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Instrument Summary for Spinal Cord Injury

Please note that this section is an archive and is no longer being updated.

Development: The Functional Independence Measure (FIM) was developed to provide a uniform measurement and data on disability and rehabilitation outcomes. A national task force sponsored by the American Academy of Physical Medicine and Rehabilitation and the American Congress of Rehabilitation Medicine help develop the FIM between 1984 and 1987.

Purpose: To provide a screening measurement to assess the level of independence in functioning.

Useful Facts: The FIM is an 18-item measure that evaluates the following: self-care, sphincter control, mobility, locomotion, communication, and social cognition. The items on the FIM are scored on a seven point ordinal scale ranging from 1 to 7. The range of the scores on the FIM is a minimum of 18, which indicates the low level of functioning, to a maximum of 126, which indicates very high level of functioning.² The FIM is a structured interview that is administered during the first few days of admission to the hospital. It is administered periodically through the hospital stay and once again at the time of discharge.² The FIM is useful in measuring rehabilitation outcomes with individuals with disabilities. FIM is one such instrument that has been used with various disability groups to assess functionality. It is often used as an assessment tool for stroke victims to evaluate disability and level of independent functioning. Timbeck and Spaulding (2003) conducted a literature review of the FIM and its ability to predict functional outcomes.² They found that a patient's admission FIM scores are a strong predictor of their discharge FIM score.²

VA Relevance: The FIM has been used with veterans focusing on rehabilitation and level of functioning. Research has primarily focused on veterans recovering from strokes and SCI. One study tested the effects of a rehabilitative intervention using the FIM on VA nursing homes and found that specific interventions improved the level of functioning within the VA nursing home sample.⁴

References:

1. Granger CV. The emerging science of functional assessment: our tool for outcomes analysis. Arch of Phys Med Rehabil. 1998; 79(3): 235-240. [Abstract]
2. Timbeck RJ, Spaulding SJ. Ability of the functionality independence measure to predict rehabilitation outcomes after stroke: A review of the literature. Physical & Occupational Therapy in Geriatrics. 2003; 22(1): 63-76.
3. Granger CV, Cotter AC, Hamilton BB, Fiedler RC. Functional assessment scales: A study of persons after stroke. Arch of Phys Med Rehabil. 1993; 74: 133-138. [Abstract]
4. Ouslander JG, Griffith PC, McConnell E, Riolo L, Kutner M, Schnelle J. Functional incidental training: a randomized, controlled, crossover trial in Veterans Affairs nursing homes. J Am Geriatr Soc. 2005 Jul;53(7):1091-100. [Abstract]

Development: The Barthel Index (BI) was developed by Mahoney and Barthel to measure the physical aspects of a disability. The items on the BI are those that describe the level of independence of daily activities. These items focus on various activities such as feeding, dressing, and bathing to name a few.

Purpose: To assess the degree of a disability in a particular person. The BI is another instrument that allows assessment of activities of daily living.

Useful Facts: The BI consists of 10 items with a possible score of 100 points. It is interview administered by a trained professional. The index is an ordinal scale consisting of ten activities of daily living. The BI can be derived from asking the patient, the patient's friends and relatives as well as from direct observation. Administration of the BI is best when conducted by one individual over a period of time. It is an assessment that enables health professionals to determine the degree of disability in a particular individual. The BI is thought to be a good instrument because of its established reliability and validity for stroke patients.4 The BI has been modified and has been used with SCI patients to assess their functional capabilities. The instruments are available at the Stroke Center website http://www.strokecenter.org/trials/scales/barthel.html

VA Relevance: The BI has been readily used with veterans recovering from strokes. Similar to the FIM, the BI focuses on the level of functioning and disability in a patient. The BI has been used to measure functional status in veterans as they receive various interventions.⁵

Availability: This instrument may be found on the Internet Stroke Center website.

References:

1. The Internet Stroke Center. Accessed October 2005. Available: http://www.strokecenter.org/trials/scales/barthel.html
2. Roth E, Davidoff G, Haughton J, Ardner M. Functional assessment in spinal cord injury: a comparison of the modified Barthel Index and the 'adapted' functional independence measure. Clinical Rehabilitation. 1990; 4: 277-285.
3. Timbeck RJ, Spaulding SJ. Ability of the functionality independence measure to predict rehabilitation outcomes after stroke: A review of the literature. Physical & Occupational Therapy in Geriatrics. 2003; 22(1): 63-76.
4. Sainsbury A, Seebass G, Bansal A, Young JB. Reliability of the Barthel Index when used with older people. Age and Ageing. 2005; 34: 228-232. [Abstract]
5. Hughes SL, Weaver FM, Giobbie-Hurder A, Manheim L, Henderson W, Kubal JD, Ulasevich A, Cummings J; Department of Veterans Affairs Cooperative Study Group on Home-Based Primary Care. Effectiveness of team-managed home-based primary care: a randomized multicenter trial. JAMA. 2000 Dec 13;284(22):2877-85. [Abstract]

Development: The Quality of life Index (QLI) was developed by Ferrans and Powers (1985) to measure life satisfaction. There have been a number of versions of the QLI developed for use with various disorders, including SCI.

Purpose: To assess an individual's satisfaction or dissatisfaction with different areas of life. The importance one gives to various aspects of life is also measured with the QLI.

Useful Facts: Measuring the quality of life in individuals with SCI is a vital aspect of measuring the overall outcome of rehabilitation. However, quality of life is thought to be a multi-dimensional method and there has not been an agreement on a universal definition. The Quality of Life Index (QLI) and its modifications for SCI individuals have been used to assess overall life satisfaction. The QLI takes approximately 10 minutes to administer. There is no special training required to administer the test. A common set of items forms the basis for all versions, and items pertinent to each disorder have been added to create the illness-specific versions. Scores for all versions range from 0 - 30, which facilitates comparisons of findings across different versions.

VA Relevance: The QLI has been used with veterans suffering from various illnesses and disorders to assess their overall life satisfaction. For instance, the QLI has been used with veterans suffering from cancer. One study focused on measuring the quality of life in veterans with prostate cancer by using an interviewer administration approach.⁴ They found that interview administration of the QLI was found to be valid.⁴

Availability: This instrument and scoring information may be found online on Drs. Ferrans and Powers website at the University of Illinois at Chicago.

References:

1. Ferrans CE, Powers MJ. Quality of life index: development and psychometric properties. Adv Nurs Health. 1985; 8: 15-24. [Abstract]
2. The Quality of Life Index. Accessed October 2005. Available: http://www.uic.edu/orgs/qli/
3. May LA, Warren S. Measuring quality of life of persons with spinal cord injury: external and structural validity. Spinal Cord. 2002; 40: 341-350. [Abstract]
4. Knight SJ, Chmiel JS, Kuzel T, Sharp L, Albers M, Fine R, Moran EM, Nadler RB, Sharifi R, Bennett CL. Quality of life in metastatic prostate cancer among men of lower socioeconomic status: feasibility and criterion related validity of 3 measures. J Urol. 1998 Nov;160(5):1765-9. [Abstract]