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Spinal Cord Injury Functional Index (SCI-FI)
Availability
Copyright protected Kessler Foundation, David Tulsky and Boston University. However, measure available free of charge at (Assessment Center Link). Users must sign an agreement promising not to modify the scale without permission.
Classification
Supplemental-Highly Recommended: Spinal Cord Injury (SCI)*
*Recommendation for Use: Indicated for studies targeted at measuring functional performance across multiple domains for persons with SCI.  
 
Supplemental: SCI-Pediatric (not recommended for youth < 16 years)
Short Description of Instrument
Construct Measured: Physical Function
Generic vs. disease specific: Disease specific
Means of administration: Questionnaire via computer adaptive testing
Intended respondent: Participant/Subject (Patient Reported Outcome)
Item number: 238 items in total bank. Exact number of items will vary per participant based on responses.
Subscales, names of subscales (number of items per subscale): Five subscales; basic mobility (47), self-care (71), fine motor function (35), ambulation (29), wheelchair mobility (56)
 
Short Form
Item number: 61
Subscales, names of subscales (number of items per subscale): basic mobility (11), self-care (11), fine motor (9), ambulation (11), wheelchair mobility (20)
 
SCI-FI/AT standardized z scores are converted to t scores where the mean = 50, with a standard deviation of 10 points.
Comments/Special Instructions
Background: SCI-FI item banks assess capacity to perform functional activities without assistive technology in Basic Mobility, Self-Care, Fine Motor Function, and Ambulation (Tulsy et al., 2012). The SCI-FI/AT was developed to include additional items for measuring function using assistive technology (Jette et al., 2015). The SCI-FI/AT is a computer adaptive test the administration involves being able to access internet. If internet access is not available or CAT is not desirable, short forms are available. It was developed using a participant-centered approach in which many items were written based on comments and feedback from individuals with SCI. Computer adaptive testing allows tailored item selection based on previous responses.
 
SCI-Pediatric specific: A recent study developed linking coefficients to transform Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI/AM) scores to adult Spinal Cord Injury-Functional Index (SCI-FI) scores. Linking coefficients applied to PEDI-SCI/AM scores can provide valid SCI-FI estimates that vary by domain, mode, and respondent type. (Ni et al., 2019)
Rationale/Justification
Strengths/Weaknesses: The SCI-FI/AT may be used for all levels and severities of injury but may be less appropriate for acute and early Phase trials/interventions.
 
The sensitivity of the SCI-FI/AT to detect change in the first year after SCI discharge is comparable to the Functional Independence MeasureTM and the Self-Reported Functional Measure, the SCI-FI/AT provides a multidimensional profile of functioning after a SCI and yields scores that are sensitive to change across multiple distinct functional domains (Keeney et al., 2018).
References
Key references:
 
Fyffe D, Kalpakjian CZ, Slavin M, Kisala P, Ni P, Kirshblum SC, Tulsky DS, Jette AM. Clinical interpretation of the Spinal Cord Injury Functional Index (SCI-FI). J Spinal Cord Med. 2016;39(5):527-534.
 
Heinemann AW, Dijkers MP, Ni P, Tulsky DS, Jette A. Measurement properties of the Spinal Cord Injury-Functional Index (SCI-FI) short forms. Arch Phys Med Rehabil. 2014;95(7):1289-1297.e5.
 
Jette AM, Slavin MD, Ni P, Kisala PA, Tulsky DS, Heinemann AW, Charlifue S, Tate DG, Fyffe D, Morse L, Marino R, Smith I, Williams S. Development and initial evaluation of the SCI-FI/AT. J Spinal Cord Med. 2015;38(3):409-418.
 
Jette AM, Tulsky DS, Ni P, Kisala PA, Slavin MD, Dijkers MP, Heinemann AW, Tate DG, Whiteneck G, Charlifue S, Houlihan B, Williams S, Kirshblum S, Zyson-Hudson T, Zanca J, Fyffe D. Development and initial evaluation of the spinal cord injury-functional index. Arch Phys Med Rehabil. 2012;93(10):1733-1750.
 
Keeney T, Slavin M, Kisala P, Ni P, Heinemann AW, Charlifue S, Fyffe DC, Marino RJ, Morse LR, Worobey LA, Tate D, Rosenblum D, Zafonte R, Tulsky D, Jette AM. Sensitivity of the SCI-FI/AT in Individuals With Traumatic Spinal Cord Injury. Arch Phys Med Rehabil. 2018 Sep;99(9):1783-1788.
 
Sinha R, Slavin MD, Kisala PA, Ni P, Tulsky DS, Jette AM. Functional ability level development and validation: providing clinical meaning for Spinal Cord Injury Functional Index scores. Arch Phys Med Rehabil. 2015;96(8):1448-1457.
 
Slavin MD, Ni P, Tulsky DS, Kisala PA, Heinemann AW, Charlifue S, Fyffe DC, Graves DE, Marino RJ, Morse LR, Rosenblum D, Tate D, Worobey LA, Dawson MB, Jette AM. Spinal Cord Injury-Functional Index/Assistive Technology Short Forms. Arch Phys Med Rehabil. 2016;97(10):1745-1752.e7.
 
Tulsky DS, Jette AM, Kisala PA, Kalpakjian C, Dijkers MP, Whiteneck G, Ni P, Kirshblum S, Charlifue S, Heinemann AW, Forchheimer M, Slavin MD, Houlihan B, Tate DG, Dyson-Hudson T, Fyffe DG, Williams S, Zanca J. Spinal cord injury-functional index: item banks to measure physical functioning in individuals with spinal cord injury. Arch Phys Med Rehabil. 2012;93(10):1722-1732.
 
Zyson-Hudson T, Zanca J, Fyffe D. Development and initial evaluation of the spinal cord injury-functional index. Arch Phys Med Rehabil. 2012;93(10):1733-1750.
 
SCI-Pediatric specific references:
 
Calhoun CL, Haley SM, Riley A, Vogel LC, McDonald CM, Mulcahey MJ. Development of items designed to evaluate activity performance and participation in children and adolescents with spinal cord injury. Int J Pediatr. 2009;2009:854904.
 
Ni P, Mulcahey MJ, Slavin MD, Thielen CC, Vogel LC, Sadowsky C, Davidson LT, Jette AM. Tracking Spinal Cord Injury Functional Outcomes Across the Lifespan: Validation of Linking Coefficients. Arch Phys Med Rehabil. 2019 Oct;100(10):1924-1931.
 
Tian F, Ni P, Mulcahey MJ, Hambleton RK, Tulsky D, Haley SM, Jette AM. Tracking functional status across the spinal cord injury lifespan: linking pediatric and adult patient reported outcome scores. Arch Phys Med Rehab. 2014;95(11):2078-2085.