Table 2.
Summary of the Articles with Level of Evidence (LOE) Included in our Systematic Review
| Reference | Psychometric properties | Sample size | Inclusion and exclusion criteria | Study population | Injury features | Instrument | LOE |
|---|---|---|---|---|---|---|---|
| Davidoff et al. (1990) | Convergent construct validity |
N (total) = 63 n (case) = 41 n (control) = 22 |
Patients admitted to The university medical center for acute care and rehabilitation within 45 days of injury, aged 18 to 55 years were included. A group of paid neurologically intact volunteers was included as a control group |
Age range (total) = 18–55 years Mean age: • Case = 30.4 years • Control = 27.7 years Percentage of males: • Case = 80% • Control = 55% |
Level of SCI: • Cervical = 41% • Thoracic = 39% • Lumbosacral = 20% Cause of SCI: • MVA = 70% • Gunshot = 10% • Assault = 10% • Fall = 5% • Sports = 2.5% • Others = 2.5% Associated injuries (TBI) = 57% |
FIM | 2b |
| Yavuz et al. (1998) | Convergent construct validity | N = 29 | Consecutive tetraplegic patients admitted between May 1994 and January 1996 | Mean age = 37 years Age range = 14–66 yrs Males/females = 20/9 |
Severity of SCI: • Complete = 18 • Incomplete = 11 Causes of SCI: • MVA = 51.7% • Fall = 13.8% Levels of SCI: • Cervical = 28 • Thoracic = 1 Mean time since SCI = 20 weeks (Range: 2–72) |
• FIM • QIF |
2b |
| Dijkers and Yavuzer (1999) | Inter-rater reliability | N = 4128 | Patients in the National Spinal Cord Injury Database were included. Patients with missing Form I discharge neurological category were excluded. |
Mean age = 37.5 years Median age = 36 years Age range = 6–99 years Percentage of males = 80.5% |
Level of injury: • Complete tetraplegia = 23.7% • Incomplete tetraplegia = 28.1% • Complete paraplegia = 31.1% • Incomplete paraplegia = 17.0% Mean time since SCI = 6 years (Range: 1–25 years). |
FIM | 2b |
| Marino and Goin (1999) | • Item reduction • Convergent construct Validity |
N = 95 | Patients admitted from December 1987 to August 1992 with tetraplegia on initial evaluation, who were non-ambulatory at 6 months post-injury were included. Patients with concomitant upper extremity fractures, TBI, or psychiatric disturbances were excluded. | Mean age = 31.2 years Age range = 16–68 years Males/females = 85/10 |
Severity of SCI: • Frankel A = 60 • Frankel B = 23 • Frankel C = 11 • Frankel D = 1 (none was community ambulatory) |
• QIF • Short-form QIF |
2b |
| Hall et al. (1999) | Responsiveness |
n (admission) = 3971 n (discharge) = 4033 n (year 1) = 903 n (year 2) = 714 n (year 5) = 570 |
Patients admitted to inpatient rehabilitation within 60 days after injury were included. Only SCI patients aged 16 years or older with functionally complete SCI at inpatient rehabilitation admission were included. | Not reported | Severity of SCI: AIS A = 2447 AIS B = 679 AIS C = 845 Level of SCI: Cervical = 1796 Thoracic = 1718 Lumbar/sacral = 457 Mean time since injury = 8 days Median time since SCI = 1 day Maximum time since SCI = 60 days |
FIM | 2b |
| Catz, Itzkovich, Agranov et al. (2001) | Convergent construct validity | N = 22 | Only those patients with complete data were included (that is SCIM and FIM scores obtained in the first week after admission and every month until discharge). | Mean age = 48.1yrs Age range = 23–76 yrs Males/females = 17/5 |
Level of SCI: • Tetraplegia = 8 • Paraplegia = 14 Severity of SCI: • Frankel A/B = 6 • Frankel C/D = 16 Etiology of SCI: • Traumatic = 11 • Non-traumatic injury = 11 Mean follow-up time = 3 months (Range: 1–6 months) |
SCIM I | 2b |
| Kucukdeveci et al. (2001) | • Inter-rater reliability • Convergent construct validity • Content validity |
N (SCI) = 62 | Patients with stroke or SCI admitted to Department of Physical Medicine and Rehabilitation from 1994 to 1998 were included. (Only data of SCI patients are analyzed herein.) | Mean age (SCI) = 32.7 years Males = 44% |
Level of SCI: • Cervical = 21% • Thoracic = 42% • Lumbar = 37% Mean time since SCI = 16.4 years (Range: 1–210 months) |
FIM (Turkish version) | 2b |
| Masedo et al. (2005) | Intra-rater reliability | N (SCI) = 84 | Patients with amputation or SCI were included. Only participants included were those with: either an amputation or SCI > 6 months before enrollment; pain > 3 months; average pain rating in the last month > 2 for amputation and > 3 for SCI. Patients younger than 18 years, older than 65 years, with cardiovascular disease or abnormalities in a screening ECG, with seizures, pregnant, received any type of antidepressant medication or consumed > 2 alcoholic drinks per day were excluded. | Mean age = 41.43 years Males = 80% |
Level of SCI: • Cervical = 53.6% • Thoracic = 38.1% • Lumbar/sacral = 7.1% Mean time since injury = 13.96 years (Range: 8 months to 43 years) |
Self-report FIM | 2b |
| Morganti et al. (2005) | Convergent construct validity | N = 284 | Subjects included patients with a recent onset of traumatic and non-traumatic SCI admitted between 1997 and 2001. Patients without the cognitive ability to participate in the rehabilitation program were excluded. |
Mean age = 50.4 years Age range = 12–86 years Males/females = 184/100 |
Lesion of SCI: • Cervical = 81 • Thoracic = 148 • Lumbosacral = 55 Severity of SCI: • AIS A = 84 • AIS B = 19 • AIS C = 129 • AIS D = 52 Etiology of SCI: • Traumatic = 107 • Non-traumatic injury = 177 Mean time since SCI = 57 days |
WISCI II | 2b |
| Nilsson et al. (2005) | Content validity |
N = 1661 n (SCI) = 358 |
Patients admitted to one of the Scandinavian rehabilitation units with stroke, SCI, and TBI were included. | Median age (total) = 48 years Age range (total) = 16–90 years Males (total) = 64% |
Not reported | FIM | 2b |
| van Hedel et al. (2005) | • Convergent construct validity (WISCI II, TUG, 6MWT, 10MWT) • Intra and Inter-rater reliability (TUG, 6MWT, 10MWT) |
n (validity) = 75 n (reliability) = 22 |
Patients with traumatic or ischemic SCI were included. Only patients admitted for rehabilitation or ambulant check-up and were seen by physical therapist in the hospital from May 2001 to August 2003. Patients with additional gait impairment deficits and those who scored zero of WISCI II were excluded. |
• Validity: Mean age = 54 years Age range = 17–84 years Males/females = 45/30 • Reliability: Mean age = 52 yrs Age range = 21-77 yrs Males/Females = 14/8 |
Validity Level of SCI: • Cervical = 25 • Thoracic = 21 • Lumbosacral = 29 Severity of SCI: • AIS A/B = 7 • AIS C = 7 • AIS D = 61 Reliability Level of SCI: • Cervical = 7 • Thoracic = 7 • Lumbosacral = 8 Severity of SCI: • AIS A = 1 • AIS C = 3 • AIS D = 18 |
• WISCI II • TUG • 6MWT • 10MWT |
2b |
| Lawton et al. (2006) | Content validity | N = 647 | Patients recently admitted with a diagnosis of SCI in one of the 19 rehabilitation facilities were included. | Median age = 46 years Age range = 11–93 years Males = 69% |
Not reported | FIM | 2b |
| Lundgren-Nilsson et al. (2006) | Content validity |
N = 471 n (SCI) = 157 |
Patients admitted to one of the nine Scandinavian rehabilitation units with SCI. | Age range = 11–90 years Males = 70% |
Not reported | FIM | 2b |
| van Hedel et al. (2006) | • Convergent construct validity (WISCI II, 6MWT, 10MWT) • Responsiveness (6MWT, 10MWT) |
N = 22 | Only incomplete patients who were able to stand or walk within the first month after SCI were selected for this study (WISCI II score ≥ 1). All patients should have performed the 6MWT and 10MWT at all four times. | Mean age = 45.5 years Age range = 17–78 years Males/females = 18/4 |
Level of SCI: • Cervical = 13 • Thoracic = 1 • Lumbosacral = 8 Etiology of SCI: • Traumatic = 19 • Non-traumatic = 3 |
• WISCI II • 6MWT • 10MWT |
2b |
| Catz et al. (2007) | Internal consistency | N = 425 | All patients 18 years or older admitted to the 13 spinal units with spinal cord lesions were included. Patients with concomitant impairments such as brain injury or mental disease, or any other condition that might influence their everyday function were excluded. |
Mean age = 46.93 years Males/females = 309/116 |
Level of SCI: • Tetraplegia = 188 • Paraplegia = 237 Severity of SCI: • AIS A = 151 • AIS B = 59 • AIS C = 92 • AIS D = 119 Etiology of SCI: • Traumatic = 261 • Non-traumatic = 164 |
SCIM III | 2b |
| Ditunno et al. (2007) | Convergent construct validity | N = 146 | Patients with incomplete upper motor neuron (UMN) lesion (C4-T11) or lower motor neuron lesion (T11 to L3 with no UMN signs) were included. Patients with complete SCI or time from injury > 8 weeks were excluded. |
Mean age = 32 years Age range = 16–69 years Males = 78% |
Level of SCI: • Cervical = 58% • Thoracic = 18% • Lumbar = 24% Severity of SCI: • AIS B = 36 • AIS C = 90 • AIS D = 20 |
WISCI II | 2b |
| Ditunno et al. (2008) | Convergent construct validity | N = 150 | Patients with acute traumatic SCI at C2 to L3 admitted within 1 month of SCI and followed in 6–12 months were included. Patients with significant TBI, upper/lower extremity fracture, an immobilization device or those with WISCI 20 on initial evaluation were excluded. |
SCI | Level of SCI: • Paraplegia = 66 • Tetraplegia = 84 Severity of SCI: • AIS A = 59 • AIS B = 19 • AIS C = 32 • D = 40 Range of time since SCI = 3–12 months |
WISCI II | 2b |
| Gresham et al. (1986) | • Convergent construct validity • Inter-rater reliability |
n = 30 (validity) n = 20 (reliability) |
Patients with complete tetraplegia (at admission to and discharge from inpatient medical rehabilitation) were included. | Not reported | All complete SCI at C4 to C8. | QIF | 4 |
| Roth et al. (1990) | Convergent construct validity | N = 41 | Patients admitted within 45 days of traumatic SCI to a regional model system SCI care center for acute management and comprehensive rehabilitation were included. | Mean age = 30.4 years Males = 85% |
Level of SCI: • Cervical = 17 • Thoracic = 16 • Lumbosacral = 8 Cause of SCI: • MVA = 29 • Gunshot = 4 • Assault = 4 • Fall = 2 • Other = 2 |
• “Adapted” FIM (Only the self-care and mobility FIM subscales) • MBI |
4 |
| Grey and Kennedy (1993) | Inter-rater reliability | N = 40 | Only patients aged 16–65 years with traumatic SCI on admission were included. | Mean age = 29.6 years Age range = 17–54 years Males = 80% |
Cause of SCI: • MVA = 45% • Falls = 25% • Sports = 22.5% • Other = 7.5% Level of SCI: • Tetraplegia = 32.5% • Paraplegia = 67.5% |
FIM/self report FIM | 4 |
| Marino et al. (1993) | Convergent construct validity | N = 22 | Only patients with traumatic quadriplegia admitted within 72 h of SCI from November 1989 to March 1991 were included. Patients were excluded if medically unstable, acute medical conditions, amputation, stroke, TBI, upper extremity fractures, knife or gunshot wounds at the time of evaluation, or variability in functional performance. |
Males = 100% Mean age = 33 years Age range = 18–63 years |
Severity of SCI • Frankel A = 4 • Frankel B = 11 • Frankel C = 2 • Frankel D = 5 Level of SCI: • C4 = 6 • C5 = 7 • C6 = 4 • C7 = 5 Time since SCI: • 3 months = 7 • 6 months = 10 • 12 months = 5 |
• FIM • Partial QIF (only grooming, bathing and feeding) |
4 |
| Segal et al. (1993) | Inter-rater reliability | N = 57 | Patients admitted from January 1989 to May 1990, transferred without interruption of care directly from the acute care rehabilitation setting to the ongoing rehabilitation setting were included. | Not reported | Not reported | FIM | 4 |
| Marino et al. (1995) | Convergent construct validity | N = 50 | Patients with motor complete traumatic cervical SCI at a neurological level of C4-8 and Frankel grades of A or B on admission (from 1988 to 1992) were included. Individuals who had upper extremity fractures or were without data at 12 months post injury were excluded. Only patients with documented neurological examination and QIF scores. |
Age range = 16–68 years Males/females = 47/3 |
Severity of SCI: • Frankel A = 36 • Frankel B = 14 Etiology of SCI: • Diving = 16 • MVA = 11 • Fall = 6 • Gunshot = 7 • Hit by a car = 2 • Farm = 2 • Fight = 3 • Sports = 2 Level of SCI: • C4 = 29 • C5 = 12 • C6 = 6 • C7 = 2 • C8 = 1 |
Feeding QIF | 4 |
| Catz et al. (1997) | • Inter-rater reliability • Convergent construct validity |
N = 30 | Patients admitted from December 1994 to October 1995 were included. | Mean age = 45 years Age range = 17–76 years Males/females = 22/8 |
Level of SCI: • Tetraplegia = 9 • Paraplegia = 21 Severity of SCI: • Frankel A/B = 9 • Frankel C/D = 21 Etiology of SCI: • Traumatic = 15 • Non-traumatic injury = 14 Mean follow-up time = 3 months (Range: 1–6 months) |
SCIM I | 4 |
| Ditunno et al. (2000) | • Inter-rater reliability • Item generation and reduction • Content validity • Convergent construct validity |
N = 40 | “Representative of patients walking” | SCI | Not reported | WISCI I | 4 |
| Kucukdeveci et al. (2000) | • Internal consistency • Inter-rater reliability • Convergent construct validity |
N = 100; n (stroke) = 50 n (SCI) = 50 |
Patients with stroke or SCI admitted from 1993 to 1997 were included. | Mean age (SCI) = 31.5 years Males = 44% Mean follow-up time = 3.6 months (Range: 1–24 months) |
Level of SCI: • Cervical = 22% • Thoracic = 46% • Lumbar = 32% |
Modified Barthel Index | 4 |
| Catz, Itzkovich, Steinburg et al. (2001) | • Inter-rater reliability • Convergent construct validity |
N = 28 | Patients with traumatic and non-traumatic SCI were included. Patients with concurrent medical or cognitive disabilities likely to impair daily function were excluded. |
Mean age = 46 years Age range = 20–79 years Males/females = 18/10 |
Level of SCI: • Tetraplegia = 6 • Paraplegia = 22 Severity of SCI: • Frankel A/B = 7 • Frankel C/D = 21 Etiology of SCI: • Traumatic = 11 • Non-traumatic injury = 17 Range of follow-up time = 2–7 months |
SCIM II | 4 |
| Dittuno and Dittuno (2001) | Convergent construct validity | N = 103 | Not stated | SCI | Severity of SCI: • AIS A = 14 • AIS B = 18 • AIS C = 52 • AIS D = 19 |
WISCI II | 4 |
| Catz et al. (2002) | Inter-rater reliability | N = 28 | Patients with traumatic and non-traumatic SCI were included. Patients with concomitant medical problems that might have influenced everyday function, such as malignancy, brain injury or mental disease were excluded. |
Mean age = 46 years Age range = 20–79 years Males/females = 18/10 |
Level of SCI: • Tetraplegia = 6 • Paraplegia = 22 Severity of SCI: • Frankel A/B = 7 • Frankel C/D = 21 Etiology of SCI: • Traumatic = 11 • Non-traumatic injury = 17 |
SCIM II | 4 |
| Itzkovich et al. (2002) | Convergent construct validity | N = 202 | Patients with spinal cord lesion. | Mean age = 46.78 years Age range = 14–94 years Males/females = 138/64 |
Level of SCI: • Tetraplegia = 78 • Paraplegia = 124 Severity of SCI: • AIS A/B = 65 • AIS C/D = 137 Etiology of SCI: • Traumatic = 97 • Non-traumatic injury = 105 |
SCIM II | 4 |
| Itzkovich et al. (2003) | Inter-rater reliability | N = 28 | Patients with spinal cord lesions were included. Patients with concomitant medical problems such as malignancy, brain injury, or mental disease, which according to clinical judgment might influence everyday function, were excluded. |
Mean age = 46 years Age range = 20–79 years Males/females = 18/10 |
Level of SCI: • Tetraplegia = 6 • Paraplegia = 22 Severity of SCI: • AIS A/B = 7 • AIS C/D = 21 None of the patients was ventilation dependent. Etiology of SCI: • Traumatic = 11 • Non-traumatic injury = 17 |
SCIM II | 4 |
| Beninato et al. (2004) | Convergent construct validity | N = 20 | Patients with a lower cervical SCI (C5–C7), English speakers, and who were admitted to rehabilitation within 1 year Of initial SCI were included. Patients were excluded if they had TBI or orthopedic or medical diagnoses other than the neck injury that would affect function at discharge. Subjects with incomplete SCI with abdominal or lower extremity manual muscle testing scores greater than 2 of 5 were also excluded. |
• Mean age = 36.8 years Median age = 36 years Age range = 18–62 years Males/females = 16/4 Ethnicity: • White = 19 • Hispanic = 1 |
Level of SCI: • C6 = 11 • C5 = 7 • C7 = 2 Severity of SCI: • AIS A = 65% • AIS B = 30% • One patient had anterior cord syndrome |
FIM | 4 |
| Kim et al. (2007) | • Content validity • Convergent construct validity |
N = 50 | Inclusion criteria: traumatic SCI > 12 months, motor incomplete status and a motor level of C4 to L1 inclusive. Exclusion criteria: medication that could affect heart rate; history of heart disease, uncontrolled asthma, or other medical condition that could limit their ability to ambulate safely. | Mean age = 47.4 years Age range = 21–72 years Males = 86% |
Level of SCI: • Tetraplegia = 28 • Paraplegia = 22 Severity of SCI: • AIS C = 5 • AIS D = 45 |
WISCI II | 4 |
| Itzkovich et al. (2007) | Inter-rater reliability | N = 425 | Patients with spinal cord lesions were included. Patients younger than 18 years, having concomitant impairments that might influence everyday function, such as brain injury or mental disease were excluded. |
Mean age = 46.93 years Males/females = 309/116 |
Level of SCI: • Tetraplegia = 188 • Paraplegia = 237 Severity of SCI: • AIS A = 151 • AIS B = 59 • AIS C = 92 • AIS D = 119 Etiology of SCI: • Traumatic = 261 • Non-traumatic = 164 |
SCIM III | 4 |
| Olmos et al. (2008) | Internal consistency | N = 18 | Patients between 16 and 75 yrs with an AIS-D SCI > 6 months were included. Patients with active cardiac or pulmonary pathologic conditions, Parkinson's disease, or other active clinical conditions were excluded. |
Mean age = 42.9 years Median age = 39.5 years Age range = 19–72 years Males/females = 12/6 |
Level of SCI: • C3–6 = 12 • L3 = 2 • T4–T11 = 4 Severity of SCI: • AIS D = 22 |
• 6MWT • 10WMT |
4 |
| van Hedel et al. (2008) | Convergent construct validity | N = 917 | Inclusion criteria: • Patients with a single event (traumatic or ischemic) that resulted in para- or tetraplegia. • First assessment within the first 6 weeks after SCI • Patient capable and willing of giving written informed consent Exclusion criteria • Non-traumatic SCI except for a single ischemic event • Pre-injury dementia or severe reduction of intelligence • Peripheral nerve lesions above the level of SCI • Severe craniocerebral injury |
Not reported | Not reported | • TUG • 10WMT |
4 |
SCI, spinal cord injury; MVA, motor vehicle accident; AIS, American Spinal Injury Association (ASIA) Impairment Scale; TBI, traumatic brain injury.