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Spinal cord independence measure evidence-based recommendation: a systematic review of measurement properties

Spinal Cord (2025)Cite this article

Subjects

Abstract

Study design

Systematic Review (PROSPERO CRD42022297211).

Objectives

To evaluate the measurement properties of Spinal Cord Independence Measure (SCIM) versions and to derive recommendations.

Methods

We followed the COSMIN methodology for systematic reviews of Patient-Reported Outcome Measures (PROM) and adapted criteria for non-PROM to conduct the review and derive SCIM evidence-based recommendations. PubMed, CINAHL, EMBASE, Scopus and Lilacs databases were searched (November 2025). Studies reporting the development or evaluation of any SCIM measurement properties were included. We used the COSMIN Risk of Bias tool and the Criteria for Good Measurement Properties to critically appraise the studies and to summarise and rate the measurement properties. Evidence levels were established using a modified GRADE system.

Results

The review included 50 articles, reporting five SCIM versions and 127 individual measurement property studies. The SCIM SR presented low-level evidence for sufficient content validity. The SCIM II, III, SR and IV presented high-level evidence for sufficient criterion validity and indeterminate structural validity. The SCIM III, SR and IV presented high-level evidence for sufficient internal consistency. The SCIM SR also presented high-level evidence for sufficient reliability. Moderate-level evidence for sufficient reliability was presented by SCIM II, III and IV, and for measurement error by SCIM III and SR.

Conclusions

None of the SCIM versions fully fit all the COSMIN criteria for recommendation. The SCIM III, SR, and IV present the highest evidence levels for most measurement properties. Additionally, the SCIM SR meets the criteria for potential recommendation for having at least low-level evidence for sufficient content validity.

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UDESC.

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Data availability

The data generated and analyzed during this study are included in this published article and its supplementary information files.

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Acknowledgements

We are grateful to Professor Natalia Duarte Pereira (UFSCar) for her assistance on the evaluation of some of the structural validity studies.

Funding

This study forms part of the first author’s master’s degree dissertation and was partially financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) – Brazil – Finance Code 001, and by the Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina (FAPESC; 2023TR501 and 2025TR00163) - Brazil.

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Authors and Affiliations

  1. Spinal Cord Injury Rehabilitation Research Group (SCIR-Group), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil

    Clarissa Volpato Sombrio Foschi, Aline de Lima & Jocemar Ilha

  2. Physiotherapy Graduate Program, Department of Physiotherapy, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil

    Clarissa Volpato Sombrio Foschi, Aline de Lima, Stella Maris Michaelsen & Jocemar Ilha

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  1. Clarissa Volpato Sombrio Foschi
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  2. Aline de Lima
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  3. Stella Maris Michaelsen
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  4. Jocemar Ilha
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Contributions

All authors contributed to the conception and design of the study. C.V.S.F. and A.L. conducted data extraction and analysis. C.V.S.F. and J.I. wrote the manuscript. A.L. provided feedback on the manuscript draft. S.M.M. provided feedback on data analysis and the manuscript draft.

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Correspondence to Jocemar Ilha.

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Foschi, C.V.S., de Lima, A., Michaelsen, S.M. et al. Spinal cord independence measure evidence-based recommendation: a systematic review of measurement properties. Spinal Cord (2025). https://doi.org/10.1038/s41393-025-01159-w

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