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SCIM Spanish
SCIM Spanish
com/dre
ISSN 0963-8288 print/ISSN 1464-5165 online
RESEARCH PAPER
Spinal Cord Unit, Department of Rehabilitation Medicine, Hospital Universitario Virgen del Rocı́o, Seville, Spain
Abstract Keywords
Purpose: To provide a translation and cross-cultural adaptation of the Spinal Cord Reliability, Spain, Spanish version of the
Independence Measure (SCIM) version III for Spain and to validate the Spanish version of Spinal Cord Independence Measure
the SCIM III (eSCIM III). Patients and methods: Development of eSCIM III has involved translation, version III, spinal cord injury, validity
back-translation and assessment of cultural equivalence procedures. eSCIM version III, was
administered to 64 patients with spinal cord injury, admitted to our hospital. Investigation of History
the psychometric characteristics included: (1) study of the inter-rater reliability, (2) internal
consistency (Cronbach’s a), (3) validation and confirmation of the correlation between eSCIM III Received 6 May 2013
For personal use only.
and Functional Independence Measure (FIM), and (4) sensitivity to change. Results: The Revised 28 October 2013
reliability of eSCIM III showed an intra-class coefficient value 40.97 in the different subscales Accepted 7 November 2013
assessed. Internal consistency of eSCIM III was shown by a Cronbach’s a value of 0.93. The Published online 9 December 2013
validity of eSCIM III was confirmed by the close correlation with FIM (r ¼ 0.94, p50.0001).
The sensitivity to change of eSCIM III was also confirmed. Conclusions: eSCIM III was found to be
culturally equivalent to the original version, as reliability and validity of this tool were
demonstrated. It can be used in Spain for functional assessment of patients with spinal
cord injury.
Introduction
Spinal cord injury represents a significant health problem due to The Functional Independence Measure (FIM) was developed
its clinical complexity, prolonged hospitalizations required, and designed to assess the functional level of patients, including
clinical follow-up needed throughout life and frequency of those with spinal cord injury [2,3]. Since its creation, this scale
complications involved. has been widely used and diffused, with multiple investigations
To describe the real impact derived from the spinal cord injury, demonstrating its metric characteristics [3–5]. However, some
it is required not only to assess the degree of deficiency presented studies showed certain limitations when this tool is used in
by these people, but also to evaluate the level of disability subjects with spinal cord injury, as difficulty to the sensitivity to
originated. The concept of functionality is not easy to quantify, a change [6], and in the evaluation of the functional level of patients
circumstance to be resolved by the use of tools of measurement [1]. with tetraplegia, which led to the development of specific
Hence, the importance of developing scales for functional instruments [7,8].
assessments. Under these premises, the Spinal Cord Independence Measure
(SCIM), was designed specifically to quantify the functional
assessment of patients with spinal cord injury. Since its
Address for correspondence: Dr Maria Jose Zarco-Periñan, PhD, Spinal
establishment, different versions were developed, resulting each
Cord Unit, Department of Rehabilitation Medicine, Hospital Universitario version in a more accurate and sensitive tool compared with the
Virgen del Rocı́o, Seville, Spain. Tel: +34 617557940; +34 955012598. previous one. Currently, the version III is used, as reliability,
E-mail: mjzarcop@ono.com validity and sensitivity to change of this scale have been
2 M. J. Zarco-Periñan et al. Disabil Rehabil, Early Online: 1–8
evidenced [9,10]. The validity of each version of the SCIM has or C were discussed by the members of the committee, until a
been determined by comparison with FIM [9,10]. consensus was reached.
SCIM covers the evaluation of specific areas of function with Pilot study: The new Spanish version was assessed by two study
great relevance in the spinal cord injury, including self-care, investigators, and used initially in five patients with spinal cord
respiration and sphincter management, and mobility. Each area is injury. Clinicians were asked about: (1) difficulties in the use of
scored according to its proportional weight in the patient’s global the new tool, (2) difficulties with any of the items.
activity.
The use of SCIM version III is currently recommended to Validation of the Spanish version of the eSCIM III: patients
assess the functional recovery of patients with spinal cord injury, and procedure
both in clinical and research settings, due to the clinical viability
Patients
and the clinimetric characteristics shown by the tool [9,11].
The English version of the SCIM scale has been developed, but A total of 64 patients with spinal cord injury previously treated in
the use of these scales has to be standardized for different the Spinal Cord Injury Unit were included. Inclusion criteria
countries and cultures. Cross-cultural adaptation of a tool not only were: (1) spinal cord injury of traumatic or medical origin; (2)
requires its translation following a specific methodology, but also spinal cord injury (ASIA impairment grade A, B, C or D); (3)
evaluates its metric characteristics in the new language and verbally given consent for inclusion in the study.
culture [12]. Exclusion criteria included: (1) concomitant neurological
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The purpose of this study is to provide the translation and disease which may alter the functional level previously estab-
cultural adaptation of the SCIM III to the Spanish language for its lished by the spinal cord injury; (2) presence of cognitive deficit
use in our country, Spain, and subsequently confirm the reliability or psychiatric disease, which may prevent collaboration of the
and validity of the new tool, the Spanish version of the SCIM III patient and influence the functional level.
(eSCIM III).
Procedure
Patients and method
Two authors of the study performed all evaluations. In a first
Study design: cross-sectional study. This study has two well- phase, demographic variables were collected and, subsequently
defined parts, as explained in the following sections. functional assessments were performed by using eSCIM III and
the FIM. Clinicians involved in patient assessment were trained
Cross-cultural adaptation: methodology with different scales.
(1) Assessment of the reliability of the scale: To show the
For the development of eSCIM III, we used a procedure with the
For personal use only.
scale homogeneity was intended to be improved after systematic p50.0001) than at discharge (r ¼ 0.94, p50.0001). A significant
elimination of the items. Cronbach’s a coefficient at discharge for correlation (p50.0001) was also obtained between the eSCIM III
the eSCIM III was 0.93. subscales and FIM (Table 6), with a higher correlation at
Cronbach’s a for different subscales was higher than 0.80 discharge of rehabilitation (0.85–0.91).
(Table 5), except in the ‘‘Respiration – sphincter management’’
subscale with an a value of 0.63. In this subscale, a-value Sensitivity to change
increased when ‘‘Respiration’’ item was eliminated, and
eSCIM III showed sensitivity to functional changes of the patients
decreased when any of the other items of the scale were
with spinal cord injury (p50.0001). Comparison of the differ-
eliminated. In the mobility scale, Cronbach’s a also improved
ences between eSCIM III scale at admission and discharge of the
after elimination of the ‘‘Transfer bed – chair’’ item.
rehabilitation period, and FIM showed that values obtained were
higher for eSCIM III than for FIM (p50.0001).
Validity study
eSCIM III showed a significant correlation with FIM, as Discussion
described in Table 5. The correlation between the eSCIM III
Functional assessment with specific tools is fundamental in
and FIM was lower at admission in rehabilitation (r ¼ 0.87,
patients with spinal cord injury. The SCIM III scale, designed
specifically for these patients, assessed the most relevant areas,
Disabil Rehabil Downloaded from informahealthcare.com by University Of Wisconsin Madison on 08/20/14
Table 4. Reliability: inter-observer reliability. Intraclass correlation including self-care, sphincter management and mobility [9,10].
coefficient: discharge.
Table 6. Validity: correlation between FIM and eSCIM III at admission
1 evaluator 2 evaluator and discharge.
eSCIM Mean (sd) Mean (sd) ICC
Self-care 13.95 (6.81) 13.59 (6.87) 0.95 Admission Rho Discharge Rho
Respiration/sphincter 28.89 (8.59) 29.07 (8.72) 0.94 eSCIM III Spearman Spearman
Mobility in the room 6.85 (3.71) 6.89 (3.75) 0.96 Self-care 0.89 (p50.0001) 0.90 (p50.0001)
Mobility indoors/outdoors 9.43 (7.63) 9.5 (7.52) 0.96 Respiration-sphincter 0.86 (p50.0001) 0.87 (p50.0001)
eSCIM total 59.07 (23.63) 58.65 (23.57) 0.96 management
Mobility in the rooms 0.87 (p50.0001) 0.90 (p50.0001)
eSCIM: Spanish Spinal Cord Independence Measure. Mobility indoors/outdoors 0.81 (p50.0001) 0.85 (p50.0001)
sd: standard deviation. eSCIM total 0.87 (p50.0001) 0.94 (p50.0001)
ICC: Intra-class correlation coefficient.
For personal use only.
usually accepted limit of 0.7 for the global eSCIM III (0.93 in our
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Appendix
SPANISH VERSION OF THE SPINAL CORD INDEPENDENCE MEASURE VERSION III (eSCIM III)
Unidad de Lesionados Medulares. Hospital Universitario Virgen del Rocı́o, Sevilla
CUIDADO PERSONAL
1. ALIMENTACIÓN œœœœœœ
(Cortar, abrir envases, servirse, llevarse la comida a la boca, sostener una taza con lı́quido)
For personal use only.
2. BAÑO
(Enjabonarse, lavarse, secarse cuerpo y cabeza, manejar el grifo)
A. Parte superior del cuerpo œœœœœœ
0. Requiere asistencia total.
1. Requiere asistencia parcial.
2. Se lava de forma independiente con ayudas técnicas o accesorios especı́ficos (por ej. silla, barras. . .).
3. Se lava de forma independiente; no requiere ayudas técnicas o accesorios especı́ficos (no habituales para personas sanas).
3. VESTIDO
(Ropa, zapatos, ortesis permanentes: ponérselos, llevarlos puesto y quitárselos)
A. Parte superior del cuerpo œœœœœœ
0. Requiere asistencia total.
1. Requiere asistencia parcial con prendas de ropa sin botones, cremalleras o cordones.
2. Independiente con prendas de ropa sin botones, cremalleras o cordones; requiere ayudas técnicas y/o accesorios especı́ficos.
3. Independiente con prendas de ropa sin botones, cremalleras o botones; no requiere ayudas técnicas ni accesorios especı́ficos; requiere asistencia o
ayudas técnicas o accesorios especı́ficos sólo para botones, cremalleras o cordones.
4. Se pone (cualquier prenda) independientemente; no requiere ayudas técnicas o accesorios especı́ficos.
8. WC - INODORO œœœœœœ
(Higiene perineal, ajuste de prendas antes/después, uso de compresas o pañales)
0. Requiere asistencia total.
1. Requiere asistencia parcial: no se limpia solo.
2. Requiere asistencia parcial: se limpia independientemente.
4. Usa el WC de forma independiente en todas las tareas pero necesita ayudas técnicas o accesorios especı́ficos (por ej. barras).
5. Usa el WC de forma independiente; no requiere ayudas técnicas o accesorios especı́ficos.
(Acercarse al coche, frenar la silla de ruedas, retirar reposabrazos y reposapiés, realizar transferencias a y desde el coche, introducir la silla de ruedas
dentro y fuera del coche)
0. Requiere asistencia total.
1. Necesita asistencia parcial y/o supervisión y/o ayudas técnicas.
2. Se transfiere de forma independiente; no requiere ayudas técnicas (o no requiere silla de ruedas).