[SCIM--spinal cord independence measure (version II): sensitivity to functional changes].

Until recently, the functional ability of patients with spinal cord lesions (SCL) was assessed by standardized scales designed for various disabilities. However, these scales have either a relatively low sensitivity to changes in the functions that are most important for SCL patients or a limited suitability for a specific SCL subgroup. To counter this problem the team of the Spinal Department of Loewenstein Rehabilitation Hospital developed the Spinal Cord Independence Measure (SCIM), which is specific for SCL patients, adjusts for disadvantages of earlier scales, and is user-friendly. It was found to be reliable and more sensitive to functional changes in SCL patients than the Functional Independence Measure (FIM), the most often used disability scale today. A second version (SCIM II) was constructed with improved phrasing of some of the components. It too, was found reliable, even more than the original version for certain functions. The present study examined the sensitivity of the SCIM II to changes in function in SCL patients compared to the FIM. Twenty-six patients with SCL underwent sequential SCIM II and FIM examinations during hospitalization for rehabilitation. A high correlation was found between the total scores of the two scales (r = 0.915; p < 0.0001). The mean change in function score from the first to the last examination was significantly larger with the SCIM II than with the FIM (p < 0.04), and the rate of detection of functional change was usually higher with the SCIM II. The advantage of the SCIM II over the FIM in detecting functional changes was evident in areas in which the two scales differ substantially. These results support the validity of the SCIM II. Studies with larger groups in different countries and cultures are still needed before the scale can be applied on an international basis.