Determining Complete Functional Independence in Patients with a Traumatic Cervical Spinal Cord Injury: Proposal of a Two-Level Scale Based on the Spinal Cord Independence Measure

Abstract

Objective: The SCIM scale is a valid measure of functional outcome for the spinal cord injury (SCI) population, but continuous scores are difficult to translate into functional independence (FI). The purpose of this study was to develop a new tool based on the third version of the SCIM questionnaire that would identify patients reaching complete-FI. In order to confirm that this new scale is relevant, we investigated whether it was associated with four factors often proposed as predictors of chronic functional outcome. Design: A prospective cohort study including 109 patients with cervical traumatic SCI was performed. Based on a minimal score obtained on each item of the SCIM questionnaire, the cohort was dichotomized into complete FI (N=52) or non-complete FI (N=57). Baseline characteristics were compared between the two cohorts. A multivariate logistic regression analysis using age, trauma severity, and neurological characteristics of the SCI was performed. Results: 52.3% of subjects reached complete-FI, sustaining less severe neurological deficits, a lower cervical SCI, and a less severe trauma with decreased associated injuries than non-complete FI patients (p<0.05). Incomplete SCI (AIS grade B, C and D) and younger age were the main predictors of complete FI. Conclusions: This new 2-level functional scale is easily applicable in a clinical setting, may be used retrospectively and provide meaningful information to patients and users on the functional recovery in the chronic phase following cervical SCI.