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RehabMeasures Instrument

Sickness Impact Profile

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Purpose

  • 68-question assessment of quality of life and level of dysfunction that results from disability or illness

  • Provides a valid and sensitive assessment of outcomes that result from health care related services

Link to Instrument

Instrument Details

Acronym SIP-68

Area of Assessment

Behavior
Life Participation
Mental Health
Social Relationships

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Brain Injury
  • Cardiac Dysfunction
  • Cerebral Palsy
  • Multiple Sclerosis
  • Parkinson's Disease + Neurologic Rehabilitation
  • Pulmonary Disorders
  • Spinal Cord Injury
  • Stroke Recovery

Key Descriptions

  • The SIP-68 was created from a Principal Components Analysis of the items contained in the full SIP. Items are divided into 3 dimensions composed of 2 subscales each:

    1) Physical dimension
    -Somatic autonomy
    -Mobility control

    2) Psychological dimension
    -Psychological autonomy and Communication
    -Emotional stability

    3) Social dimension
    -Mobility range
    -Social behavior
  • All items are scored dichotomously (no = 0, yes = 1); scores are then summed.
  • Total Scores on the SIP-68 range from 0 (best health) to 68 (worst health).
  • Areas of Assessment:
    1) Behavior
    2) Life Participation
    3) Mental Health
    4) Social Relationships

Number of Items

68

Time to Administer

15-30 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated by Wendy Romney, PT, DPT, NCS, Cara Weisbach, PT, DPT, and the SCI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Sue Saliga PT, DHSc, CEEAA and the TBI EGDE task force of the Neurology section of the APTA in September 2012; Updated by Lynne Marino, OTR/L, OTD Candidate, The George Washington University, November 2016.

ICF Domain

Body Structure
Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Emotion
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

NR

R

R

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

NR

NR

NR

LS

LS

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

R

R

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

Yes

Yes

Not reported

TBI EDGE

No

Yes

Yes

Not reported

Considerations

  • A modified SIP for head injury populations has been developed. The modifications fail to make improvements sufficiently large or consistent to provide practical advantage over the SIP. See Temkin et al. (1989) for more information.

  • The SIP 68 is more sensitive to health-related task-specific behaviors than the Barthel Index when used for long-term outcomes measures (Boerboom et al., 2016).

  • The SIP 68 has been used in those with moderate to severe TBI. Cognition and awareness deficits may impact outcomes on this self-report questionnaire (Weilengna-Boiten et al., 2015).

  • The SIP – CP (Sickness Impact Profile – Chronic Pain) was developed from the original 136-item SIP measure. The SIP – CP has 42 items across 7 subscales and physical and psychosocial dimensions (McEntee et al., 2016).

Brain Injury

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Standard Error of Measurement (SEM)

Acute TBI: (van Baalen et al., 2006; n = 25; aged 18 to 50; Glasgow Coma Scale score 3-14; mean hospital stay = 35 (19) days; assessed at discharge)

  • SEM = 3.79

Minimal Detectable Change (MDC)

Acute TBI: (van Baalen et al., 2006) 

  • Smallest Detectable Difference (SDD) = 10.51

Normative Data

Acute TBI: (van Baalen et al., 2006)

  • Mean score = 15.62 (11.5)

Aneurysmal Subarachnoid Hemorrhage: (Boerboom et al, 2016; = 76; mean age= 53.8 (11.5); mean time after onset 0.4 (0.3) years; mean Glasgow Coma Scale 13.0 (3.5); WFNS score grade 1, n = 31; grade 2, n = 12; grade 3, n = 3; grade 4, n = 7; grade 5, n = 6)

  • Mean (SE) Sickness Impact Profile 68 score 9.3 (1.5).

Chronic Traumatic Brain Injury: (Wielenga-Goiten, J. et al, 2015; n = 85; mean age 32.1 (13.1); TBI severity GCS 9-12 moderate severity n = 20, GCS 3-8 severe TBI n = 65; measured physical and psychological dimensions of SIP 68)

 

SIP 68

 

 

M (SD)

M (SD)

 

12 months

36 months

Total score

11.4 (1.1)

9.9 (1.0)

Physical dimension

3.5 (0.6)

2.6 (0.4)

Psychosocial dimension

7.9 (0.7)

7.3 (0.7)

Interrater/Intrarater Reliability

Acute TBI: (van Baalen et al., 2006)

  • Excellent intrarater reliability (SWK = 0.87)

  • Excellent interrater reliability (ICC = 0.89)

Construct Validity

Traumatic Brain Injury: (Levine et al., 2000; n= 12 (mild), 16 (moderate-severe); mean age 32.3 (4.2) for mild, 31.0 (7.4) for mod/severe; time since injury 3.9(0.53) for mild, 3.6 (0.80) for mod/severe; participants tested 3-4 years post-injury; used the original SIP) 

  • Revised Strategy Application Test (R-SAT) significantly related to SIP total score r(38) = -0.4, p <.05 for mod/severe group; correlations for controls and mild group were not significant 
  • The R-SAT R-SAT performance was related to the SIP psychosocial summary score, r(38) = -.34, p < .05 and a significant relationship between the physical summary score and R-SAT performance, r(38) = -.50, < .002

Non-Specific Patient Population

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Normative Data

Niemann-Pick type C: (Koens et al, 2016; n = 8; age range 19-61 years; measured either directly after diagnosis up to 4 years post diagnosis);

  • A Strong correlation was found between the severity of the movement disorder as measured by the Global Clinical Impressions Scale and the Physical and Psychosocial Dimension of the SIP 68.

 

SIP 68

 

 

Somatic Autonomy

Psychological Autonomy and Communication

GCI*

rs = 0.706**, = 0.050

rs = 0.727**, = 0.041

*Global Impressions Scale-scale of 1-7, 1=no movement disorder, 7=most affected by movement disorder. Range for this population 2-5.

**Spearman’s rho

Content Validity

  • The original SIP assesses three critical aspects of health recommended by the World Health Organization:

    • Physical Health

    • Mental Health

    • Social Health

  • The SIP-68 is a shortened subset of this original set of items.

Responsiveness

Literature Review: (de Bruin et al., 1997; n = 7; studies composed of different diagnoses) 

  • Responsiveness for the SIP-68 = 0.62

  • Responsiveness for the SIP-136 = 0.64

Stroke

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Normative Data

Acute Stroke: (Kwakkel et al, 2002; n = 37; mean age = 64.1 (15.0) years, (level of consciousness assessed within 24 hours of stroke onset) median Glasgow Coma Scale 15 (IRQ = 15–15), median Mini Mental State Examination score 26 (24–28) Dutch sample)

  • SIP-68 baseline score = 41.2 (11.7)

Spinal Injuries

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Normative Data

Respiratory function in those with spinal cord injury: (Postma et al, 2016; n = 147; mean age 45.5 (13.8); 6.6 (0.8) years post initial inpatient rehabilitation stay; American Spinal Injury Association Impairment Scale (AIS) lesion level as shown:

Lesion Group*

n (%)

Motor complete (AIS A and B) tetraplegia

33 (22.4)

Incomplete (AIS C and D) tetraplegia

21 (14.3)

Motor complete (AIS A and B) paraplegia

67 (45.6)

Incomplete (AIS C and D) paraplegia

26 (17.7)

  • Mean (SD) SIP 68 Social Dimension for combined lesion levels 6.7 (4.7).

Internal Consistency

Chronic SCI : (Post et al., 1996, n = 315, mean age 39.4 years, AIS A-D, 1-7 years post injury) 

  • Excellent internal consistency (r = 0.92)

Criterion Validity (Predictive/Concurrent)

Chronic SCI: (Post et al., 1996)

 

Level of lesion (n = 158)

Barthel Index (n = 315)

Life Satifaction Questionnaire (n = 315)

Somatic Autonomy

-0.72* ᵃ

-0.91* ᵃ

-0.32* ᵇ

Mobility Control

-0.47* ᵇ

-0.47* ᵇ

-0.22*

Mobility Range

-0.39* ᵇ

-0.54* ᵇ

-0.42* ᵇ

Social Behavior

-0.29*

-0.41* ᵇ

-0.53* ᵇ

Emotional Stability

-0.07

-0.11

-0.41* ᵇ

Psychic autonomy & communication

-0.31* ᵇ

-0.21*

-0.34* ᵇ

SIP-68

-0.59* ᵇ

-0.74* ᵃ

-0.52* ᵇ

*p < .001 ;ᵃexcellent correlation (> 0.60); ᵇadequate correlation (0.31-0.59)

 

 

 

Construct Validity

Chronic SCI: (Post et al., 1999; n = 318; mean age = 43.0 (range = 18 to 65) years; time since injury = 4.5 years; Dutch sample)

SIP-68 Correlations between demographic variables and Social Support:

 

EMOTFAM

PROBFAM

EMOTPROF

PROBPROF

SIPSOM

SIPPSY

SIPSOC

LSQ

Age

0.11

0.10

-0.03

-0.15*

0.09

0.18*

0.07

0.01

Sex

-0.08

-0.10

-0.01

-0.03

0.03

0.17*

-0.11

0.02

Level of education

-0.03

-0.08

-0.03

-0.01

-0.12

-0.05

-0.16*

-0.20*

Marital status

-0.18*

-0.34*

-0.11

-0.04

-0.08

-0.03

-0.08

-0.00

Emotional support from family (EMOTFAM)

 

 

 

 

 

 

-0.01

-0.07

Problem-oriented support from family (PROBFAM)

0.30**

 

 

 

 

 

0.17*

-0.01

Emotional support from friends (EMOTINFO)

0.47**

0.16*

 

 

 

 

-0.06

-0.26**

Problem-oriented support from friends (PROBINFO)

0.15*

0.51**

0.48**

 

 

 

0.05

-0.08

Emotional support from professional (EMOTPROF)

0.31**

0.25**

0.56**

0.36**

 

 

-0.01

0.02

Problem-oriented support from professionals (PROBPROF)

0.12

0.38**

0.31**

0.47**

0.54**

 

0.05

0.07

p < 0.05; ** p < 0.01; SIPSOM = Physical dimension of functional health; SIPPSY = Psychological dimension of functional health; SIPSOC = Social dimension of functional health; all correlations have a strength of poor except age/SIPSOC

Chronic SCI: (Post et al., 1996)

  • Poor subscale correlations indicate little redundancy between domains (r = 0.08-0.54), except between mobility range and social behavior (r = 0.67)

Wheelchair Usage

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Normative Data

Wheelchair-dependent Individuals: (Post et al., 2001; n = 111, Athletes = 49, SCI = 32 & Rheumatic diseases = 30; average ages range from 36.5 to 69.9 years)

SIP-68: Norms

 

 

 

Sub-scale

Mean

SD

Median

Somatic Autonomy

36.4

23.9

29.4

Mobility Control

72.2

15.7

75.0

Emotional Stability

14.1

20.9

0

Social Behaviour

45.9

25.6

50.0

Mobility Range

26.2

24.4

20.0

Psychol. Auton. Comm.

12.1

16.4

9.1

Internal Consistency

Wheelchair-dependent Individuals : (Post et al., 2001)

SIP-68: Internal Consistency

Strength

ICC

Somatic Autonomy

Excellent

0.85

Mobility Control

Poor

0.53

Emotional Stability

Poor

0.67

Social Behavior

Adequate

0.79

Mobility Range

Adequate

0.78

Criterion Validity (Predictive/Concurrent)

Wheelchair-dependent Individuals: (Post et al., 2001)

Correlations between Nottingham Health Profile (NHP) and the SIP-68

 

 

 

 

 

 

 

NHP Physical mobility

NHP Emotional reactions

NHP Social isolation

NHP

Pain

NHP Energy

NHP

Sleep

SIP-68 Somatic Autonomy

0.68

0.18

0.20

0.10

0.28

0.09

SIP-68 Mobility Control

0.22

- 0.15

- 0.11

0.01

0.06

- 0.01

SIP-68 Emotional Stability

- 0.09

0.56

0.41

0.36

0.46

0.15

SIP-68

Social Behavior

0.12

0.41

0.35

0.54

0.58

0.37

SIP-68

Mobility Range

0.15

0.26

0.28

0.38

0.46

0.26

SIP-68

Psychol. Auton. Comm.

0.20

0.43

0.43

0.35

0.43

0.24

* Correlations 0.19 or higher significant at p < 0.05 ; correlations 0.26 or higher significant at p < 0.01

Correlation Strength:

  • > .60 = Excellent (IN BOLD)

  • .31-.59 = Adequate

  • < .30 = Poor

Mixed Populations

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Test/Retest Reliability

Chronic Disability: (Nanda et al, 2003; n = 398; mean age = 53.8 (18.2) years; sample composed of 29.9% SCI, 9.3% Multiple Sclerosis, 7.8% stroke, and 5.0% Parkinson's disease)

SIP-68: Test-Retest Reliability

 

 

 

 

 

Test*

Retest*

Strength

ICC (95% CI)

Somatic autonomy

7.6 (3.5)

7.6 (3.3)

Excellent

0.85 (0.73, 0.92)

Mobility control

4.0 (2.5)

3.9 (2.7)

Excellent

0.85 (0.74, 0.92)

Psych/auton/comm.

2.3 (2.5)

2.3 (2.5)

Excellent

0.88 (0.78, 0.93)

Social behavior

5.8 (3.4)

5.4 (3.2)

Excellent

0.81 (0.67, 0.89)

Emotional stability

0.9 (1.1)

0.7 (1.1)

Excellent

0.77 (0.61, 0.87)

Mobility range

2.6 (2.6)

2.8 (2.7)

Excellent

0.90 (0.82, 0.95)

Physical dimension

11.6 (3.1)

11.5 (3.0)

Adequate

0.61 (0.38, 0.78)

Psychological dimension

3.1 (3.3)

2.9 (3.2)

Excellent

0.86 (0.93, 0.76)

Social dimension

8.4 (5.4)

8.1 (5.0)

Excellent

0.90 (0.82, 0.95)

Total score

23.1 (9.8)

22.5 (9.2)

Excellent

0.88 (0.79, 0.93)

*Mean (SD)

 

 

 

 

Rhematology Outpatients: (DeBruin, 1994, n = 51, mean age = 57 years; 47% rheumatoid arthritis; 10% arthritis; 10% ankylosing spondylitis; remaining 33% with varying diagnoses)

SIP-68: Test-Retest Reliability

(ICC) p<0.001

Strength

ICC

Somatic Autonomy

Excellent

0.97

Mobility Control

Excellent

0.95

Psychological Autonomy 
& Communication

Excellent

0.95

Social Behavior

Excellent

0.94

Emotional Behavior

Excellent

0.94

Mobility Range

Excellent

0.90

SIP68 Total Score

Excellent

0.97

Interrater/Intrarater Reliability

Chronic Disability: (Nanda et al., 2003, n = 133, patient and proxy)

  • Poor inter-rater reliability (ICC = 0.55)

Internal Consistency

Individuals at an outpatient Rhematologist office: (DeBruin et al., 1994) 

  • Excellent internal consistency (= 0.90-0.92) 

Criterion Validity (Predictive/Concurrent)

Chronic Disability: (Nanda et al, 2003) 

  • Excellent correlation between the SIP and the SIP-68 (r = 0.94) 

  • Adequate correlation between SIP-68 subscales and SF 36 subscales (r = 0.33-0.59) 

  • Excellent correlation between ADL and IADL subscale with SIP-68 somatic autonomy subscale (r = 0.64-0.81)

Construct Validity

Chronic Disability: (Nanda et al., 2003) 

  • Excellent correlation between the SIP and the SIP-68 (r = 0.94)

Floor/Ceiling Effects

Chronic Disability: (Nanda et al., 2003)

SIP-68 Norms, % of Individuals reaching Floor / Ceiling Scores:

 

 

 

 

Domain (possible scores)

Mean (SD)

Min/max

Ceiling %

Floor %

Somatic autonomy (0–17)

5.1 (4.2)

0/16

16.5

0.0

Mobility control (0–12)

4.3 (2.9)

0/12

8.2

0.2

Psych/auto/comm. (0–11)

2.9 (2.9)

0/11

23.7

1.7

Social behavior (0–12)

5.5 (3.1)

0/12

4.0

0.7

Emotional stability (0–6)

0.9 (1.3)

0/12

53.6

1.2

Mobility range (0–10)

3.0 (2.7)

0/10

23.7

2.0

Physical dimension (0–29)

9.4 (4.9)

0/21

5.0

0.0

Psycho logic dimension (0–17)

3.8 (3.7)

0/16

18.5

0.0

Total score (0–68)

21.6 (10.9)

0/51

 

 

  • Excellent: No floor or ceiling effects

  • Adequate: < 20%

  • Poor: > 20%

Bibliography

Boerboom, W., Heijenbrok-Kal, M. H., et al,. (2016). “Long-term functioning of patients with aneurysmal subarachnoid hemorrhage: a 4-yr follow-up study.” American Journal of Physical Medicine & Rehabilitation 95(2): 112-120. Find it on PubMed

Bergner, M., Bobbitt, R. A., et al. (1981). "The Sickness Impact Profile: development and final revision of a health status measure." Medical care 19(8): 787-805. 

de Bruin, A. F., Diederiks, J. P., et al. (1997). "Assessing the responsiveness of a functional status measure: the Sickness Impact Profile versus the SIP68." J Clin Epidemiol 50(5): 529-540. Find it on PubMed

Gilson, B. S., Gilson, J. S., et al. (1975). "The sickness impact profile. Development of an outcome measure of health care." Am J Public Health 65(12): 1304-1310. Find it on PubMed

Koens, L. H. et al, (2016). “Ataxia, dystonia and myoclonus in adult patients with Niemann-Pick type C.” Orphanet Journal of Rare Diseases 11: 1-8. Find it on PubMed

Kwakkel, G., Kollen, B., et al. (2002). "Long term effects of intensity of upper and lower limb training after stroke: a randomised trial." Journal of Neurology, Neurosurgery & Psychiatry 72(4): 473. 

Levine, B., Dawson, D., et al. (2000). "Assessment of strategic self-regulation in traumatic brain injury: its relationship to injury severity and psychosocial outcome." Neuropsychology 14(4): 491-500. Find it on PubMed

McEntee, M. L. & Vowles, K. E. (2016). “Development of a chronic pain-specific version of the sickness impact profile.” Health Psychology, 35, 228-237. Find it on PubMed

Nanda, U., McLendon, P. M., et al. (2003). "The SIP68: an abbreviated sickness impact profile for disability outcomes research." Qual Life Res 12(5): 583-595. Find it on PubMed

Post, M. W., Gerritsen, J., et al. (2001). "Measuring health status of people who are wheelchair-dependent: validity of the Sickness Impact Profile 68 and the Nottingham Health Profile." Disabil Rehabil 23(6): 245-253. Find it on PubMed

Post, M. W. M., de Bruin, A., et al. (1996). "The SIP68: a measure of health-related functional status in rehabilitation medicine." Archives of physical medicine and rehabilitation 77(5): 440-445. 

Post, M. W. M., Ros, W. J. G., et al. (1999). "Impact of social support on health status and life satisfaction in people with a spinal cord injury." Psychology & Health 14(4): 679-695.

Postma, K., Post, M.W.M. et al, (2016). “Impaired respiratory function and associations with health-related quality of life in people with spinal cord injury.” Spinal Cord 54: 866-871. Find it on PubMed

Temkin, N. R., Dikmen, S., et al. (1989). "General versus disease-specific measures. Further work on the Sickness Impact Profile for head injury." Med Care 27(3 Suppl): S44-53. Find it on PubMed

van Baalen, B., Odding, E., et al. (2006). "Reliability and sensitivity to change of measurement instruments used in a traumatic brain injury population." Clin Rehabil 20(8): 686-700. Find it on PubMed

Wielenga-Boiten, J. E., Heijenbrok-Kal, M. H. et al, (2015). “The relationship of health locus of control and health-related quality of life in the chronic phase after traumatic brain injury.” Journal of Head Trauma Rehabilitation 30(60): 424-431. Find it on PubMed

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