Study design: Multi-center, prospective, cohort study. Objectives: To assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in persons with spinal cord injury (SCI). Setting: Inpatient rehabilitation hospitals in the United States (US). Methods: Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM), the default functional measure currently used in most US hospitals, was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III. Results: Total agreement between raters was above 70% on most SCIM III tasks and all k-coefficients were statistically significant (Po0.001). The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach's-a was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8 (Po0.001). For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM (Po0.0001). Conclusion: Overall, the SCIM III is a reliable and valid measure of functional change in SCI. However, improved scoring instructions and a few modifications to the scoring categories may reduce variability between raters and enhance clinical utility.

The prevalence of low testosterone among men with acute SCI seems to be high. The results suggest the need for routine screening for low testosterone among men with SCI and consideration given to testosterone replacement therapy. Future research is needed to investigate the etiology, pathogenesis, and potential avenues for treatment of low testosterone among men with SCI.

The results indicate that men with spinal cord injury are at risk for low serum testosterone. Testosterone levels were also related to time since injury and hemoglobin and prolactin levels. These findings suggest the need for changes to occur in clinical practice. Guidelines are needed for when and how often testosterone monitoring should be conducted. Future research should address the pathophysiology of low testosterone and the outcomes of testosterone treatment.