ABSTRACT
A self-report measure is considered a practical alternative tool for longitudinal monitoring and for community models of disability. Spinal Cord Independence Measure Self-Report (SCIM-SR) was developed to measure the functional independence of the spinal cord injury (SCI) population. For the application of this questionnaire in Nepali setting, the cross-cultural adaptation and reliability of the Nepali version of the SCIM-SR were also warranted. The aim of the study was to cross-culturally adapt the Nepali version of the SCIM-SR and determine its reliability. The English version of the SCIM-SR was translated into the Nepali language with cross-cultural adaptations following the Beaton guidelines. A total of 45 community-dwelling individuals with SCI administered the Nepali version of the SCIM-SR two times, with an interval of one week. The intraclass correlation coefficient (ICC) and Cronbach's alpha (α) were used to assess the test-retest reliability and internal consistency, respectively. Cross-cultural equivalence was achieved between the English version and the Nepali version of the SCIM-SR. The test-retest reliability was excellent, with ICCs for the total score 0.968 (95% confidence interval 0.941-0.982), self-care subscale 0.964 (0.934-0.980), respiration and sphincter management subscale 0.941 (0.893-0.968), and mobility subscale 0.966 (0.938-0.981). The internal consistency reached an acceptable range for the total score and most of the subscales except for those of respiration and sphincter management. Cronbach's α coefficients for the total score, self-care subscale, respiration and sphincter management subscale, and mobility subscale were 0.801, 0.959, 0.506, and 0.838, respectively. The Nepali version of the SCIM-SR was cross-culturally adapted and can be used as a reliable self-report instrument to assess functional independence among the community-dwelling SCI population in Nepal.
ABSTRACT
STUDY DESIGN: Descriptive study. OBJECTIVES: To describe functional outcomes using Spinal Cord Independence Measure III (SCIM III) following inpatient rehabilitation among individuals with complete spinal cord injury (SCI) in the low-income setting of Nepal; to evaluate functional changes from rehabilitation admission to discharge and to compare functional outcomes between neurological levels of injury (NLI) at discharge. SETTING: Spinal Injury Rehabilitation Centre (SIRC), Kavrepalanchowk, Nepal. METHODS: We present data of all individuals with complete SCI who completed rehabilitation at SIRC in 2017. Data collected included: demographics, aetiology, neurological assessment, admission/discharge SCIM III scores, and length of stay. Data were analyzed using descriptive statistics. Pre/post-SCIM III scores were analyzed using Related-Samples Wilcoxon signed-rank test. Comparative analysis between NLIs was done using the Kruskal Wallis ANOVA test followed by pairwise Mann-Whitney U tests. RESULTS: Ninety-six individuals were included. Mean (SD) age was 33.5 (14.2) years, with a male/female ratio of 3.4:1. Median admission and discharge total SCIM III scores for cervical, thoracic and lumbosacral levels were 10 and 21, 16 and 61, and 41 and 79.5, respectively. Median total SCIM III score change between admission and discharge were 11 (p = 0.003), 43 (p < 0.001) and 40 (p = 0.068) for cervical, thoracic and lumbar groups, respectively. CONCLUSIONS: This study is the first of its kind to describe functional outcomes among individuals with complete SCI in the low-income setting of Nepal. All SCI groups showed a positive trend in SCIM III from admission to discharge, with improvements reaching statistical significance among groups with cervical and thoracic NLIs.
