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Rehabilitation Measures Database

Spinal Cord Injury Lifestyle Scale

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Purpose

The SCILS measures health behaviors that delay or prevent the development of secondary impairments in patients with spinal cord injury.

Link to Instrument

Instrument Details

Acronym SCILS

Area of Assessment

Behavior

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Key Descriptions

  • The SCILS is a 25-item self report that measures the frequency of general health behaviors performed by persons with SCI for avoiding secondary impairments.
  • The purpose is to evaluate the effectiveness of clinical and education efforts for health maintenance and the prevention of secondary impairments following SCI (Miller et al., 2010).
  • Health categories include:
    1) Cardiovascular
    2) Genitourinary
    3) Neuromusculoskeletal
    4) Skin
    5) Psychosocial
  • The SCILS uses a 5-point ordinal scale with scores generated by totaling the item scores of each category.
  • A total score consists of the sum of the 5 category scores. Higher scores indicate increased performances of behaviors promoting health.

Number of Items

25

Time to Administer

30 minutes

Outcome measure is a self-paced questionnaire

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Initially reviewed by Eileen Tseng, PT, DPT, NCS, Rachel Tappan, PT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 4/2012. Updated by Tayler Cypin, OTS, Alli Ferlin, OTS, Ada Terman, OTS in 05/2016.

ICF Domain

Activity
Participation

Measurement Domain

General Health
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

NR

NR

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

NR

NR

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

No

No

Not reported

Considerations

A 22-item Dutch version is available with excellent internal consistency (Cronbach’s alpha = 0.80) (Bloemen-Vrencken 2007).

The SCILS requires further testing and development of the measure before recommending it for clinical use. (Miller et al., 2010).

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Spinal Injuries

back to Populations

Internal Consistency

Chronic SCI:

(Pruitt et al, 1998; n = 49; mean age = 45.54 (13.05) years; mean time post-SCI = 17.67 (11.90) years; 59% with quadriplegia, 41% with paraplegia)

  • Excellent internal consistency for total measure (Cronbach’s alpha = 0.81)
  • Variable internal consistency of sub-categories
    • Excellent for skin (Cronbach’s alpha = 0.86)
    • Adequate for cardiovascular and neuromusculoskeletal (Cronbach’s alpha = 0.73-0.75)
    • Poor for genitourinary and psychosocial (Cronbach’s alpha = 0.31-0.32)

 

Tetrepelgia and Parapelgia: 

(Webb, Toussaint, Kalpakjian & Tate, 2010; n= 140; mean age = 39.9 (15.2) years; mean time post-SCI = 8.8 (4.6) years;48% with tetreplegia, 52% paraplegia)

  • Excellent internal consistency for this scale for this sample (alpha = .79). This is within the range for clinical application.

Criterion Validity (Predictive/Concurrent)

Concurrent validity

Chronic SCI:

(Pruitt et al, 1998)

  • Poor relationship between SCILS scores and current impairments (r = 0.04)
  • Poor relationship between SCILS scores and lifetime impairments (r = 0.08)

Construct Validity

Discriminant validity

Chronic SCI

(Pruitt et al, 1998)

  • Poor correlation of SCILS with the constructs measured by:
    • Beck depression inventory (r = -0.17)
    • Brief symptom inventory for depression (r = -0.13) and anxiety (r = -0.16)
    • Impact of events scale for intrusion (r = -0.16) and avoidance (r = 0.10)
    • Functional Independence measure (r =-0.06)

 

Convergent validity

Chronic SCI:

(Pruitt et al, 1998)

  • Adequate correlation of SCILS total score was correlated with participants’ self ratings (r = 0.51, p = 0.004) and physician assistants’ ratings (r = 0.41, p = 0.02)
  • Poor correlation of SCILS score and physical therapists’ ratings (r = 0.30, p = 0.13) and nurses’ ratings (r = -0.18, p = 0.39)

Content Validity

Chronic SCI:

(Pruitt et al, 1998)

  • The final SCILS measure was developed via the following process:
    • 47 potential items were generated via literature review and expert clinician opinion
    • 5 items were eliminated based on review by people with SCI and expert clinicians
    • 17 items were eliminated due to low item-total subscale correlations (< 0.25)

Face Validity

See evidence for Content Validity and Convergent Validity

Bibliography

Bloemen-Vrencken, J. H., de Witte, L. P., et al. (2007). "Health behaviour of persons with spinal cord injury." Spinal Cord 45(3): 243-249. Find it on PubMed

Griebling, T.L., Karellas, M.E., Holmes, D.G., & Weigel, J.W. (2001). Quality of life in patients with spinal cord injuries following cystectomy and continent urinary diversion using the Indiana pouch. Abstract retrieved from International Continence Society.

Pruitt, S. D., Wahlgren, D. R., et al. (1998). "Health behavior in persons with spinal cord injury: development and initial validation of an outcome measure." Spinal Cord 36(10): 724-731. Find it on PubMed

Webb, J.R., Toussaint, L., Kalpakjian, C. Z., & Tate, D.G. (2010). Forgiveness and health-related outcomes among people with spinal cord injury. Disability and Rehabilitation 32(5), 360-366. Find it on PubMed

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