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The Spine Functional Index: development and clinimetric validation of a new whole-spine functional outcome measure
Journal article   Open access   Peer reviewed

The Spine Functional Index: development and clinimetric validation of a new whole-spine functional outcome measure

Charles P Gabel, M Melloh, Brendan J Burkett and L A Michener
The Spine Journal, Vol.19(2), pp.e19-e27
2019
DOI: https://doi.org/10.1016/j.spinee.2013.09.055
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PDF - Author's Accepted Version (Open Access)239.24 kBDownloadView
Accepted VersionCC BY-NC-ND V4.0,  Open Access

Abstract

Spine Functional Index (SFI) spinal injury Functional Rating Index (FRI)
Background Context: Most spine patient-reported outcome measures are divided into neck and back subregions. This prevents their use in the assessment of the whole spine. By contrast, whole-spine patient-reported outcome measures assess the spine from cervical to lumbar as a single kinetic chain. However, existing whole-spine patient-reported outcomes have been critiqued for clinimetric limitations including concerns with practicality. Purpose: To develop the Spine Functional Index (SFI) as a new whole-spine patient-reported outcome measure that addressed the limitations of existing whole-spine questionnaires; then to determine the SFI's clinimetric and practical characteristics concurrently with a recognised criterion, the Functional Rating Index (FRI). Study Design/Setting: Observational cohort study within ten physical therapy outpatient clinics. Patient Sample: Spine-injured patients were recruited from a convenience sample referred by a medical practitioner to physical therapy. A pilot study (n=52, 57% female, age 47.6±17.5) followed by the main study (n=203, 48% female, age 41.0±17.8) that had an average symptom duration of less than five weeks. Outcome Measures: SFI, FRI and Numerical Rating Scale (NRS). Methods: The SFI was developed through three stages: 1) item generation, 2) item reduction with an expert panel and patient focus group, then 3) pilot field testing to provide provisional clinimetric properties, sample size requirements and to determine suitability for a larger study. Participants completed the SFI, FRI and NRS every two weeks for six weeks, then every four weeks until discharge or study completion at six months. Responses were assessed to provide individual psychometric and practical characteristics for both patient-reported outcomes, with the overall performance evaluated by the Measurement of Outcome Measures and Bot clinimetric assessment scales. Results: The SFI demonstrated high criterion validity with the FRI, (Pearson's r=0.87, 95%CI), equivalent internal consistency (a=0.91) and a single-factor structure. The SFI and FRI demonstrated suitable reliability (ICC2,1=0.97:0.95), responsiveness (standardized response mean=1.81:1.68), minimal detectable change with 90%CI (6.4%:9.7%), Flesch-scale reading ease (64%:47%) and user errors (1.5%:5.3%). The clinimetric performance was higher for the SFI on the Measurement of Outcome Measures (96%:64%) and on the Bot scale (100%:75%). Conclusions: The SFI demonstrated sound clinimetric properties with lower response errors, efficient completion and scoring, and improved responsiveness and overall clinimetric performance compared to the FRI. These results indicated that the SFI was suitable for functional outcome measurement of the whole-spine in both the research and clinical settings.

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