Non-linear formulas for the spinal cord injury ability realization measurement index

Abstract

Study design: The spinal cord injury ability realization measurement index (SCI-ARMI) assesses rehabilitation potential and efficacy based on the linear relationship between the Spinal Cord Independence Measure (SCIM) and the American Spinal Injury Association impairment scale (AIS) motor scores (AMS). Objectives: The objective of this study is to develop new SCI-ARMI formulas using a more flexible approach that is less sensitive to the distribution of the AMS score among spinal cord lesion (SCL) patients. Setting: Loewenstein Rehabilitation Hospital, Raanana, and the Statistical Laboratory, School of Mathematics, Faculty of Exact Sciences, Tel-Aviv University, Israel. Methods: SCIM III and AMS of 226 Israeli SCL patients were monitored. Linear formulas, quadratic formulas and non-parametric formulas were estimated to express the relationship between the 95th percentile of the SCIM III values for patients with given AMS at discharge from rehabilitation (SCIM95) and the corresponding AMS value. This relationship was used to calculate SCI-ARMI values, defined as the ratio of the observed SCIM score and the respective SCIM95 for a given patient's AMS score. Results: The estimated quadratic formula for the relationship between the 95th percentile of the SCIM III and the AMS score was found to be most appropriate, and formulas are provided for SCIM95 calculation in the various areas of function. The use of these formulas to calculate SCI-ARMI values is presented. Conclusion:The new formulas improve the accuracy of calculated ability realization for any AMS. The new statistical procedure will be used for the upcoming data analysis of a larger-scale international SCI-ARMI study.

Functional impact of multidisciplinary outpatient program on patients with chronic complete spinal cord injury

“…For incomplete SCI cases, mathematical models have been proposed to predict the expected SCIM III scores, based on ASIA motor score for various ASIA Impairment Scales. [10][11][12] Our patients consisted of 20% cervical cases compared with 50% in other outpatient-based studies. 3 This discrepancy may be attributable to the fact that it is more difficult for cervical patients to participate in outpatient programs because of travel distance and/or problems with local accessibility in outpatient setups.…”

“…10 To assess the quality of outcome regardless of the neurological level, the SCI Ability Realization Measurement Index (SCI-ARMI) has been developed as an independent assessment of functional gain after rehabilitation. [10][11][12] Given the very low probability of auto-recovery in patients with American Spinal Injury Association (ASIA) impairment scale A 13 choosing this group of patients minimizes the functional variation between cases due to auto-recovery, and helps attribute any changes to the rehabilitation interventions.…”

Traumatic versus non-traumatic spinal cord injuries: are there differential rehabilitation outcomes?

“…10,11 Recent research has found that when controlling for neurological deficits functional improvement was higher in patients with traumatic injuries, although the researchers suggested that this finding may be due to the younger age of these patients. 12 Some studies have reported FIM admission scores to be significantly greater in patients with NT-SCI than T-SCI, 10 although other studies have found no difference. 11 Importantly, however, both patients with traumatic and nontraumatic injuries have demonstrated significant FIM change from admission to discharge, highlighting the effective rehabilitation of both the groups undergoing the same rehabilitation programme.…”

Observational study of the effectiveness of spinal cord injury rehabilitation using the Spinal Cord Injury-Ability Realization Measurement Index

“…[12][13][14] For SCI patients with complete lesions, in whom the likelihood of significant neurological recovery is low or absent, the difference between functional status at admission and discharge is likely to reflect the effectiveness of rehabilitation solely, but for those with incomplete SCI, who might experience natural neurological recovery, the differences in disability scores do not represent the net effect of the treatment. 2 To overcome this problem, the SCI-ARMI, based on the Spinal Cord Independence Measure, was developed in the Spinal Department of Loewenstein Rehabilitation Hospital, Israel, and first published in 2004 1 to detect changes in functional performance that are independent of neurological changes, constituting a new approach to quantitating the prospect and success of rehabilitation. The initial version of the SCI-ARMI merely took into account the relationship between SCIM and AIS motor scores.…”

“…1,2 Ability realization is defined as the ratio of the observed and maximum possible performance of daily activities, for any level of severity of an SCI. The SCI-ARMI score is ability realization, expressed as a percentage.…”