Abstract
Study design
Validation cross-sectional study.
Objective
To adapt the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) to Italian and to assess the validity and reliability of this instrument.
Setting
Multicentre study in outpatient clinics of three urban spinal units across Italy.
Methods
After a five-step translation/validation process, the Italian SCI-SCS was administered in a toolset composed of a sociodemographic questionnaire, the Modified Barthel Index, the Short-Form 8, the Patient Health Questionnaire 9, and the General Anxiety Disorder 7. The Italian SCI-SCS construct validity was assessed through exploratory factor analysis (EFA). The internal consistency and test–retest reliability of the instrument were evaluated using Cronbach’s α and the intraclass correlation coefficient (ICC) for the total scale and its subscales. Pearson’s correlation coefficient with all administered instruments was calculated to evaluate the concurrent validity.
Results
One-hundred fifty-six participants were recruited from February to October 2018. EFA suggested a three-factor structure explaining 45% of the total variance. After experts’ consideration about the clinical relevance of its components, a final version of the Italian SCI-SCS with four different subscales and 15 items was proposed. The total scale Cronbach’s α was 0.73. The ICC agreement for test–retest reliability was 0.91. Correlations of the Italian SCI-SCS with the administered instruments were statistically significant (p < 0.05), highlighting congruent hypothesized relations.
Conclusion
Findings of this study provided a first psychometric evaluation of the SCI-SCS. The modified Italian version of this tool may represent a valuable instrument for the longitudinal assessment of the impact of secondary conditions in people with SCI.
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Data archiving
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
References
Piatt JA, Nagata S, Zahl M, Li J, Rosenbluth JP. Problematic secondary health conditions among adults with spinal cord injury and its impact on social participation and daily life. J Spinal Cord Med. 2016;39:693–8.
Post MWM, van Leeuwen CMC. Psychosocial issues in spinal cord injury: a review. Spinal Cord. 2012;50:382–9.
Jensen MP, Truitt AR, Schomer KG, Yorkston KM, Baylor C, Molton IR. Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review. Spinal Cord. 2013;51:882–92.
Jörgensen S, Iwarsson S, Lexell J. Secondary health conditions, activity limitations, and life satisfaction in older adults with long-term spinal cord injury. PM R. 2017;9:356–66.
Alexander MS, Aisen CM, Alexander SM, Aisen ML. Sexual concerns after spinal cord injury: an update on management. NeuroRehabilitation. 2017;41:343–57.
DeJong G, Tian W, Hsieh C-H, Junn C, Karam C, Ballard PH, et al. Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation. Arch Phys Med Rehabil. 2013;94(4 Suppl):S87–97.
Müller R, Landmann G, Béchir M, Hinrichs T, Arnet U, Jordan X, et al. Chronic pain, depression and quality of life in individuals with spinal cord injury: Mediating role of participation. J Rehabil Med. 2017;49:489–96.
Adriaansen JJE, Asbeck FWA, van, Lindeman E, Woude LHV, van der, Groot S, de, Post MWM. Secondary health conditions in persons with a spinal cord injury for at least 10 years: design of a comprehensive long-term cross-sectional study. Disabil Rehabil. 2013;35:1104–10.
Rabadi MH, Mayanna SK, Vincent AS. Predictors of mortality in veterans with traumatic spinal cord injury. Spinal Cord. 2013;51:784–8.
Gabbe BJ, Nunn A. Profile and costs of secondary conditions resulting in emergency department presentations and readmission to hospital following traumatic spinal cord injury. Injury. 2016;47:1847–55.
Ullah MM, Fossey E, Stuckey R. The meaning of work after spinal cord injury: a scoping review. Spinal Cord. 2018;56:92–105.
Brinkhof MWG, Al-Khodairy A, Eriks-Hoogland I, Fekete C, Hinrichs T, Hund-Georgiadis M, et al. Health conditions in people with spinal cord injury: Contemporary evidence from a population-based community survey in Switzerland. J Rehabil Med. 2016;48:197–209.
Dryden DM, Saunders LD, Rowe BH, May LA, Yiannakoulias N, Svenson LW, et al. Utilization of health services following spinal cord injury: a 6-year follow-up study. Spinal Cord. 2004;42:513–25.
Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MWG. Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology. 2015;44:182–98.
Kalpakjian CZ, Scelza WM, Forchheimer MB, Toussaint LL. Preliminary reliability and validity of a Spinal Cord Injury Secondary Conditions Scale. J Spinal Cord Med. 2007;30:131–9.
Seekins T, Ravesloot C. Secondary conditions experienced by adults with injury-related disabilities in Montana. Top Spinal Cord Inj Rehabil. 2000;6:43–53.
Craven C, Hitzig SL, Mittmann N. Impact of impairment and secondary health conditions on health preference among Canadians with chronic spinal cord injury. J Spinal Cord Med. 2012;35:361–70.
Arora M, Harvey LA, Lavrencic L, Bowden JL, Nier L, Glinsky JV, et al. A telephone-based version of the spinal cord injury-secondary conditions scale: a reliability and validity study. Spinal Cord. 2016;54:402–5.
New PW. Secondary conditions in a community sample of people with spinal cord damage. J Spinal Cord Med. 2016;39:665–70.
Terwee CB, Mokkink LB, Knol DL, Ostelo RWJG, Bouter LM, de Vet HCW. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2012;21:651–7.
Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract. 2011;17:268–74.
Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30:459–67.
Küçükdeveci AA, Yavuzer G, Tennant A, Süldür N, Sonel B, Arasil T. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med. 2000;32:87–92.
Bonavita J, Torre M, China S, Bressi F, Bonatti E, Capirossi R, et al. Validation of the Italian version of the Spinal Cord Independence Measure (SCIM III) Self-Report. Spinal Cord. 2016;54:553–60.
Lang L, Zhang L, Zhang P, Li Q, Bian J, Guo Y. Evaluating the reliability and validity of SF-8 with a large representative sample of urban Chinese. Health Qual Life Outcomes. 2018;16:55.
Ware JE, Kosinski M, Dewey JE, Gandek B, Ware JE, Kisinski M, et al. How to score and interpret single-item health status measures: a manual for users of the SF-8TM Health Survey. 5 Jan 2008 [cited 2019 Jun 29]; Available from: https://www.scienceopen.com/document?vid=5c6a3101-a200-45a3-a2dc-f2724767d327.
Tolva VS, Casana R, Lonati L, Invitti C, Bertoni GB, Bianchi PG, et al. Percutaneous transluminal angioplasty improves glucose control and quality of life in patients with critical limb ischemia. Eur Rev Med Pharm Sci. 2012;16:2082–7.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Krause JS, Saunders LL, Reed KS, Coker J, Zhai Y, Johnson E. Comparison of the patient health questionnaire and the older adult health and mood questionnaire for self-reported depressive symptoms after spinal cord injury. Rehabil Psychol. 2009;54:440–8.
Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46:266–74.
Ivziku D, Clari M, Piredda M, De Marinis MG, Matarese M. Anxiety, depression and quality of life in chronic obstructive pulmonary disease patients and caregivers: an actor-partner interdependence model analysis. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2019;28:461–72.
Jones DH. ERIC-EJ598316-‘Statistical Methods,’ 8th ed., by George W. Snedecor and William G. Cochran [book review]. J Educ Behav Stat. 1994;19:304–7.
Kimberlin CL, Winterstein AG. Validity and reliability of measurement instruments used in research. Am J Health-Syst Pharm AJHP J Am Soc Health-Syst Pharm. 2008;65:2276–84.
Altman D, Machin D, Bryant T, Gardner M. Statistics with confidence: confidence intervals and statistical guidelines, 2nd ed. Hoboken, USA: John Wiley & Sons; 2000. 254 p.
Jörgensen S, Ginis KA, Iwarsson S, Lexell J. Depressive symptoms among older adults with long-term spinal cord injury: associations with secondary health conditions, sense of coherence, coping strategies and physical activity. J Rehabil Med. 2017;49:644–51.
Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury: a survey and longitudinal study. Spinal Cord. 2005;43:704–12.
Park SE, Elliott S, Noonan VK, Thorogood NP, Fallah N, Aludino A, et al. Impact of bladder, bowel and sexual dysfunction on health status of people with thoracolumbar spinal cord injuries living in the community. J Spinal Cord Med. 2017;40:548–59.
Bossuyt FM, Arnet U, Brinkhof MWG, Eriks-Hoogland I, Lay V, Müller R, et al. Shoulder pain in the Swiss spinal cord injury community: prevalence and associated factors. Disabil Rehabil. 2018;40:798–805.
Solinsky R, Linsenmeyer TA. Anxiety masquerading as autonomic dysreflexia. J Spinal Cord Med. 2019;42:639–42.
Suero EM, Meindl R, Schildhauer TA, Citak M. Clinical prediction rule for heterotopic ossification of the hip in patients with spinal cord injury. Spine. 2018;43:1572–8.
Acknowledgements
We wish to thank the participants and the staff at the Spinal Cord Injury Units of Città della Salute e della Scienza Hospital of Torino, Careggi Hospital of Firenze, and Cannizzaro Hospital of Catania for dedicating their time to this study.
Author contributions
AC was responsible for designing and writing the study protocol, and for submitting the study to the ethical committee. He was also responsible for writing the report, coordinating the recruiting centers, and interpreting results. MC was responsible for the database managing, analyzing data, and interpreting results. He contributed to writing the report. SA and SF were responsible for designing and writing the study protocol. BB, LC, SA and SM were responsible for recruiting the participants and managing the data. They provided feedback on the report. EV and SC provided feedback on the report.
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Ethical approval (Resolution no. CS2/596, March 13, 2018) was granted by the Città della Salute e della Scienza di Torino, Mauriziano Hospital, ASL TO 1 Research Ethics Committee, Turin, Italy. All recruitment centers gave their authorization for participation in the study. Additionally, all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed.
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Conti, A., Clari, M., Arese, S. et al. Validation and psychometric evaluation of the Italian version of the Spinal Cord Injury Secondary Conditions Scale. Spinal Cord 58, 496–503 (2020). https://doi.org/10.1038/s41393-019-0384-z
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DOI: https://doi.org/10.1038/s41393-019-0384-z
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