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Scivoletto G.,IRCCS S Lucia Foundation | Glass C.,North West Regional Spinal Injuries Center | Anderson K.D.,University of Miami | Galili T.,Tel Aviv University | And 15 more authors.
Neurorehabilitation and Neural Repair | Year: 2015

Background. A quadratic formula of the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) has previously been published. This formula was based on a model of Spinal Cord Independence Measure (SCIM95), the 95th percentile of the SCIM III values, which correspond with the American Spinal Injury Association Motor Scores (AMS) of SCI patients. Objective. To further develop the original formula. Setting. Spinal cord injury centers from 6 countries and the Statistical Laboratory, Tel-Aviv University, Israel. Methods. SCIM95 of 661 SCI patients was modeled, using a quantile regression with or without adjustment for age and gender, to calculate SCI-ARMI values. SCI-ARMI gain during rehabilitation and its correlations were examined. Results. A new quadratic SCIM95 model was created. This resembled the previously published model, which yielded similar SCIM95 values in all the countries, after adjustment for age and gender. Without this adjustment, however, only 86% of the non-Israeli SCIM III observations were lower than those SCIM95 values (P < .0001). Adding the variables age and gender to the new model affected the SCIM95 value significantly (P < .04). Adding country information did not add a significant effect (P > .1). SCI-ARMI gain was positive (38.8 ± 22 points, P < .0001) and correlated weakly with admission age and AMS. Conclusions. The original quadratic SCI-ARMI formula is valid for an international population after adjustment for age and gender. The new formula considers more factors that affect functional ability following SCI. © The Author(s) 2014.


Aidinoff E.,Loewenstein Rehabilitation Hospital | Front L.,Loewenstein Rehabilitation Hospital | Itzkovich M.,Loewenstein Rehabilitation Hospital | Itzkovich M.,Tel Aviv University | And 27 more authors.
Spinal Cord | Year: 2011

Study design: Multicenter international cohort study. Objective: The objective of this study was to establish target values for Spinal Cord Independence Measure (SCIM) III scoring in rehabilitation for clinically complete spinal cord lesion (SCL) neurological levels. Setting: In total, 13 spinal cord units in six countries from North America, Europe and the Middle East were taken. Methods: Total SCIM III scores and gain at discharge from rehabilitation were calculated for SCL levels in 128 patients with American Spinal Injury Association Impairment Scale (AIS) grade A on admission to rehabilitation. Results: Median, quartiles, mean and s.d., values of discharge SCIM III scores and SCIM III gain for the various SCL levels are presented. Total SCIM III scores and gain were significantly correlated with the SCL level (r=0.730, r=0.579, P<0.001). Conclusions: Calculated discharge SCIM III scores can be used as target values for functional achievements at various neurological levels in patients after AIS A SCL. They are generally, but not always, inversely correlated with SCL level. © 2011 International Spinal Cord Society All rights reserved.


Bluvshtein V.,Loewenstein Rehabilitation Hospital | Bluvshtein V.,Tel Aviv University | Front L.,Loewenstein Rehabilitation Hospital | Itzkovich M.,Loewenstein Rehabilitation Hospital | And 27 more authors.
Spinal Cord | Year: 2011

Study design:A multi-center international cohort study.Objective:To evaluate the reliability and validity of the third version of the Spinal Cord Independence Measure (SCIM III), separately for patients with traumatic spinal cord lesions (SCLs).Setting:A total of 13 spinal cord units in six countries from North America, Europe and the Middle-East.Methods:SCIM III and Functional Independence Measure (FIM) were assessed for 261 patients with traumatic SCLs, on admission to rehabilitation and before discharge, by two raters. Conventional statistical measures were used to evaluate the SCIM III reliability and validity.Results:In almost all SCIM III tasks, the total agreement between the paired raters was >80%. The κ coefficients were all >0.6 and statistically significant. Pearson's coefficients of the correlations between the paired raters were >0.9, the mean differences between raters were nonsignificant and the intraclass correlation coefficients (ICCs) were ≥0.95. Cronbach's α values for the entire SCIM III scale were 0.833-0.835. FIM and SCIM III total scores were correlated (r=0.84, P0.001). SCIM III was more responsive to changes than FIM. In all subscales, SCIM III identified more changes in function than FIM, and in 3 of the 4 subscales, differences in responsiveness were statistically significant (P<0.02).Conclusion:The results confirm the reliability and validity of SCIM III for patients with traumatic SCLs in a number of countries. © 2011 International Spinal Cord Society All rights reserved.


Bluvshtein V.,Loewenstein Rehabilitation Hospital | Bluvshtein V.,Tel Aviv University | Front L.,Loewenstein Rehabilitation Hospital | Itzkovich M.,Loewenstein Rehabilitation Hospital | And 30 more authors.
Spinal Cord | Year: 2012

Background:Disability scales do not enable the transmission of concise, meaningful and daily function description for clinical purposes.Study design:Cross-sectional statistical analysis of 328 patients Spinal Cord Independence Measure (SCIM) III item scores (SIS).Objective:To develop a concise and clinically interpretable data-based characterization of daily task accomplishment for patients with spinal cord lesions (SCLs).Setting:Multi-center study at 13 spinal units in 6 countries.Methods:Patients were grouped into clusters characterized by smaller differences between the patients SIS within the clusters than between their centers, using the k-medoides algorithm. The number of clusters (k) was chosen according to the percent of SIS variation they explained and the clinical distinction between them.Results:Analysis showed that k8 SIS clusters offer a good description of the patient population. The eight functional clusters were designated as A-H, each cluster (grade) representing a combination of task accomplishments. Higher grades were usually (but not always) associated with patients implementing more difficult tasks. Throughout rehabilitation, the patients functional grade improved and the distribution of patients with similar functional grades within the total SCIM III score deciles remained stable.Conclusions:A new classification based on SIS clusters enables a concise description of overall functioning and task accomplishment distribution in patients with SCL. A software tool is used to identify the patients functional grade. Findings support the stability and utility of the grades for characterizing the patients functional status. © 2012 International Spinal Cord Society All rights reserved.

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