Itzkovich M, Tripolski M, Zeilig G, Ring H, Rosentul N, Ronen J, Spasser R, Gepstein R, Catz A
Loewenstein Rehabilitation Hospital, Raanana, Israel.
Spinal Cord. 2002 Aug;40(8):396-407. doi: 10.1038/sj.sc.3101315.
The Spinal Cord Independence Measure (SCIM) is a new disability scale developed specifically for patients with spinal cord lesions (SCL). Its original and second versions (SCIM and SCIM II) were found to be reliable and more sensitive than the Functional Independence Measure (FIM) to functional changes in SCL patients.
To further validate the SCIM II, examining its components on a larger population.
Retrospective cohort study.
Two rehabilitation centers in Israel.
Two hundred and two inpatients with SCL.
Routine SCIM assessments by staff nurses. Rasch and accompanying analyses.
Unidimensionality of subscales (areas of function); goodness of fit of the tasks to the Rasch model; relationship of total-patient and single-task performance-ability; usability of task categories and the order of threshold locations between them; subscale discrimination of ability and difficulty and hierarchical nature; discrimination of task-categories ability, ie, distribution of thresholds along ability levels; and differential task behavior by age, gender and examination subgroups.
Four unidimensional subscales were identified, and an acceptable goodness of fit to the Rasch model was demonstrated in most of their tasks (infit mean square=0.8-1.2, outfit mean square=0.6-1.4). However, some tasks showed overfit (bathing lower body) and some showed misfit (wheelchair-car transfer). Additional analyses performed to check for reasons for less than acceptable fit revealed flaws in a minority of the outcome measures.
The findings of this analysis confirm the validity and reliability of the SCIM II. To a large extent we can infer that the SCIM II construct allows for the detection of any level of disability in any patient with SCL. A few item categories, however, should be rephrased or removed.
脊髓独立测量量表（SCIM）是一种专门为脊髓损伤（SCL）患者开发的新型残疾量表。研究发现其原始版本和第二版（SCIM和SCIM II）可靠，并且比功能独立性测量量表（FIM）对SCL患者的功能变化更敏感。
进一步验证SCIM II，在更大规模人群中检验其各个组成部分。
回顾性队列研究。
以色列的两家康复中心。
202例SCL住院患者。
由护士进行常规SCIM评估。进行拉施分析及相关分析。
分量表（功能领域）的单维性；任务与拉施模型的拟合优度；患者总体表现与单项任务表现能力的关系；任务类别的可用性及其阈值位置顺序；分量表对能力和难度的区分度及层级性质；任务类别能力的区分度，即阈值沿能力水平的分布；以及不同年龄、性别和检查亚组的任务差异行为。
确定了四个单维分量表，并且其大多数任务显示出与拉施模型可接受的拟合优度（内拟合均方=0.8 - 1.2，外拟合均方=0.6 - 1.4）。然而，一些任务显示过度拟合（下身沐浴），一些任务显示拟合不佳（轮椅 - 汽车转移）。为检查拟合度欠佳的原因而进行的其他分析揭示了少数结果测量指标存在缺陷。
该分析结果证实了SCIM II的有效性和可靠性。我们可以在很大程度上推断，SCIM II结构能够检测任何SCL患者的任何残疾水平。然而，少数项目类别应重新措辞或删除。
