Rehabilitation goals of people with spinal cord injuries can be classified against the International Classification of Functioning, Disability and Health Core Set for spinal cord injuries

Objectives: To establish whether inter-professional rehabilitation goals from people with non-traumatic spinal cord injury (SCI) can be classified against the International Classification of Functioning, Disability and Health (ICF) SCI Comprehensive and Brief Core Sets early postacute situation. Setting: Neurological rehabilitation unit. Methods: Rehabilitation goals of 119 patients with mainly incomplete and non-traumatic SCIs were classified against the ICF SCI Core Sets following established linking rules. Results: A total of 119 patients generated 1509 goals with a mean (and s.d.) of 10.5 (9.1) goals per patient during the course of their inpatient rehabilitation stay. Classifying the 1509 rehabilitation goals against the Comprehensive ICF Core Set generated 2909 ICF codes. Only 69 goals (4.6%) were classified as ‘not definable (ND)’. Classifying the 1509 goals against the Brief ICF Core Set generated 2076 ICF codes. However, 751(49.8%) of these goals were classified as ‘ND’. In the majority of goals (95.7%), the ICF code description was not comprehensive enough to fully express the goals set in rehabilitation. In particular, the notion of quality of movement or specificity and measurability aspects of a goal (usually described with the criteria and acronyms SMART) could not be expressed through the ICF codes. Conclusion: Inter-professional rehabilitation goals can be broadly described by the ICF Comprehensive Core Set for SCI but not the Brief Core Set

Psychometric properties of the Nottwil Environmental Factors Inventory Short Form

Objectives: To examine the psychometric properties of the Nottwil Environmental Factors Inventory Short Form using Rasch analysis; to determine its construct validity and internal consistency; and to develop a metric for scoring. Design: Cross-sectional psychometric study. Construct validity of the Nottwil Environmental Factors Inventory Short Form, including model fit, person and item fit, local item dependence, dimensionality, and differential item functioning (DIF), was investigated with Rasch analysis. Internal consistency was assessed with Cronbach alpha and item-total correlations. Setting: Community. Participants: Swiss residents aged >16 years and living with traumatic or nontraumatic spinal cord injury (SCI) (NZ1549). Interventions: Not applicable. Main Outcome Measure: The Nottwil Environmental Factors Inventory Short Form, a 14-item questionnaire developed to assess perceived impact of environmental barriers on participation. Results: Local dependencies between items addressing a similar content could be solved by creating a testlet. With 1 testlet there was strong evidence for unidimensionality of the Nottwil Environmental Factors Inventory Short Form. Although person-item targeting revealed a floor effect, indicating few perceived environmental barriers to participation in the Swiss SCI population, the item fit was good. Only a few items presented DIF. The Nottwil Environmental Factors Inventory Short Form showed good internal consistency (aZ.82). Conclusions: This psychometric analysis supports the use of the Nottwil Environmental Factors Inventory Short Form to evaluate perceived environmental barriers to participation in persons with SCI living in the community

Determining the most robust dimensional structure of ICF categories across subgroups of persons with spinal cord injury to build the basis for future clinical measures

ObjectivesTo determine the most robust dimensional structure of the International Classification of Functioning, Disability and Health (ICF) categories relevant to spinal cord injury (SCI) across subgroups of [1] lesion level, [2] health care context, [3] gender, [4] age, and [5] the countries’ resources.DesignA multidimensional between-item response Rasch model was used. The choice of the dimensions was conceptually driven using the ICF components from the functioning chapters and the splits of the Activity and Participation component described in the ICF.SettingSecondary analysis of data from an international, cross-sectional, multi-centric study for the ‘Development of ICF Core Sets for Spinal Cord Injury’.Participants1048 persons with SCI from the early post acute and long term living context from 14 middle/low and high resource countries.Interventionsn.a.Main outcome MeasuresRatings of categories of the ICF relevant for SCI were analysed.Results5 Models were tested on the complete sample and the 5 subgroups. The overall reliability of all models as well as the reliability within dimensions of the unidimensional and bidimensional models was good to excellent. The ICF categories spread well along the disability scale. The model fit improvement from the unidimensional to the bidimensional and from the bidimensional to the tridimensional model was significant in all groups (p-values &lt; 0.0001). The improvement, however, from a unidimensional to a bidimensional structure was markedly better than from a bidimensional to a tridimensional one.ConclusionWe propose, that a two dimensional structure separating body functions and body structures from activity and participation categories should serve as a basis for developing clinical measures in SCI in the future.<br/

Explanatory power does not equal clinical importance: study of the use of the Brief ICF Core Sets for Spinal Cord Injury with a purely statistical approach

Study design: Psychometric study analyzing the data of a cross-sectional, multicentric study with 1048 persons with spinal cord injury (SCI).Objective: To shed light on how to apply the Brief Core Sets for SCI of the International Classification of Functioning, Disability and Health (ICF) by determining whether the ICF categories contained in the Core Sets capture differences in overall health.Methods: Lasso regression was applied using overall health, rated by the patients and health professionals, as dependent variables and the ICF categories of the Comprehensive ICF Core Sets for SCI as independent variables.Results: The ICF categories that best capture differences in overall health refer to areas of life such as self-care, relationships, economic self-sufficiency and community life. Only about 25% of the ICF categories of the Brief ICF Core Sets for the early post-acute and for long-term contexts were selected in the Lasso regression and differentiate, therefore, among levels of overall health.Conclusion: ICF categories such as d570 Looking after one's health, d870 Economic self-sufficiency, d620 Acquisition of goods and services and d910 Community life, which capture changes in overall health in patients with SCI, should be considered in addition to those of the Brief ICF Core Sets in clinical and epidemiological studies in persons with SCI