Spinal Cord Independence Measure (SCIM)

Objective
The SCIM has been developed to address three specific areas of function in patients with spinal cord injuries (SCI). It looks at self-care (feeding, grooming, bathing, and dressing), respiration and sphincter management, and a patient’s mobility abilities (bed and transfers and indoors/outdoors). Additionally, the SCIM can also be used to help guide clinicians in determining treatment goals and objectives for patients with a SCI.(1) By helping clinicians determine areas of limitations for their patients with spinal cord injuries, both therapists and patients alike will be benefitting from this functional measurement tool.

Intended Population
The SCIM has been developed, validated, and found to be highly reproducible for patients with spinal cord injuries.(1)

Method of Use
A clinician or member of the clinical staff scores the patient on the items that this outcome measure addresses. Ideally the information obtained for scoring would be through direct observation of the activities listed, however patient report or interview information can be used.(1)

Equipment Needed
Equipment is not needed to perform and utilize this outcome measure.(2)

Completion Time
The SCIM takes approximately 30-45 min to administer and score.(2)

Scoring
This outcome measure is very user friendly. Its scoring system is self-explanatory; therefore there isn’t a manual to instruct the clinician in the scoring process. Scores range from 0-100, where a score of 0 defines total dependence and a score of 100 is indicative of complete independence. Each subscale score is evaluated within the 100-point scale (self-care: 0-20; respiration and sphincter management: 0-40; mobility: 0-40). (2)

Evidence
The newly revised SCIM produced by Catz-Itzkovich is a valid and highly reproducible measure of daily function in patients with spinal cord injuries.(3) 

Reliability
Catz et al found the interrater reliability to be modestly high with Kappa’s ranging from 0.696-0.983 across the tasks listed in each subscale.(4)

Validity
Internal consistency: excellent (Cronbach’s alpha = 0.9227) (4)
Criterion Validity: difficult to establish due to a lack of ‘gold standard’ to measure the SCIM against.(4)
Construct Validity: Excellent correlation between the SCIM and the FIM (r =.85) (4)
Excellent correlation between the SCIM and the Walking Index for Spinal Cord Injury (WISCI). (r = .97) (5)

Responsiveness
The SCIM and the SCIM III were found to be more responsive than the FIM.(6)

Miscellaneous
The newest version of the SCIM was preceded by two previous versions. The SCIM I and II were both found to be valid and reliable but did not take into account intercultural differences. Therefore, the SCIM III was developed in 2002 as an international version of the prior forms.(1) Catz et al designed this version to encompass patients in every walk of life, regardless of their culture.

Click here for an example of how to use and score the SCIM. 

Recent Related Research

1. Catz A, Itzkovich M. Spinal cord independence measure: comprehensive ability to rating scale for the spinal cord lesion. JRRD. 2007;44(1):65-68.
2. The Spinal Cord Independence Measure (SCIM). Available at: http://www.scireproject.com/book/export/html/152
3. Catz A, Itzkovich M, Steinberg F, Philo O, et al. The Catz-Itzkovich SCIM: a revised version of the spinal cord independence measure. Disability and Rehabilitation. 2001;23(6):263-268.
4. Catz, A., Itzkovich, M., et al. (1997). "SCIM-spinal cord independence measure: a new disability scale for patients with spinal cord lesions." Spinal Cord. 35(12): 850-856.
5. Morganti, B., Scivoletto, G., et al. (2004). "Walking index for spinal cord injury (WISCI): criterion validation." Spinal Cord. 43(1): 27-33.
6. Dawson, J., Shamley, D., et al. (2008). "A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury." Spinal Cord. 46(12): 768-780.