A comparison of two functional tests in quadriplegia: The quadriplegia index of function and the functional independence measure

Abstract

Individuals with spinal cord injury are evaluated according to a set of guidelines based on motor, sensory, and functional tests. The resulting scores are used to quantify the extent of neurological injury and functional loss. The purpose of the present study was to compare certain scoring systems using the same group of patients. Twenty-nine subjects with cervical spine cord injury were evaluated by the same examiner using three scales: (1) The American Spinal Cord Injury Association (ASIA) (2) The Quadriplegia Index of Function (QIF) (3) The Functional Independence Measure (FIM) Assessments were made both at admission to, and discharge from, the rehabilitation center. Positive change in motor score is widely used as an indicator of recovery after spinal cord injury. We assessed the relationship of the two functional tests, the FIM and the QIF, to ASIA scores and found strong correlations in both cases. The feeding and dressing categories of QIF showed an even stronger correlation to ASIA motor scores, though the statistical signi®cance was the same for corresponding categories of FIM and QIF. The percent of recovery on ASIA motor scores was signi®cantly correlated only to gain in QIF scores, not FIM. FIM lacks the category of bed activities. Some additions to the FIM may be useful, especially in the feeding and dressing categories, and a category of bed activities could be included as well, in order to improve sensitivity.

Relationship between motor FIM and muscle strength in lower cervical-level spinal cord injuries

“…[18][19][20][21] Others have suggested that the FIM may not be the optimal tool to measure functional abilities due to its design as a measure of burden of care. 20,21 This has resulted in the development of other tools to measure function such as the Spinal Cord Independence Measure, 22,23 the Quadriplegia Index of Function [24][25][26][27] and the Spinal Cord Injury Realization Measurement Index (SCI-ARMI). 20,21 Despite these limitations, the FIM is the most widely used measure of functional limitation for the SCI population during rehabilitation 6,13 and is accepted by the American Spinal Cord Injury Association (ASIA).…”

A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury

“…Evidence of acceptable concurrent validity was found with the FIM; 24 and for some subscales, some of the time, representing the FIM Turkish version, 29 MBI (Turkish version), 19 short form QIF 32 and SIP68. 45 Evidence of construct validity could appear inconsistent or contradictory in some instances.…”

“…Evidence of good responsiveness was found for the BI and FIM motor scale (both had effect size 0.9, comparing scores between patients' admission and discharge dates). 31 There was other (weaker) evidence suggesting that the FIM was less sensitive than the QIF); 15,24 that the FIM was similar to the BI, 15 the QIF was better than the BI 31 and the FIM. 24 The original SCIM and SCIM version III were each found to be superior to the FIM 33,34,56 and the WISCI was possibly superior to the (Locomotor Functional Independence Measure) LFIM and SCIM 57 and had superior sensitivity to walking recovery than the BI, RMI, SCIM, LEMS or FIM.…”

Tetraplegia Hand Activity Questionnaire (THAQ): the development,assessment of arm–hand function-related activities in tetraplegic patients with a spinal cord injury

“…54 The feeding, grooming and bathing categories have good correlations with the level of injury documented in the ASIA upper extremity motor score, although ceiling effects have been reported. [55][56][57][58] The QIF seems more appropriate to assess the overall rehabilitation treatment of tetraplegics rather than specific hand function interventions. The spinal cord independence measure (SCIM) is another diseasespecific activity scale in which the score focuses on poor sphincter control and mobility.…”