A Rasch-Based Comparison of the Functional Independence Measure and Spinal Cord Independence Measure for Outcome and Quality in the Rehabilitation of Persons with Spinal Cord Injury.
Roxanne Maritz, Carolina Fellinghauer, Mirjam Brach and 7 others
PMID 35166364WHAT IT FOUND
Spinal Cord Independence Measure (SCIM) scores can be mathematically converted to Functional Independence Measure (FIM) motor scores with high accuracy.
The SCIM is more sensitive for patients with severe injuries, capturing finer differences in low-functioning mobility and self-care than the FIM.
Key findings
01The SCIM III has a broader measurement range than the FIM motor scores, allowing it to better detect limitations in patients with low functional independence.
02A transformation table allows SCIM scores to be converted to FIM motor scores with 68.12% precision when predicting specific quantiles.
03The FIM assesses cognitive functions, while the SCIM focuses exclusively on motor independence.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study used secondary data, so patient characteristics like age, sex, and lesion level were not available for analysis. This means we do not know if the conversion works equally well for all subgroups of patients with spinal cord injury. The precision of converting a SCIM score to a specific FIM quantile was 68.12%. While errors were mostly adjacent to the correct score, this means the conversion is not perfect for individual patient prediction. The FIM and SCIM measure different constructs in terms of cognition; the FIM includes cognitive items, but the SCIM does not. The conversion only applies to motor independence.
Declared interests
The data collection was part of a larger investigation for the development of a new reimbursement system in rehabilitation in Switzerland.
The easy way to misread this
Do not assume the SCIM and FIM are interchangeable for all domains. The conversion applies only to motor scores. The FIM measures cognitive independence, which the SCIM does not, so using a converted SCIM score will miss any changes in a patient's cognitive status.