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Evaluating the modified spinal cord injury secondary conditions scale (SCI-SCS) combining severity and mortality-based weights

Spinal Cord (2026)Cite this article

Subjects

Abstract

Study design

Cross-sectional study

Objective

To evaluate alternative scoring approaches for the modified Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) using severity- and mortality-based weights, and to examine their associations with functioning and self-reported health in individuals with SCI.

Setting

Community

Methods

We analyzed data from 10,347 participants in the International Spinal Cord Injury Survey (InSCI). Eight scoring approaches were constructed from 14 secondary health conditions and a depression item, varying by severity coding and by whether mortality weights were applied equally or condition-specifically. Associations with functioning (ICF-based composite score) and self-reported health were assessed using Pearson and Spearman correlations, with additional country-level analyses to explore variability.

Results

All scoring approaches were negatively correlated with both outcomes, indicating that higher secondary health condition burden was associated with worse functioning and poorer health. The score combining the modified SCI-SCS with condition-specific mortality weights showed the highest correlations, though differences from the unweighted score were small. Both scores demonstrated moderate associations with the outcomes. Country-level analyses revealed variability, partly related to sample size, but overall patterns were consistent.

Conclusion

The modified SCI-SCS demonstrated moderate and robust associations with functioning and self-reported health, supporting its use as a pragmatic proxy of overall health status in individuals with SCI. Weighting by mortality risks yielded only marginal gains, suggesting that the unweighted score remains a suitable option for research and practice. These findings advance the use of self-reported measures to capture health burden in SCI and encourage further validation with independent outcomes and across diverse contexts.

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Fig. 1: Validation of the scores using two health outcomes.
Fig. 2
Fig. 3

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Data availability

The data that support the findings of this study are available from the International Spinal Cord Injury Community Survey (InSCI) Study Center, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the InSCI Study Center. To request the data please contact ana.ona@paraplegie.ch.

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Acknowledgements

This study is based on data from the International Spinal Cord Injury (InSCI) Community Survey (Ref. Am J Phys Med Rehabil. 2017;96[suppl]: S23-S34). The members of the InSCI Steering Committee are J. Middleton, J. Patrick Engkasan, G. Stucki, M. Brach, J. Bickenbach, M. Gross-Hemmi, C. Thyrian, L. Battistella, J. Li, B. Perrouin-Verbe, C. Gutenbrunner, C. Rapidi, L.K. Wahyuni, M. Zampolini, E. Saitoh, B.S. Lee, A. Juocevicius, N. Hasnan, A. Hajjioui, M.W.M. Post, V Strøm, P. Tederko, D. Popa, C. Joseph, M. Avellanet, M. Baumberger, A. Kovindha, and R. Escorpizo.

Funding

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 801076, through the SSPH n Global PhD Fellowship Programme in Public Health Sciences (GlobalP3HS) of the Swiss School of Public Health.

Author information

Authors and Affiliations

  1. Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland

    Ana Oña, Carla Sabariego & Diana Pacheco Barzallo

  2. Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland

    Ana Oña, Carla Sabariego, Armin Gemperli & Diana Pacheco Barzallo

  3. Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway

    Vegard Strøm

  4. Center for Rehabilitation in Global Health Systems, University of Lucerne, Lucerne, Switzerland

    Carla Sabariego & Diana Pacheco Barzallo

  5. Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland

    Armin Gemperli

Authors
  1. Ana Oña
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  2. Vegard Strøm
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  3. Carla Sabariego
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  4. Armin Gemperli
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  5. Diana Pacheco Barzallo
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Contributions

AO and DP were involved in the conceptualization and formal analysis of the study. AO performed the statistical analysis and wrote the original draft. DP reviewed and approved the methodology. DP, VS, CS, and AG critically reviewed and interpreted the results. All the authors read and approved the final draft of the manuscript before submission.

Corresponding author

Correspondence to Diana Pacheco Barzallo.

Ethics declarations

Competing interests

Authors must declare whether or not there are any competing financial interests in relation to the work described.

Ethics approval

Ethical approval and consent to participate are not required for this study. The InSCI Study Group ensures that all the research teams from the participant countries follow international standards for ethical approval and obtain consent to participate in each country. In addition, all the data from the International Spinal Cord Injury Survey (InSCI) are anonymized, and all research bases on data from this community survey, including the present study, need to be evaluated and approved before obtaining the data.

Consent to participate

All methods were performed in accordance with the relevant guidelines and regulations of the InSCI Study Group protocol for best practices in cross-cultural surveys.

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Oña, A., Strøm, V., Sabariego, C. et al. Evaluating the modified spinal cord injury secondary conditions scale (SCI-SCS) combining severity and mortality-based weights. Spinal Cord (2026). https://doi.org/10.1038/s41393-026-01167-4

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