in locomotor ability over the 6-month period than FIM locomotor items. Results of a preliminary factor analysis indicated that the 5-AML items measure different aspects of mobility and locomotor function than the FIM. Conclusion: The 5-AML items, when used in conjunction with the FIM, provides better delineation of function between people with tetraplegia and paraplegia and provides