A new instrument for outcome assessment in rehabilitation medicine: Spinal cord injury ability realization measurement index

Objectives: To introduce a new measure of disability weighted for the neurologic deficit in patients with spinal cord lesions and to examine the effect on the instrument of being in rehabilitation. Design: Development of instrument and preliminary comparative before-after study. Setting: Spinal department in a rehabilitation hospital in Israel. Participants: Seventy-nine patients with spinal cord lesions. Interventions: Patients were repeatedly assessed during rehabilitation with the American Spinal Injury Association Impairment Scale (AIS) to measure neurologic motor impairment and with the Spinal Cord Independence Measure (SCIM-II) to measure disability. Scores of the 2 assessments were combined to create the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI). Main Outcome Measures: A preliminary formula for the calculation of SCI-ARMI using the individual patients' SCIM-II and AIS motor scores and changes in SCI-ARMI values through rehabilitation. Results: The highest observed SCIM-II scores at patients' AIS level correlated highly with the AIS motor scores (r=.96, P<.01). A regression performed for this linear relationship resulted in a preliminary SCI-ARMI formula. The calculated SCI-ARMI values improved during rehabilitation irrespective of patient age, gender, lesion level, or lesion severity (P<.001). Conclusions: The preliminary version of the SCI-ARMI can be used to assess quantitatively changes in functional ability, isolating them from the effect of neurologic changes.