Psychometric properties of the Swedish versions of Spinal Cord Independence Measure IV (SCIM IV) and Self-report (SCIM-SR) in inpatient and outpatient rehabilitation settings

Psychometric properties of the Swedish versions of Spinal Cord Independence Measure IV (SCIM IV) and Self-report (SCIM-SR) in inpatient and outpatient rehabilitation settings | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Psychometric properties of the Swedish versions of Spinal Cord Independence Measure IV (SCIM IV) and Self-report (SCIM-SR) in inpatient and outpatient rehabilitation settings Sophie Jörgensen, Ulrica Antepohl, Emelie Butler Forslund, Peter Flank, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5949503/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Jan, 2026 Read the published version in Spinal Cord → Version 1 posted 10 You are reading this latest preprint version Abstract Study design : Psychometric study. Objectives : To evaluate the data completeness, targeting, internal consistency reliability and convergent validity of the Swedish versions of the Spinal Cord Independence Measure IV (s-SCIM IV) and the Spinal Cord Independence Measure Self-report (s-SCIM-SR). Setting: Inpatient and outpatient spinal cord injury (SCI) rehabilitation in Sweden. Methods: In total, 101 participants (82% men) were included. The translation process was based on established guidelines and involved researchers, clinicians and consumers. s-SCIM IV and FIM TM assessments were performed by observation and/or interview. Data for s-SCIM-SR were collected through self-report using paper forms. Results: There were no missing data for the s-SCIM IV and 92% had answered all items in the s-SCIM-SR. No ceiling or floor effects were observed. Cronbach´s alpha for the total s-SCIM IV scale was 0.91 (subscales 0.68–0.93) and for the total s-SCIM-SR scale 0.91 (subscales 0.62-0.93), with the lowest alphas for the subscale Respiration and Sphincter management in both outcome measures. The s-SCIM IV and s-SCIM-SR correlated strongly with each other and with FIM TM . Conclusions: Our results support the data completeness, targeting, internal consistency reliability and convergent validity of the s-SCIM IV and s-SCIM-SR. These outcome measures can thus be considered suitable to assess physical independence in inpatient and outpatient rehabilitation and long-term follow-up after SCI, for both clinical and research purposes. The available and psychometrically sound Swedish versions will now enable a uniform national assessment of SCI-specific physical independence and facilitate research and international collaborations and comparisons. Sponsorship : Not applicable Health sciences/Neurology/Neurological disorders/Spinal cord diseases Health sciences/Medical research/Outcomes research Figures Figure 1 INTRODUCTION To assess the outcome of interventions and to monitor improvements, valid and reliable outcome measures that evaluate functioning and disability over time after spinal cord injury (SCI) are needed [ 1 ], in inpatient and community rehabilitation settings. Thereby, there is a need for international translations and validation studies of SCI-specific outcome measures to facilitate both comparison and pooling of international data as well as to allow for multi-center studies [ 2 ]. Such psychometric studies are particularly important for ensuring that outcome measures are culturally and linguistically appropriate for different populations and contexts. The Spinal Cord Independence Measure (SCIM) was developed as a comprehensive clinician-administered assessment to evaluate the performance of daily activities in individuals with SCI [ 3 ]. It comprises three subscales: Self-care, Sphincter and respiratory management, and Mobility [ 3 ]. The total score ranges from 0-100 where higher scores indicate greater functional capacity and greater physical independence. The agreement with the generic Functional Independence Measure (FIM™) [ 4 ] is high, but the SCIM has been found to be more sensitive to changes in function after SCI [ 5 , 6 ]. SCIM has become a standard outcome measure in clinical practice and clinical studies worldwide [ 7 ]. The most recent version, SCIM IV [ 7 ] is a further development of SCIM III. SCIM IV was developed based on the limitations found in the psychometric properties of SCIM III and feedback of staff members and international experts. SCIM IV was developed to focus on assessing specific patient conditions or situations that SCIM III did not address and thereby provide more accurate definitions of certain scoring alternatives [ 7 ]. SCIM IV has been shown to be valid and reliable in an international multicenter study with satisfying psychometric properties [ 7 ]. To enable people with SCI to evaluate their physical independence and facilitate data collection in community settings, a self-report version of SCIM III (SCIM-SR) has also been developed [ 8 ]. As SCIM IV and SCIM-SR are being translated and used in different rehabilitation settings, further testing is needed. The World Health Organization (WHO) and the International Spinal Cord Society (ISCoS) have underscored the need for more robust, comprehensive and internationally comparable data through SCI-specific assessment tools [ 2 ]. This has not been fully feasible in Sweden due to a lack of Swedish versions of internationally used SCI-specific outcome measures. As part of the research project Inter-PEER [ 9 ], the SCIM-SR was translated into Swedish (s-SCIM-SR) through a rigorous process to ensure accurate linguistic translation and cultural adaptation. Psychometric testing of s-SCIM-SR has been conducted in a community-based rehabilitation setting, showing sound psychometric properties [ 10 ]. We have now translated the clinician-administered SCIM IV into Swedish (s-SCIM IV) through a similar process. To our knowledge, there have been no studies testing a translated version of the SCIM IV, and no studies exploring correlations between SCIM IV and SCIM-SR. Thus, the aim of the current study was to evaluate the psychometric properties (data completeness, targeting, internal consistency reliability and convergent validity) of s-SCIM IV and s-SCIM-SR in inpatient and outpatient rehabilitation settings to ensure their usability along the entire hospital-based rehabilitation continuum. METHODS Design This cross-sectional study is part of the pilot phase of the research project STRIVE-SCI (Strengthening the rehabilitation continuum and optimizing the path to regaining a good life following acute SCI) in Sweden. STRIVE-SCI is a national, prospective, multicenter project aiming to generate comprehensive knowledge of patient outcomes, needs and experiences following an acute SCI in Sweden. The project protocol has been approved by the Swedish Ethical Review Authority (dnr 2022-01962-01). The pilot phase was conducted with the aims of testing study procedures and establishing the psychometric properties of the outcome measures that were recently translated into Swedish as part of Inter-PEER and STRIVE-SCI. Participants and procedures Participants in the pilot phase were recruited between November 2022 and December 2023 from 10 clinics representing different regions in Sweden (Skåne, Stockholm, Västerbotten, Värmland, Halland, Östergötland, and Jönköping), providing inpatient and outpatient rehabilitation as well as lifelong follow-up. Three of these healthcare regions (Skåne, Stockholm, Västerbotten) also conduct the national highly specialized initial inpatient rehabilitation (Nationell högspecialiserad vård). Together the clinics represent both densely and sparsely populated geographical areas from the north to the south of Sweden. Inclusion criteria for the pilot phase were: (1) having a SCI (traumatic or non-traumatic); (2) aged ≥ 18 years; (3) adequate cognitive capacity to complete questionnaires; and (4) Swedish speaking. A study coordinator at each participating site approached eligible participants with information about the study and obtained written informed consent prior to inclusion. Data were collected through self-report questionnaires, interviews, and observation. Information about which phase of rehabilitation the participant was undergoing was extracted from the medical record (Table 1). Insert table 1 about here Data collection Sociodemographics and injury characteristics Data on sex, age, education, employment status, marital status, date of injury, cause of injury, neurological level, and completeness according to the International Standards for Neurological Classification of SCI [11], were extracted from medical records and completed by self-report. Spinal Cord Independence Measure (SCIM IV) s-SCIM IV assessments were managed mainly by observation; if direct observation could not be accomplished (e.g., in outpatient settings), assessments were completed through interviews. SCIM IV consists of three subscales: the Self-care subscale comprises items 1–4 (0–20 points), the Respiration and Sphincter Management subscale comprises items 5–8 (0–40 points), and the Mobility subscale comprises items 9–14 (0–40 points). SCIM IV has been found to be valid, reliable and responsive, and can thus be used for clinical and research trials, including international multi-center studies. Scores on group level can be compared with those of SCIM III [7]. Spinal Cord Independence Measure – Self report (SCIM-SR) SCIM-SR is based on SCIM III [8] and consists of the same three subscales as SCIM IV with the same subscale and total score ranges. Sound psychometric properties of the s-SCIM-SR in a community rehabilitation setting were found [10], corroborating results from other international studies [12,13]. Prodinger et al [1] used Rasch analysis to examine the internal construct validity and reliability of the SCIM-SR in a community survey and found that SCIM-SR violated certain assumptions of the Rasch measurement model. Prodinger et al [1] therefore suggested an intermediate solution with anchoring sub-group characteristics on a common testlet and recommended the computation of Rasch transformed SCIM-SR scores. These transformations are only relevant for total scores and not for domain scores. As we are interested in both domain and total scores, we chose not to use that approach in the present study. Data for SCIM-SR were collected through self-reported completion of the questionnaire in paper format. Other outcome measures The generic FIM TM [4] was used to assess the convergent validity of the s-SCIM IV and s-SCIM-SR. FIM TM assessments were performed by observation and/or interview. Translation process of SCIM IV to s-SCIM IV A flow chart of the translation process of SCIM IV to s-SCIM IV can be found in Figure 1. Overall, the expert committee reached consensus on all translated items. Some items rendered discussions about scoring, and the developer was contacted for clarifications. One example was the item 6.6 (“Sufficient bladder emptying (PVR < 100cc) or intermittent self-catheterization; assistance for applying drainage instrument and/or insufficient (<300 cc) bladder filling”) where we found it unclear if “assistance for applying drainage instrument” referred to assistance with catheterization or assistance only for applying an external drainage instrument such as a condom catheter. The latter interpretation was supported by the developer, and this definition was clarified in the Swedish version. The developer also emphasized that observation is preferred, and assumptions should never be used. If observation is not possible, the rater should ask the person or the rehabilitation team about activity performance. In item 9 (Mobility in bed and action to prevent pressure sores), the wording “doing push-ups in the wheelchair” was culturally adapted to fit clinical practice in Sweden and thus replaced by the equivalent phrase “lifting oneself or leaning in the wheelchair for pressure relief”. In the Mobility subscale, the walking aid “rollator” (4-wheeled walker) was added as this is a very common aid in Sweden. Statistical analyses Data completeness To evaluate data completeness, the percentage of missing data for each item, each subscale and the total score was calculated for s-SCIM IV and s-SCIM-SR. Targeting Score distributions and floor and ceiling effects were examined for s-SCIM IV and s-SCIM-SR. Floor and ceiling effects are present if more than 15% of participants achieve the lowest or highest score [14]. Internal consistency reliability Internal consistency reliability was evaluated by using the Cronbach´s alpha coefficient for the full scale and each subscale for s-SCIM IV and s-SCIM-SR. Cronbach´s alpha should be between 0.70 and 0.95 for the scale to be considered internally consistent [14]. Validity Convergent validity was evaluated by correlation analyses (Spearman’s rho; r s ) between the different subscale scores in s-SCIM IV and s-SCIM-SR, and between the total score of s-SCIM IV, s-SCIM-SR, and FIM TM . The level of significance used was p < 0.05. For testing correlations of subscales in s-SCIM IV and s-SCIM-SR in relation to FIM TM , FIM TM items A-M were divided into subscales matching those of SCIM; items A-E correspond to self-care, item F “Toileting” which according to FIM is part of self-care, was grouped with item G “Bladder” and H “Bowel” to better match the subscale Respiration and Sphincter Management in SCIM. All analyses were carried out using IBM Statistics SPSS version 29. RESULTS Sociodemographic and injury characteristics Table 2 shows the 101 participants’ sociodemographics and injury characteristics. A large majority of the participants were men (82%) and the median time since injury was 2 years, with a range of 0-54 years. Approximately 64% had been living with SCI for less than 5 years. A majority (66%) had a traumatic lesion, and 44% had AIS D. Insert Table 2 around here The Swedish version of the Spinal Cord Independence Measure (s-SCIM IV) Scoring The mean (SD; min-max) total score was 54 (27; 0-100). Table 3 shows the total and subscale scores of SCIM IV and SCIM-SR. Insert Table 3 around here Data completeness There were no missing data for s-SCIM IV. Targeting The score covered the full possible range in both total score and all subscales (Table 4). Ratings of the lowest possible score were observed in both the total score (1%, n=1) and the subscales; Self-care 4% (n=4), Respiration and Sphincter Management 2% (n=2), and Mobility 6% (n=6). Ratings of the highest possible score were noted in all subscales; 9% (n=9) for Self-care, 9% (n=9) for Respiration and Sphincter Management and 8% (n=8) for Mobility. One participant achieved the highest possible total score. Internal consistency reliability The Cronbach´s alpha coefficient for the full scale was 0.91, for Self-care 0.93, for Respiration and Sphincter Management 0.68, and for Mobility 0.92. The Swedish version of the Spinal Cord Independence Measure – Self report (s-SCIM-SR) Scoring The mean (SD; min-max) total score was 55 (26; 5–100), see Table 3. Data completeness Ninety-tree participants (92%) had answered all items in the s-SCIM-SR. Some missing data were found in two of the three subscales, with response rates of 95% (Respiration and Sphincter) and 97% (Mobility). Targeting The total score ranged from 5 to 100 (full range: 0-100), with full range in both Self-care (0-20) and Mobility (0-40), whereas Respiration and Sphincter Management ranged from 5-40 (full range: 0-40) (Table 4). Ratings of the lowest possible score were observed in Self-care 6% (n=6) and Mobility 4% (n=4). Ratings of the highest possible score were noted in all subscales; 13% (n=13) for Self-care, 8% (n=8) for Respiration and Sphincter Management and 9% (n=9) for Mobility. One participant rated the highest possible score on the total score. Internal consistency reliability The Cronbach´s alpha coefficient for the full scale was 0.91, for Self-care 0.93, for Respiration and Sphincter Management 0.62 and for Mobility 0.90. Validity for s-SCIM IV and s-SCIM-SR All correlations are presented in Supplementary table. There were strong positive correlations between the corresponding subscales in s-SCIM IV and s-SCIM-SR; Self-care r s =0.92, p<0.001, Respiration and Sphincter Management r s =0.88, p<0.001, and Mobility r s =0.96, p<0.001. Further, there was a strong positive correlation between the total score of s-SCIM IV and s-SCIM-SR (r s =0.96, p< 0.001). A strong positive correlation was also found between the FIM TM total score and s-SCIM IV (r s =0.89, p< 0.001) and s-SCIM-SR (r s =0.89, p< 0.001) total scores. Using FIM TM subscale A-M, including self-care, bladder and bowel care together with mobility, and thus excluding five items for communication and social cognition, the correlation was similar (r s =0.90, p< 0.001 for s-SCIM IV and r s =0.89, p< 0.001 for s-SCIM-SR). FIM TM Self-care (items A-E), FIM TM Sphincter control (items F-H) and FIM TM Mobility (items I-M) were positively correlated with the corresponding subscales of s-SCIM IV and s-SCIM-SR (r s =0.79 to 0.94, p< 0.001). DISCUSSION This study examines the psychometric properties of the Swedish version of SCIM IV and SCIM-SR in inpatient and outpatient rehabilitation settings to ensure their usability along the entire hospital-based rehabilitation continuum. The translation and adaptation process of the English versions of the SCIM IV and SCIM-SR into Swedish resulted in minor clarifications and cultural adaptations. There were few missing data and no observed ceiling or floor effects. The internal consistency was generally high, although the subscale Respiration and Sphincter management exhibited lower Cronbach’s alpha values compared to the other subscales. Expected positive correlations between the two translated scales as well as with the FIM™, support the convergent validity of s-SCIM IV and s-SCIM-SR. Study participants and translation process The sample size of 101 participants is greater or similar to that of previously published studies of the psychometric properties of SCIM III and SCIM-SR [ 12 , 15 , 16 ]. Participants in the present study represented men and women, a wide range of ages (22–86 years) and duration of SCI (0–54 years), traumatic and non-traumatic injuries, and most levels and severities of injury. This, in combination with including participants undergoing different types of rehabilitation, provided a solid ground for our analyses. The translation process was performed according to established guidelines [ 17 , 18 , 19 ] and included persons with SCI, clinicians and researchers. Both for self-reported and clinician-administered outcome measures, the items need to be clear and easy to understand to minimize misinterpretations as well as respondent and clinician burden. During discussions in the expert committee, we identified a need for clarification on how to score some items and contacted the developer. After reaching consensus, we developed a workshop for clinicians on how to administer and score s-SCIM IV, following recommendations proposed by Liu et al [ 20 ]. This workshop has been delivered on several occasions and is continuously being provided to clinicians using the outcome measure in their practice and/or for research purposes. Scoring, data completeness and targeting For s-SCIM IV, the participants in the present study scored lower on all subscales when compared to a Swedish sample of older adults with long-term SCI assessed with s-SCIM III [ 21 ]. The sample in Waller et al [ 21 ] consisted of more individuals with AIS D injuries, which likely explains the differences. Similar results emerged for s-SCIM-SR when comparing the present study sample with participants and peer mentors in a community-based rehabilitation programme [ 10 ]. As the sample in the present study had a median age of 62 years and almost half of them were undergoing inpatient rehabilitation, a greater level of independence in the community-based, younger (median age 41 years) sample could be expected. A comprehensive study by Catz et al [ 7 ] demonstrated higher scores at discharge from inpatient rehabilitation compared to admission, which further supports this reasoning. For the subscale Respiration and Sphincter management, the sample in the present study reported a comparable level of independence as the community sample in Jörgensen et al [ 10 ]. Possibly, a high level of independence and/or functioning in respiration and sphincter management is reached during inpatient rehabilitation as these are focus areas during this rehabilitation phase. Moreover, the present study did not include persons with motor complete injuries, neurological level C1-C4 who generally have low scores on the subscale Respiration and Sphincter Management. Persons sustaining motor complete high-level injuries in Sweden are initially admitted to dedicated units. These units were not included in this study. We observed slightly higher scores (although not statistically confirmed) on the s-SCIM-SR as compared to the s-SCIM IV, throughout all subscales. Similar results were found by Fekete et al [ 8 ] whereas Wang et al [ 22 ] found the opposite. It may be that the participants’ feelings about their disability can cause an underestimation or overestimation of functional independence. Nevertheless, we do not expect these small differences to affect the overall performance of the outcome measures. There were no missing data for the s-SCIM IV, indicating no systematic difficulties in understanding the items or assessing the participants. Most data collectors had participated in the workshop, which might have reduced the risk of missing data and promoted uniform scoring. Missing data were expected for the self-report version as study participants, in general, are less knowledgeable about the limits of missing data as trained data collectors or researchers and may not be as persistent in completing a questionnaire. However, the data collectors were instructed to carefully check the participants’ answers and approach them again if data were missing. Furthermore, based on lessons learned from Inter-PEER [ 9 ], data collectors offered guidance to respondents if they had difficulties understanding any item. This probably contributed to few missing data for the s-SCIM-SR. The missing data were primarily found in the subscale Respiration and Sphincter Management which might reflect privacy issues with sharing bowel and bladder functioning and management [ 8 ]. Internal consistency reliability All subscales, except Respiration and Sphincter Management, showed excellent internal consistency, corroborating previous results from Jörgensen et al [ 10 ] and others [ 7 ]. The Cronbach’s alpha for the Respiration and Sphincter Management subscale in the present study is very similar (0.68 vs 0.65) to the value obtained in a large international study conducted by the developers [ 7 ], supporting the accuracy of our Swedish version. Furthermore, the lower internal consistency of this subscale was also found in different versions of the SCIM [ 7 , 22 – 24 ]. One explanation may be that, apart from the correlation between items in a subscale, also the number of items affects Cronbach’s alpha [ 25 ]. The Respiration and Sphincter Management subscale includes fewer items than the other subscales which may contribute to the lower alpha value. The items in this subscale also assess separate areas (i.e., respiration, bowel and bladder management) that are grouped together and contain an assessment of both independence/activity performance and body functions (e.g., “Bowel movements at desired timing, without assistance; no mishaps”), which can all contribute to the low correlation between items. Validity The self-report version and the clinician administered Swedish versions of SCIM were highly correlated, supporting the convergent validity. Similar results were obtained by the developer of SCIM-SR, although showing slightly lower correlation coefficients than in the present study [ 8 ]. Fekete et al [ 8 ] used the Pearson correlation coefficient which might contribute to these small differences. We also found high correlations between SCIM and FIM™, indicating that both scales can assess functional independence in persons with SCI, although the SCIM has been shown to be more responsive to changes in persons with SCI [ 23 , 26 ]. Removing the items in FIM™ related to communication and cognition, which are usually not affected in persons with SCI, did not change the strength of the correlation. A resulting weaker correlation would have been problematic as the items in FIM™ explicitly assessing independence are expected to correlate highly with SCIM. There were also strong correlations between the different subscales of s-SCIM IV and s-SCIM-SR and the corresponding subscales of the FIM™. Thus, our results further support the convergent validity of the s-SCIM IV and s-SCIM-SR. Strengths and limitations The study has several strengths, such as a heterogeneous population, a large proportion of AIS D similar to contemporary epidemiological data in Sweden [ 27 ], a relatively large study sample, few missing data and a thorough translation procedure. The inclusion of ten SCI units for data collection is also a strength, as the study sample represents regional diversity in Sweden. Many persons collecting data could imply a limitation due to the risks of misinterpretations and differences in scoring. However, we believe that delivering the workshop on SCIM assessment has reduced such potential bias. Moreover, the professionals collecting data have much experience in assessing persons with SCI using FIM™ and the strong correlation between FIM™ and s-SCIM IV confirm the accuracy of the SCIM assessment. An observed limitation is that there were only 18% women in the study sample. About one third of those sustaining an SCI in Sweden are women [ 27 ] and a more even sex distribution would have been preferred for the psychometric testing. Individuals with the most severe injuries (motor-complete injuries, neurological level C1-C4) were not represented in our sample as these injuries occur less frequently and the units providing initial rehabilitation for these injuries did not participate. Nevertheless, participants did score along the full range of the scales. Conclusions The results support the data completeness, targeting, internal consistency reliability and convergent validity of s-SCIM IV and s-SCIM-SR. These outcomes measures can thus be considered suitable to assess physical independence in inpatient and outpatient rehabilitation and long-term follow-up after SCI, for both clinical and research purposes. The similar results for s-SCIM-SR in hospital-based and community rehabilitation settings also support the usefulness of this outcome measure along the full rehabilitation continuum. The available and psychometrically sound Swedish versions will now enable a uniform national assessment of SCI-specific physical independence and facilitate research and international collaborations and comparisons. Declarations DATA AVAILABILITY/ARCHIVING Data can be shared upon reasonable request to the corresponding author. CONFLICT OF INTEREST The authors declare no conflict of interest. ACKNOWLEDGEMENTS We are grateful to all participating persons with SCI and the staff members who were involved in the data collection at the different clinics. We acknowledge Klas Hedlund for support with building and maintaining the project specific REDCap platform. We are grateful to all members of the translation process, i.e., co-authors SJ, AD, EBF, TH, UA, JW, MW, RL, CH, EB, as well as Lamprini Lili (LL) (University of Gothenburg/Sahlgrenska University Hospital) and Inka Löfvenmark (IL) (Karolinska Institutet, Spinalis Foundation). AUTHOR CONTRIBUTIONS STRIVE-SCI was initiated and designed by AD (PI) and SJ (co-PI), in collaboration with EBF, PF, RL and WA. VW, AO, FT, Ks and MM were the study coordinators at their respective units. SJ, AD, UL, LH, EBF, TH, JW, MW, RL, CH and EB were involved in the translation process. UA drafted the first version of the manuscript in close collaboration with SJ and AD. UA performed the statistical analyses with support from AD. EBF, PF, RL, LH and WA contributed to the interpretation of findings and critically reviewed a late draft of the manuscript. All authors have subsequently critically reviewed the manuscript, provided feedback and approved the final version. FUNDING This study was funded by FORSS (Research Council of Southeast Sweden), Promobilia Foundation, the Research Fund of Neuro Sweden and Norrbacka-Eugenia Foundation and in part by the Lund University and Skåne University Hospital (ALF agreement). ETHICAL APPROVAL All participants received written and verbal information about the study, and all gave their written informed consent before enrolment. Ethical Approval was provided by the Swedish Ethical Review Authority (number 2022-01962-01). The Declaration of Helsinki for research on humans was followed throughout the research process. COMPETING INTERESTS The authors declare no competing interests. STRIVE-SCI Consortium (in alphabetical order) Ulrica Antepohl 1 , Wolfram Antepohl 1 , Erik Berndtsson 6,7 , Emelie Butler Forslund 2,3 , Anestis Divanoglou 1 , Peter Flank 4 , Lisa Holmlund 2 , Tobias Holmlund 2 , Xiaolei Hu 4 , Claes Hultling 2 , Sophie Jörgensen 5,6 , Richard Levi 1 , Jan Lexell 5,8 , Maria Moschovou 1 , Anna Olsson 9 , Nora Sandholdt 10,11 , Kristina Skill 1 , Filip Tööj 6 , Kerstin Wahman 2,12 , Mikael Waller 5,13 , Johanna Wangdell 11, 14 , Veronika Wiebols 15 , Gunilla Åhrén 11,16 , Elisabet Åkesson 2,17 Affiliations 1. Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden 2. Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden 3. Division of Clinical Geriatrics, Aleris Rehab Station, Stockholm, Sweden 4. Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Sweden 5. Department of Health Sciences, Lund University, Lund, Sweden 6. Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden 7. RG Aktiv Rehabilitering, Sweden 8. Department of Rehabilitation, Ängelholm Hospital, Ängelholm, Sweden 9. Frykcenter Rehabilitering, Torsby, Sweden 10. Department of Improvement and Innovation, Region Östergötland, Linköping, Sweden 11. Gothenburg Competence Center for SCI, University of Gothenburg, Sweden 12. Aleris Rehab Station Stockholm Research and Development Unit, Stockholm, Sweden 13. Department of Rehabilitation Medicine, Sunderby Hospital, Luleå, Sweden 14. Sahlgrenska University Hospital, Gothenburg, Sweden. 15. Department of Rehabilitation Medicine, Halland hospital, Halmstad, Sweden 16. Swedish Association for Survivors of Accident and Injury (RTP) 17. R&D unit, Stockholms Sjukhem, Stockholm, Sweden References Prodinger B, Ballert CS, Brinkhof MW, Tennant A, Post MW. 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Adaptation and validation of the Spanish self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2015;53(6):451-454. https://doi.org/10.1038/sc.2014.225. Tongprasert S, Wongpakaran T, Soonthornthum C. Validation of the Thai version of the spinal cord independence measure self-report (SCIM-SR-Thai). Spinal Cord. 2022;60:361–367. https://doi.org/10.1038/s41393-022-00779-w. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42. https://doi.org/10.1016/j.jclinepi.2006.03.012. Cho DY, Shin HI, Kim HR, Lee BS, Kim GR, Leigh JH, et al. Reliability and validity of the Korean version of the spinal cord independence measure III. Am J Phys Med Rehabil. 2020;99(4),305-309. https://doi.org/10.1097/phm.0000000000001327. Zarco-Periñan MJ, Barrera-Chacón MJ, García-Obrero I, Mendez-Ferrer JB, Alarcon LE, Echevarria-Ruiz de Vargas C. Development of the Spanish version of the spinal cord independence measure version III: cross-cultural adaptation and reliability and validity study. Disabil Rehabil, 2014;36(19):1644-1651. https://doi.org/10.3109/09638288.2013.864713. Biering-Sørensen F, Charlifue S, Chen Y, New PW, Noonan V, Post M, et al. International spinal cord injury core data set (version 3.0)-including standardization of reporting. Spinal Cord. 2023;61(1):65-68. https://doi.org/10.1038/s41393-022-00862-2. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000 Dec 15;25(24):3186-3191. Epstein J, Osborne RH, Elsworth GR, Beaton DE, Guillemin F. Cross-cultural adaptation of the health education impact questionnaire: experimental study showed expert committee, not back-translation, added value. J Clin Epidemiol 2015; 68:360–369. https://doi.org/10.1016/j.jclinepi.2013.07.013. Liu N, Xing H, Zhou M, Biering-Sørensen F. Lack of knowledge and training are the major obstacles in application of the spinal cord independence measure (SCIM) in China. J Spinal Cord Med. 2019;42(4):437-443. https://doi.org/10.1080/10790268.2018.1454021. Waller M, Jörgensen S, Lexell J. Changes over 6 years in secondary health conditions and activity limitations in older adults aging with long-term spinal cord injury. PM&R. 2023;15(2):157-167. https://doi.org/10.1002/pmrj.12776. Wang T, Tang J, Xie S, He X, Wang Y, Liu T, et al. Translation and validation of the Chinese version of the spinal cord independence measure (SCIM III) self-report. Spinal Cord. 2021;59(10):1045-1052. https://doi.org/10.1038/s41393-020-00601-5. Glass CA, Tesio L, Itzkovich M, Soni BM, Silva P, Mecci M, et al. Spinal cord independence measure, version III: applicability to the UK spinal cord injured population. J Rehabil Med. 2009;41(9),723-728. https://doi.org/10.2340/16501977-0398. Unalan H, Misirlioglu TO, Erhan B, Akyuz M, Gunduz B, Irgi E, et al. Validity and reliability study of the Turkish version of spinal cord independence measure-III. Spinal Cord. 2015;53(6):455-460. https://doi.org/10.1038/sc.2014.249. Streiner DL. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess. 2003;80(1):99-103. https://doi.org/10.1207/s15327752jpa8001_18. Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, et al. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil, 2007;29(24):1926-1933. https://doi.org/10.1080/09638280601046302. Josefson C, Rekand T, Lundgren-Nilsson Å, Sunnerhagen KS. Epidemiology of spinal cord injury in adults in Sweden, 2016–2020: A retrospective registry-based study. Neuroepidemiology. 2024; https://doi.org/10.1159/000540818. Moschovou M, Antepohl W, Halvorsen A, Pettersen AL, Divanoglou A. Temporal changes in demographic and injury characteristics of traumatic spinal cord injuries in Nordic countries - a systematic review with meta-analysis. Spinal Cord, 2022; 60(9):765-773. https://doi.org/10.1038/s41393-022-00772-3 Tables Table 1. Participant distribution across different phases of rehabilitation Phase of rehabilitation n (%) Inpatient rehabilitation* 43 (42.5) Outpatient rehabilitation* 17 (16.9) Clinical appointment 19 (18.8) Follow-up visit/Annual check-up 17 (16.8) Other** 5 (5.0) * Includes both primary and secondary rehabilitation; ** Not specified Table 2. Sociodemographics and injury characteristics of the participants (n=101) Sex, n (%) Men 83 (82%) Women 18 (18%) Age, median (IQR) [min-max], years 62.0 (23) [22-86] Time since injury, median (IQR) [min-max], n (%) 2.0 (8) [0-54] <1 year 27 (27%) 1-4 years 38 (38%) 5-9 years 16 (16%) 10-19 years 9 (9%) 20-29 years 2 (2%) 30-39 years 4 (4%) 40-54 years 5 (5%) Cause of injury, (missing=1), n (%) Traumatic 66 (66%) Non-traumatic 34 (34%) Level and severity of injury (missing=1), n (%) C1-4; AIS A, B, and C 25 (25%) C5-8; AIS A, B, and C 6 (6%) T1-S3; AIS A, B, and C 25 (25%) AIS D at any neurological level of injury 44 (44%) Main mode of mobility, n (%) Manual Wheelchair 67 (66%) Power wheelchair 8 (8%) Walking device (e.g. crutches, walking frame) 12 (12%) No assistive devices 14 (14%) Education, n (%) Elementary school (9 years) 18 (18%) Gymnasium/Vocational training (12 years) 52 (52%) University 28 (28%) Other 3 (3%) *Several options where possible to choose for each participant Table 3. Total and subscale scores of s-SCIM IV and s-SCIM-SR Total score (0-100) Subscale Self-care (0-20) Subscale Respiration & Sphincter Management (0-40) Subscale Mobility (0-40) s-SCIM IV s-SCIM SR s-SCIM IV s-SCIM SR s-SCIM IV s-SCIM SR s-SCIM IV s-SCIM SR Total, n (%) 101 (100) 93 (92) 101 (100) 101 (100) 101 (100) 96 (95) 101 (100) 98 (97) Missing, n (%) 0 (0) 8 (8) 0 (0) 0 (0) 0 (0) 5 (5) 0 (0) 3 (3) Mean (s.d.) 53.67 (26.9) 54.97 (26.2) 11.87 (6.6) 12.39 (6.9) 25.81 (10.4) 26.22 (9.7) 15.99 (12.6) 16.98 (12.4) Median 59.0 59.0 14.0 15.0 27.0 27.0 15.0 16.0 IQR 43.5 44.0 12.5 13.0 18.0 18.0 18.0 18.2 Range scoring (min-max) 0-100 5-100 0-20 0-20 0-40 5-40 0-40 0-40 IQR: Inter-quartile range Additional Declarations There is no duality of interest Supplementary Files SupplementaryTable.docx Cite Share Download PDF Status: Published Journal Publication published 22 Jan, 2026 Read the published version in Spinal Cord → Version 1 posted Editorial decision: revise 09 Apr, 2025 Review # 2 received at journal 06 Mar, 2025 Reviewer # 2 agreed at journal 17 Feb, 2025 Review # 1 received at journal 15 Feb, 2025 Reviewer # 1 agreed at journal 11 Feb, 2025 Reviewers invited by journal 11 Feb, 2025 Submission checks completed at journal 10 Feb, 2025 First submitted to journal 07 Feb, 2025 Unknown event 05 Feb, 2025 Editor assigned by journal 03 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5949503","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":414152144,"identity":"d5c3d589-f730-4e65-9d1c-d336aab26919","order_by":0,"name":"Sophie 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Institutet","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Holmlund","suffix":""},{"id":414152149,"identity":"12364617-4481-411d-9d75-6b80011245b8","order_by":5,"name":"Wolfram Antepohl","email":"","orcid":"https://orcid.org/0000-0003-3209-2707","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Wolfram","middleName":"","lastName":"Antepohl","suffix":""},{"id":414152150,"identity":"dadc5033-31b1-4d40-82b2-58606ede89ae","order_by":6,"name":"Richard Levi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"","lastName":"Levi","suffix":""},{"id":414152151,"identity":"9f7e2aa9-f30e-481a-9afa-d4931dc7ccbf","order_by":7,"name":"STRIVE-SCI Consortium STRIVE-SCI Consortium","email":"","orcid":"","institution":"Lund University/Skåne University Hospital","correspondingAuthor":false,"prefix":"","firstName":"STRIVE-SCI","middleName":"Consortium STRIVE-SCI","lastName":"Consortium","suffix":""},{"id":414152152,"identity":"32e4facf-05e2-423d-b88f-b8642b3a8c2c","order_by":8,"name":"Anestis Divanoglou","email":"","orcid":"https://orcid.org/0000-0001-7376-6793","institution":"Linköping University","correspondingAuthor":false,"prefix":"","firstName":"Anestis","middleName":"","lastName":"Divanoglou","suffix":""}],"badges":[],"createdAt":"2025-02-03 08:35:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5949503/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5949503/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41393-026-01168-3","type":"published","date":"2026-01-22T05:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":78751868,"identity":"73652b6d-2f57-4af7-af5c-4cccd70e2c56","added_by":"auto","created_at":"2025-03-18 11:59:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":183530,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTranslation process of\u003c/strong\u003e\u003cem\u003e \u003c/em\u003e\u003cstrong\u003eSCIM IV to s-SCIM IV\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Antepohletalfigure.png","url":"https://assets-eu.researchsquare.com/files/rs-5949503/v1/981d571329ad3a2458d06b25.png"},{"id":100960005,"identity":"1e0fc597-b856-47ac-bda2-22e62f2b1f26","added_by":"auto","created_at":"2026-01-23 08:21:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1145040,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5949503/v1/02bacfd8-4812-4bd0-b5a5-153ba368bfdc.pdf"},{"id":78752374,"identity":"745fa80b-0370-4504-a214-16717c7231c9","added_by":"auto","created_at":"2025-03-18 12:07:36","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19226,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-5949503/v1/e33d81d1cf1e81d0f9f3343a.docx"}],"financialInterests":"There is no duality of interest","formattedTitle":"Psychometric properties of the Swedish versions of Spinal Cord Independence Measure IV (SCIM IV) and Self-report (SCIM-SR) in inpatient and outpatient rehabilitation settings","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTo assess the outcome of interventions and to monitor improvements, valid and reliable outcome measures that evaluate functioning and disability over time after spinal cord injury (SCI) are needed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], in inpatient and community rehabilitation settings. Thereby, there is a need for international translations and validation studies of SCI-specific outcome measures to facilitate both comparison and pooling of international data as well as to allow for multi-center studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Such psychometric studies are particularly important for ensuring that outcome measures are culturally and linguistically appropriate for different populations and contexts.\u003c/p\u003e \u003cp\u003eThe Spinal Cord Independence Measure (SCIM) was developed as a comprehensive clinician-administered assessment to evaluate the performance of daily activities in individuals with SCI [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It comprises three subscales: Self-care, Sphincter and respiratory management, and Mobility [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The total score ranges from 0-100 where higher scores indicate greater functional capacity and greater physical independence. The agreement with the generic Functional Independence Measure (FIM\u0026trade;) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] is high, but the SCIM has been found to be more sensitive to changes in function after SCI [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. SCIM has become a standard outcome measure in clinical practice and clinical studies worldwide [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most recent version, SCIM IV [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] is a further development of SCIM III. SCIM IV was developed based on the limitations found in the psychometric properties of SCIM III and feedback of staff members and international experts. SCIM IV was developed to focus on assessing specific patient conditions or situations that SCIM III did not address and thereby provide more accurate definitions of certain scoring alternatives [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. SCIM IV has been shown to be valid and reliable in an international multicenter study with satisfying psychometric properties [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. To enable people with SCI to evaluate their physical independence and facilitate data collection in community settings, a self-report version of SCIM III (SCIM-SR) has also been developed [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. As SCIM IV and SCIM-SR are being translated and used in different rehabilitation settings, further testing is needed.\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) and the International Spinal Cord Society (ISCoS) have underscored the need for more robust, comprehensive and internationally comparable data through SCI-specific assessment tools [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This has not been fully feasible in Sweden due to a lack of Swedish versions of internationally used SCI-specific outcome measures. As part of the research project Inter-PEER [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the SCIM-SR was translated into Swedish (s-SCIM-SR) through a rigorous process to ensure accurate linguistic translation and cultural adaptation. Psychometric testing of s-SCIM-SR has been conducted in a community-based rehabilitation setting, showing sound psychometric properties [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. We have now translated the clinician-administered SCIM IV into Swedish (s-SCIM IV) through a similar process. To our knowledge, there have been no studies testing a translated version of the SCIM IV, and no studies exploring correlations between SCIM IV and SCIM-SR.\u003c/p\u003e \u003cp\u003eThus, the aim of the current study was to evaluate the psychometric properties (data completeness, targeting, internal consistency reliability and convergent validity) of s-SCIM IV and s-SCIM-SR in inpatient and outpatient rehabilitation settings to ensure their usability along the entire hospital-based rehabilitation continuum.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eDesign\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study is part of the pilot phase of the research project STRIVE-SCI (Strengthening the rehabilitation continuum and optimizing the path to regaining a good life following acute SCI) in Sweden. STRIVE-SCI is a national, prospective, multicenter project aiming to generate comprehensive knowledge of patient outcomes, needs and experiences following an acute SCI in Sweden. The project protocol has been approved by the Swedish Ethical Review Authority (dnr 2022-01962-01). The pilot phase was conducted with the aims of testing study procedures and establishing the psychometric properties of the outcome measures that were recently translated into Swedish as part of Inter-PEER and STRIVE-SCI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in the pilot phase were recruited between November 2022 and December 2023 from 10 clinics representing different regions in Sweden (Sk\u0026aring;ne, Stockholm, V\u0026auml;sterbotten, V\u0026auml;rmland, Halland, \u0026Ouml;sterg\u0026ouml;tland, and J\u0026ouml;nk\u0026ouml;ping), providing inpatient and outpatient rehabilitation as well as lifelong follow-up. Three of these healthcare regions (Sk\u0026aring;ne, Stockholm, V\u0026auml;sterbotten) also conduct the national highly specialized initial inpatient rehabilitation (Nationell h\u0026ouml;gspecialiserad v\u0026aring;rd). Together the clinics represent both densely and sparsely populated geographical areas from the north to the south of Sweden. Inclusion criteria for the pilot phase were: (1) having a SCI (traumatic or non-traumatic); (2) aged \u0026ge; 18 years; (3) adequate cognitive capacity to complete questionnaires; and (4) Swedish speaking. A study coordinator at each participating site approached eligible participants with information about the study and obtained written informed consent prior to inclusion. Data were collected through self-report questionnaires, interviews, and observation. Information about which phase of rehabilitation the participant was undergoing was extracted from the medical record (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert table 1 about here\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSociodemographics and injury characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData on sex, age, education, employment status, marital status, date of injury, cause of injury, neurological level, and completeness according to the International Standards for Neurological Classification of SCI [11], were extracted from medical records and completed by self-report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSpinal Cord Independence Measure (SCIM IV)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003es-SCIM IV assessments were managed mainly by observation; if direct observation could not be accomplished (e.g., in outpatient settings), assessments were completed through interviews.\u0026nbsp;SCIM IV consists of three subscales: the Self-care subscale comprises items 1\u0026ndash;4 (0\u0026ndash;20 points), the Respiration and Sphincter Management subscale comprises items 5\u0026ndash;8 (0\u0026ndash;40 points), and the Mobility subscale comprises items 9\u0026ndash;14 (0\u0026ndash;40 points). SCIM IV has been found to be valid, reliable and responsive, and can thus be used for clinical and research trials, including international multi-center studies. Scores on group level can be compared with those of SCIM III [7].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSpinal Cord Independence Measure \u0026ndash; Self report (SCIM-SR)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSCIM-SR is based on SCIM III [8] and consists of the same three subscales as SCIM IV with the same subscale and total score ranges. Sound psychometric properties of the s-SCIM-SR in a community rehabilitation setting were found\u0026nbsp;[10], corroborating results from other international studies [12,13]. Prodinger et al [1] used Rasch analysis to examine the internal construct validity and reliability of the SCIM-SR in a community survey and found that SCIM-SR violated certain assumptions of the Rasch measurement model. Prodinger et al [1] therefore suggested an intermediate solution with anchoring sub-group characteristics on a common testlet and recommended the computation of Rasch transformed SCIM-SR scores. These transformations are only relevant for total scores and not for domain scores. As we are interested in both domain and total scores, we chose not to use that approach in the present study. Data for SCIM-SR were collected through self-reported completion of the questionnaire in paper format.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOther outcome measures\u003c/em\u003e\u003cu\u003e\u003cbr\u003e\u003c/u\u003eThe generic FIM\u003csup\u003eTM\u003c/sup\u003e [4] was used to assess the convergent validity of the s-SCIM IV and s-SCIM-SR. FIM\u003csup\u003eTM\u003c/sup\u003e assessments were performed by observation and/or interview.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Translation process of\u003c/strong\u003e\u003cstrong\u003eSCIM IV to s-SCIM IV\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA flow chart of the translation process of SCIM IV to s-SCIM IV can be found in Figure 1. Overall, the expert committee reached consensus on all translated items. Some items rendered discussions about scoring, and the developer was contacted for clarifications. One example was the item 6.6 (\u0026ldquo;Sufficient bladder emptying (PVR \u0026lt; 100cc) or intermittent self-catheterization; assistance for applying drainage instrument and/or insufficient (\u0026lt;300 cc) bladder filling\u0026rdquo;) where we found it unclear if \u0026ldquo;assistance for applying drainage instrument\u0026rdquo; referred to assistance with catheterization or assistance only for applying an external drainage instrument such as a condom catheter. The latter interpretation was supported by the developer, and this definition was clarified in the Swedish version. The developer also emphasized that observation is preferred, and assumptions should never be used. If observation is not possible, the rater should ask the person or the rehabilitation team about activity performance. In item 9 (Mobility in bed and action to prevent pressure sores), the wording \u0026ldquo;doing push-ups in the wheelchair\u0026rdquo; was culturally adapted to fit clinical practice in Sweden and thus replaced by the equivalent phrase \u0026ldquo;lifting oneself or leaning in the wheelchair for pressure relief\u0026rdquo;. In the Mobility subscale, the walking aid \u003cem\u003e\u0026ldquo;rollator\u0026rdquo;\u003c/em\u003e (4-wheeled walker) was added as this is a very common aid in Sweden.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analyses\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData completeness\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo evaluate data completeness, the percentage of missing data for each item, each subscale and the total score was calculated for s-SCIM IV and s-SCIM-SR.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTargeting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eScore distributions and floor and ceiling effects were examined for s-SCIM IV and s-SCIM-SR. Floor and ceiling effects are present if more than 15% of participants achieve the lowest or highest score [14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInternal consistency reliability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInternal consistency reliability was evaluated by using the Cronbach\u0026acute;s alpha coefficient for the full scale and each subscale for s-SCIM IV and s-SCIM-SR. Cronbach\u0026acute;s alpha should be between 0.70 and 0.95 for the scale to be considered internally consistent [14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eValidity\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConvergent validity was evaluated by correlation analyses (Spearman\u0026rsquo;s rho; r\u003csub\u003es\u003c/sub\u003e) between the different subscale scores in s-SCIM IV and s-SCIM-SR, and between the total score of s-SCIM IV, s-SCIM-SR, and FIM\u003csup\u003eTM\u003c/sup\u003e.\u0026nbsp;The level of significance used was p \u0026lt; 0.05. For testing correlations of subscales in s-SCIM IV and s-SCIM-SR in relation to FIM\u003csup\u003eTM\u003c/sup\u003e, FIM\u003csup\u003eTM\u003c/sup\u003e items A-M were divided into subscales matching those of SCIM; items A-E correspond to self-care, item F \u0026ldquo;Toileting\u0026rdquo; which according to FIM is part of self-care, was grouped with item G \u0026ldquo;Bladder\u0026rdquo; and H \u0026ldquo;Bowel\u0026rdquo; to better match the subscale Respiration and Sphincter Management in SCIM. All analyses were carried out using IBM Statistics SPSS version 29.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic and injury characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the 101 participants’ sociodemographics and injury characteristics. A large majority of the participants were men (82%) and the median time since injury was 2 years, with a range of 0-54 years. Approximately 64% had been living with SCI for less than 5 years. A majority (66%) had a traumatic lesion, and 44% had AIS D.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 2 around here\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Swedish version of the Spinal Cord Independence Measure (s-SCIM IV)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eScoring\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe mean (SD; min-max) total score was 54 (27; 0-100). Table 3 shows the total and subscale scores of SCIM IV and SCIM-SR.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 3 around here\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData completeness\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere were no missing data for s-SCIM IV.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTargeting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe score covered the full possible range in both total score and all subscales (Table 4). Ratings of the lowest possible score were observed in both the total score (1%, n=1) and the subscales; Self-care 4% (n=4), Respiration and Sphincter Management 2% (n=2), and Mobility 6% (n=6). Ratings of the highest possible score were noted in all subscales; 9% (n=9) for Self-care, 9% (n=9) for Respiration and Sphincter Management and 8% (n=8) for Mobility. One participant achieved the highest possible total score.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cbr\u003e\u0026nbsp;Internal consistency reliability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Cronbach´s alpha coefficient for the full scale was 0.91, for Self-care 0.93, for Respiration and Sphincter Management 0.68, and for Mobility 0.92.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;The Swedish version of the Spinal Cord Independence Measure – Self report (s-SCIM-SR)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eScoring\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe mean (SD; min-max) total score was 55 (26; 5–100), see Table 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData completeness\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNinety-tree participants (92%) had answered all items in the s-SCIM-SR. Some missing data were found in two of the three subscales, with response rates of 95% (Respiration and Sphincter) and 97% (Mobility).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTargeting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe total score ranged from 5 to 100 (full range: 0-100), with full range in both Self-care (0-20) and Mobility (0-40), whereas Respiration and Sphincter Management ranged from 5-40 (full range: 0-40) (Table 4). Ratings of the lowest possible score were observed in Self-care 6% (n=6) and Mobility 4% (n=4). Ratings of the highest possible score were noted in all subscales; 13% (n=13) for Self-care, 8% (n=8) for Respiration and Sphincter Management and 9% (n=9) for Mobility. One participant rated the highest possible score on the total score.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInternal consistency reliability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Cronbach´s alpha coefficient for the full scale was 0.91, for Self-care 0.93, for Respiration and Sphincter Management 0.62 and for Mobility 0.90.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cbr\u003e\u0026nbsp;Validity for s-SCIM IV and s-SCIM-SR\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll correlations are presented in Supplementary table. There were strong positive correlations between the corresponding subscales in s-SCIM IV and s-SCIM-SR; Self-care r\u003csub\u003es\u003c/sub\u003e=0.92, p\u0026lt;0.001, Respiration and Sphincter Management r\u003csub\u003es\u003c/sub\u003e=0.88, p\u0026lt;0.001, and Mobility r\u003csub\u003es\u003c/sub\u003e=0.96, p\u0026lt;0.001. Further, there was a strong positive correlation between the total score of s-SCIM IV and s-SCIM-SR (r\u003csub\u003es\u003c/sub\u003e=0.96, p\u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eA strong positive correlation was also found between the FIM\u003csup\u003eTM\u003c/sup\u003e total score and s-SCIM IV (r\u003csub\u003es\u003c/sub\u003e=0.89, p\u0026lt; 0.001) and s-SCIM-SR (r\u003csub\u003es\u003c/sub\u003e=0.89, p\u0026lt; 0.001) total scores. Using FIM\u003csup\u003eTM\u003c/sup\u003e subscale A-M, including self-care, bladder and bowel care together with mobility, and thus excluding five items for communication and social cognition, the correlation was similar (r\u003csub\u003es\u003c/sub\u003e=0.90, p\u0026lt; 0.001 for s-SCIM IV and r\u003csub\u003es\u003c/sub\u003e=0.89, p\u0026lt; 0.001 for s-SCIM-SR).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFIM\u003csup\u003eTM\u003c/sup\u003e Self-care (items A-E), FIM\u003csup\u003eTM\u003c/sup\u003e Sphincter control (items F-H) and FIM\u003csup\u003eTM\u003c/sup\u003e Mobility (items I-M) were positively correlated with the corresponding subscales of s-SCIM IV and s-SCIM-SR (r\u003csub\u003es\u003c/sub\u003e=0.79 to 0.94, p\u0026lt; 0.001).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study examines the psychometric properties of the Swedish version of SCIM IV and SCIM-SR in inpatient and outpatient rehabilitation settings to ensure their usability along the entire hospital-based rehabilitation continuum. The translation and adaptation process of the English versions of the SCIM IV and SCIM-SR into Swedish resulted in minor clarifications and cultural adaptations. There were few missing data and no observed ceiling or floor effects. The internal consistency was generally high, although the subscale Respiration and Sphincter management exhibited lower Cronbach\u0026rsquo;s alpha values compared to the other subscales. Expected positive correlations between the two translated scales as well as with the FIM\u0026trade;, support the convergent validity of s-SCIM IV and s-SCIM-SR.\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants and translation process\u003c/h2\u003e \u003cp\u003eThe sample size of 101 participants is greater or similar to that of previously published studies of the psychometric properties of SCIM III and SCIM-SR [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Participants in the present study represented men and women, a wide range of ages (22\u0026ndash;86 years) and duration of SCI (0\u0026ndash;54 years), traumatic and non-traumatic injuries, and most levels and severities of injury. This, in combination with including participants undergoing different types of rehabilitation, provided a solid ground for our analyses.\u003c/p\u003e \u003cp\u003eThe translation process was performed according to established guidelines [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and included persons with SCI, clinicians and researchers. Both for self-reported and clinician-administered outcome measures, the items need to be clear and easy to understand to minimize misinterpretations as well as respondent and clinician burden. During discussions in the expert committee, we identified a need for clarification on how to score some items and contacted the developer. After reaching consensus, we developed a workshop for clinicians on how to administer and score s-SCIM IV, following recommendations proposed by Liu et al [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This workshop has been delivered on several occasions and is continuously being provided to clinicians using the outcome measure in their practice and/or for research purposes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003ch2\u003eScoring, data completeness and targeting\u003c/h2\u003e \u003cp\u003eFor s-SCIM IV, the participants in the present study scored lower on all subscales when compared to a Swedish sample of older adults with long-term SCI assessed with s-SCIM III [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The sample in Waller et al [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] consisted of more individuals with AIS D injuries, which likely explains the differences. Similar results emerged for s-SCIM-SR when comparing the present study sample with participants and peer mentors in a community-based rehabilitation programme [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. As the sample in the present study had a median age of 62 years and almost half of them were undergoing inpatient rehabilitation, a greater level of independence in the community-based, younger (median age 41 years) sample could be expected. A comprehensive study by Catz et al [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] demonstrated higher scores at discharge from inpatient rehabilitation compared to admission, which further supports this reasoning. For the subscale Respiration and Sphincter management, the sample in the present study reported a comparable level of independence as the community sample in J\u0026ouml;rgensen et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Possibly, a high level of independence and/or functioning in respiration and sphincter management is reached during inpatient rehabilitation as these are focus areas during this rehabilitation phase. Moreover, the present study did not include persons with motor complete injuries, neurological level C1-C4 who generally have low scores on the subscale Respiration and Sphincter Management. Persons sustaining motor complete high-level injuries in Sweden are initially admitted to dedicated units. These units were not included in this study. We observed slightly higher scores (although not statistically confirmed) on the s-SCIM-SR as compared to the s-SCIM IV, throughout all subscales. Similar results were found by Fekete et al [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] whereas Wang et al [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] found the opposite. It may be that the participants\u0026rsquo; feelings about their disability can cause an underestimation or overestimation of functional independence. Nevertheless, we do not expect these small differences to affect the overall performance of the outcome measures.\u003c/p\u003e \u003cp\u003eThere were no missing data for the s-SCIM IV, indicating no systematic difficulties in understanding the items or assessing the participants. Most data collectors had participated in the workshop, which might have reduced the risk of missing data and promoted uniform scoring. Missing data were expected for the self-report version as study participants, in general, are less knowledgeable about the limits of missing data as trained data collectors or researchers and may not be as persistent in completing a questionnaire. However, the data collectors were instructed to carefully check the participants\u0026rsquo; answers and approach them again if data were missing. Furthermore, based on lessons learned from Inter-PEER [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], data collectors offered guidance to respondents if they had difficulties understanding any item. This probably contributed to few missing data for the s-SCIM-SR. The missing data were primarily found in the subscale Respiration and Sphincter Management which might reflect privacy issues with sharing bowel and bladder functioning and management [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInternal consistency reliability\u003c/h3\u003e\n\u003cp\u003eAll subscales, except Respiration and Sphincter Management, showed excellent internal consistency, corroborating previous results from J\u0026ouml;rgensen et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and others [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The Cronbach\u0026rsquo;s alpha for the Respiration and Sphincter Management subscale in the present study is very similar (0.68 vs 0.65) to the value obtained in a large international study conducted by the developers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], supporting the accuracy of our Swedish version. Furthermore, the lower internal consistency of this subscale was also found in different versions of the SCIM [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. One explanation may be that, apart from the correlation between items in a subscale, also the number of items affects Cronbach\u0026rsquo;s alpha [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The Respiration and Sphincter Management subscale includes fewer items than the other subscales which may contribute to the lower alpha value. The items in this subscale also assess separate areas (i.e., respiration, bowel and bladder management) that are grouped together and contain an assessment of both independence/activity performance and body functions (e.g., \u0026ldquo;Bowel movements at desired timing, without assistance; no mishaps\u0026rdquo;), which can all contribute to the low correlation between items.\u003c/p\u003e\n\u003ch3\u003eValidity\u003c/h3\u003e\n\u003cp\u003eThe self-report version and the clinician administered Swedish versions of SCIM were highly correlated, supporting the convergent validity. Similar results were obtained by the developer of SCIM-SR, although showing slightly lower correlation coefficients than in the present study [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Fekete et al [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] used the Pearson correlation coefficient which might contribute to these small differences. We also found high correlations between SCIM and FIM\u0026trade;, indicating that both scales can assess functional independence in persons with SCI, although the SCIM has been shown to be more responsive to changes in persons with SCI [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Removing the items in FIM\u0026trade; related to communication and cognition, which are usually not affected in persons with SCI, did not change the strength of the correlation. A resulting weaker correlation would have been problematic as the items in FIM\u0026trade; explicitly assessing independence are expected to correlate highly with SCIM. There were also strong correlations between the different subscales of s-SCIM IV and s-SCIM-SR and the corresponding subscales of the FIM\u0026trade;. Thus, our results further support the convergent validity of the s-SCIM IV and s-SCIM-SR.\u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThe study has several strengths, such as a heterogeneous population, a large proportion of AIS D similar to contemporary epidemiological data in Sweden [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], a relatively large study sample, few missing data and a thorough translation procedure. The inclusion of ten SCI units for data collection is also a strength, as the study sample represents regional diversity in Sweden. Many persons collecting data could imply a limitation due to the risks of misinterpretations and differences in scoring. However, we believe that delivering the workshop on SCIM assessment has reduced such potential bias. Moreover, the professionals collecting data have much experience in assessing persons with SCI using FIM\u0026trade; and the strong correlation between FIM\u0026trade; and s-SCIM IV confirm the accuracy of the SCIM assessment. An observed limitation is that there were only 18% women in the study sample. About one third of those sustaining an SCI in Sweden are women [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and a more even sex distribution would have been preferred for the psychometric testing. Individuals with the most severe injuries (motor-complete injuries, neurological level C1-C4) were not represented in our sample as these injuries occur less frequently and the units providing initial rehabilitation for these injuries did not participate. Nevertheless, participants did score along the full range of the scales.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results support the data completeness, targeting, internal consistency reliability and convergent validity of s-SCIM IV and s-SCIM-SR. These outcomes measures can thus be considered suitable to assess physical independence in inpatient and outpatient rehabilitation and long-term follow-up after SCI, for both clinical and research purposes. The similar results for s-SCIM-SR in hospital-based and community rehabilitation settings also support the usefulness of this outcome measure along the full rehabilitation continuum. The available and psychometrically sound Swedish versions will now enable a uniform national assessment of SCI-specific physical independence and facilitate research and international collaborations and comparisons.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY/ARCHIVING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData can be shared upon reasonable request to the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to all participating persons with SCI and the staff members who were involved in the data collection at the different clinics. We acknowledge Klas Hedlund for support with building and maintaining the project specific REDCap platform. We are grateful to all members of the translation process, i.e., co-authors SJ, AD, EBF, TH, UA, JW, MW, RL, CH, EB, as well as Lamprini Lili (LL) (University of Gothenburg/Sahlgrenska University Hospital) and Inka L\u0026ouml;fvenmark (IL) (Karolinska Institutet, Spinalis Foundation).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003cbr\u003e\u003c/strong\u003eSTRIVE-SCI was initiated and designed by AD (PI) and SJ (co-PI), in collaboration with EBF, PF, RL and WA. VW, AO, FT, Ks and MM were the study coordinators at their respective units. SJ, AD, UL, LH, EBF, TH, JW, MW, RL, CH and EB were involved in the translation process. UA drafted the first version of the manuscript in close collaboration with SJ and AD. UA performed the statistical analyses with support from AD. EBF, PF, RL, LH and WA contributed to the interpretation of findings and critically reviewed a late draft of the manuscript. All authors have subsequently critically reviewed the manuscript, provided feedback and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING\u003cbr\u003e\u003c/strong\u003eThis study was funded by FORSS (Research Council of Southeast Sweden), Promobilia Foundation, the Research Fund of Neuro Sweden and Norrbacka-Eugenia Foundation and in part by the Lund University and Sk\u0026aring;ne University Hospital (ALF agreement).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003c/strong\u003eAll participants received written and verbal information about the study, and all \u0026nbsp;gave their written informed consent before enrolment. Ethical Approval was \u0026nbsp;provided by the Swedish Ethical Review Authority (number 2022-01962-01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Declaration of Helsinki for research on humans was followed throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eSTRIVE-SCI Consortium (in alphabetical order)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eUlrica Antepohl\u003csup\u003e1\u003c/sup\u003e , Wolfram Antepohl\u003csup\u003e1\u003c/sup\u003e , Erik Berndtsson\u003csup\u003e6,7\u003c/sup\u003e, Emelie Butler Forslund\u003csup\u003e2,3\u003c/sup\u003e , Anestis Divanoglou\u003csup\u003e1\u003c/sup\u003e , Peter Flank\u003csup\u003e4\u003c/sup\u003e , Lisa Holmlund\u003csup\u003e2\u003c/sup\u003e , Tobias Holmlund\u003csup\u003e2\u003c/sup\u003e, Xiaolei Hu\u003csup\u003e4\u003c/sup\u003e, Claes Hultling\u003csup\u003e2\u003c/sup\u003e\u0026nbsp; , Sophie J\u0026ouml;rgensen\u003csup\u003e5,6\u003c/sup\u003e , Richard Levi\u003csup\u003e1\u003c/sup\u003e, Jan Lexell\u003csup\u003e5,8\u003c/sup\u003e, Maria Moschovou\u003csup\u003e1\u003c/sup\u003e , Anna Olsson\u003csup\u003e9\u003c/sup\u003e, Nora Sandholdt\u003csup\u003e10,11\u003c/sup\u003e, Kristina Skill\u003csup\u003e1\u003c/sup\u003e , Filip T\u0026ouml;\u0026ouml;j\u003csup\u003e6\u003c/sup\u003e, Kerstin Wahman\u003csup\u003e2,12\u003c/sup\u003e, Mikael Waller\u003csup\u003e5,13\u003c/sup\u003e, Johanna Wangdell\u003csup\u003e11, 14\u003c/sup\u003e , Veronika Wiebols\u003csup\u003e15\u003c/sup\u003e, Gunilla \u0026Aring;hr\u0026eacute;n\u003csup\u003e11,16\u0026nbsp;\u003c/sup\u003e, Elisabet \u0026Aring;kesson\u003csup\u003e2,17\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAffiliations\u003cbr\u003e\u0026nbsp;1. Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Link\u0026ouml;ping University, Link\u0026ouml;ping, Sweden\u003cbr\u003e\u0026nbsp;2. Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden\u003cbr\u003e\u0026nbsp;3. Division of Clinical Geriatrics, Aleris Rehab Station, Stockholm, Sweden\u003cbr\u003e\u0026nbsp;4. Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Ume\u0026aring; University, Sweden\u003cbr\u003e\u0026nbsp;5. Department of Health Sciences, Lund University, Lund, Sweden\u003cbr\u003e\u0026nbsp;6. Department of Rehabilitation Medicine, Sk\u0026aring;ne University Hospital, Lund, Sweden\u003cbr\u003e\u0026nbsp;7. RG Aktiv Rehabilitering, Sweden\u003cbr\u003e\u0026nbsp;8. Department of Rehabilitation, \u0026Auml;ngelholm Hospital, \u0026Auml;ngelholm, Sweden\u003cbr\u003e\u0026nbsp;9. Frykcenter Rehabilitering, Torsby, Sweden\u003cbr\u003e\u0026nbsp;10. Department of Improvement and Innovation, Region \u0026Ouml;sterg\u0026ouml;tland, Link\u0026ouml;ping, Sweden\u003cbr\u003e\u0026nbsp;11. Gothenburg Competence Center for SCI, University of Gothenburg, Sweden\u003cbr\u003e\u0026nbsp;12. Aleris Rehab Station Stockholm Research and Development Unit, Stockholm, Sweden\u003cbr\u003e\u0026nbsp;13. Department of Rehabilitation Medicine, Sunderby Hospital, Luleå, Sweden\u003cbr\u003e\u0026nbsp;14. Sahlgrenska University Hospital, Gothenburg, Sweden.\u003cbr\u003e\u0026nbsp;15. Department of Rehabilitation Medicine, Halland hospital, Halmstad, Sweden\u003cbr\u003e\u0026nbsp;16. Swedish Association for Survivors of Accident and Injury (RTP)\u003cbr\u003e\u0026nbsp;17. R\u0026amp;D unit, Stockholms Sjukhem, Stockholm, Sweden\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eProdinger B, Ballert CS, Brinkhof MW, Tennant A, Post MW. Metric properties of the Spinal Cord Independence Measure \u0026ndash; self report in a community survey. J Rehabil Med. 2016;48(2):149-164. https://doi.org/10.2340/16501977-2059.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). The way forward: recommendations. In: International Perspectives on Spinal Cord Injury. 2013. https://iris.who.int/bitstream/handle/10665/94190/9789241564663_eng.pdf?sequence=1. Accessed 19 Dec 2024.\u003c/li\u003e\n\u003cli\u003eCatz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM\u0026ndash; spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord. 1997;35(12):850-856. https://doi.org/10.1038/sj.sc.3100504.\u003c/li\u003e\n\u003cli\u003eKeith RA, Granger CV, Hamilton BB, Sherwin FS. The Functional Independence Measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987;1:6\u0026ndash;18.\u003c/li\u003e\n\u003cli\u003eCatz A, Itzkovich M, Agranov E, Ring H, Tamir A. The spinal cord independence measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients. Spinal Cord. 2001;39(2):97\u0026ndash;100.\u003c/li\u003e\n\u003cli\u003eCatz A, Itzkovich M, Steinberg F, Philo O, Ring H, Ronen J, Spasser R, Gepstein A, Tamir A. The Catz-Itzkovich SCIM: a revised version of the spinal cord independence measure. Disabil Rehabil. 2001;23(6):263\u0026ndash;268). https://doi.org/10.1080/096382801750110919.\u003c/li\u003e\n\u003cli\u003eCatz A, Itzkovich M, Elkayam K, Michaeli D, Gelernter I, Benjamini Y, et al. Reliability validity and responsiveness of the spinal cord independence measure 4th version in a multicultural setup. Arch Phys Med Rehabil, 2022;103(3):430-440. https://doi.org/10.1016/j.apmr.2021.07.811. \u003c/li\u003e\n\u003cli\u003eFekete C, Eriks-Hoogland I, Baumberger M, Catz A, Itzkovich M, L\u0026uuml;thi H, et al. Development and validation of a self-report version of the spinal cord independence measure (SCIM III). Spinal Cord. 2013;51(1):40\u0026ndash;47. https://doi.org/10.1038/sc.2012.87 \u003c/li\u003e\n\u003cli\u003eDivanoglou A, Tasiemski T, J\u0026ouml;rgensen S. (2020). INTERnational Project for the Evaluation of \u0026ldquo;activE Rehabilitation\u0026rdquo; (interPEER) \u0026ndash; a protocol for a prospective cohort study of community peer-based training programmes for people with spinal cord injury. BMC Neurol. 2020;20(14). https://doi.org/10.1186/s12883-019-1546-5. \u003c/li\u003e\n\u003cli\u003eJ\u0026ouml;rgensen S, Butler Forslund E, Lundstr\u0026ouml;m U, Nilsson E, Levi R, Berndtsson E, Divanoglou A. Sound psychometric properties of the Swedish version of the spinal cord independence measure self-report. J Rehabil Med. 2021;53(5). https://doi.org/10.2340/16501977-2839. \u003c/li\u003e\n\u003cli\u003eRupp R, Biering-S\u0026oslash;rensen F, Burns SP, Graves DE, Guest J, Jones L, et al. International standards for neurological classification of spinal cord injury: revised 2019. Top Spinal Cord Inj Rehabil. 2021;27(2):1-22. https://doi.org/10.46292/sci2702-1. \u003c/li\u003e\n\u003cli\u003eAguilar-Rodriguez M, Pena-Paches L, Grao-Castellote C, Torralba-Collados F, Hervas-Marin D, Giner-Pascual M. Adaptation and validation of the Spanish self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2015;53(6):451-454. https://doi.org/10.1038/sc.2014.225. \u003c/li\u003e\n\u003cli\u003eTongprasert S, Wongpakaran T, Soonthornthum C. Validation of the Thai version of the spinal cord independence measure self-report (SCIM-SR-Thai). 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Disabil Rehabil, 2014;36(19):1644-1651. https://doi.org/10.3109/09638288.2013.864713. \u003c/li\u003e\n\u003cli\u003eBiering-S\u0026oslash;rensen F, Charlifue S, Chen Y, New PW, Noonan V, Post M, et al. International spinal cord injury core data set (version 3.0)-including standardization of reporting. Spinal Cord. 2023;61(1):65-68. https://doi.org/10.1038/s41393-022-00862-2. \u003c/li\u003e\n\u003cli\u003eBeaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000 Dec 15;25(24):3186-3191.\u003c/li\u003e\n\u003cli\u003eEpstein J, Osborne RH, Elsworth GR, Beaton DE, Guillemin F. Cross-cultural adaptation of the health education impact questionnaire: experimental study showed expert committee, not back-translation, added value. J Clin Epidemiol 2015; 68:360\u0026ndash;369. https://doi.org/10.1016/j.jclinepi.2013.07.013.\u003c/li\u003e\n\u003cli\u003eLiu N, Xing H, Zhou M, Biering-S\u0026oslash;rensen F. Lack of knowledge and training are the major obstacles in application of the spinal cord independence measure (SCIM) in China. J Spinal Cord Med. 2019;42(4):437-443. https://doi.org/10.1080/10790268.2018.1454021. \u003c/li\u003e\n\u003cli\u003eWaller M, J\u0026ouml;rgensen S, Lexell J. Changes over 6 years in secondary health conditions and activity limitations in older adults aging with long-term spinal cord injury. PM\u0026amp;R. 2023;15(2):157-167. https://doi.org/10.1002/pmrj.12776.\u003c/li\u003e\n\u003cli\u003eWang T, Tang J, Xie S, He X, Wang Y, Liu T, et al. Translation and validation of the Chinese version of the spinal cord independence measure (SCIM III) self-report. Spinal Cord. 2021;59(10):1045-1052. https://doi.org/10.1038/s41393-020-00601-5. \u003c/li\u003e\n\u003cli\u003eGlass CA, Tesio L, Itzkovich M, Soni BM, Silva P, Mecci M, et al. Spinal cord independence measure, version III: applicability to the UK spinal cord injured population. J Rehabil Med. 2009;41(9),723-728. https://doi.org/10.2340/16501977-0398. \u003c/li\u003e\n\u003cli\u003eUnalan H, Misirlioglu TO, Erhan B, Akyuz M, Gunduz B, Irgi E, et al. Validity and reliability study of the Turkish version of spinal cord independence measure-III. Spinal Cord. 2015;53(6):455-460. https://doi.org/10.1038/sc.2014.249. \u003c/li\u003e\n\u003cli\u003eStreiner DL. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess. 2003;80(1):99-103. https://doi.org/10.1207/s15327752jpa8001_18. \u003c/li\u003e\n\u003cli\u003eItzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, et al. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil, 2007;29(24):1926-1933. https://doi.org/10.1080/09638280601046302. \u003c/li\u003e\n\u003cli\u003eJosefson C, Rekand T, Lundgren-Nilsson \u0026Aring;, Sunnerhagen KS. Epidemiology of spinal cord injury in adults in Sweden, 2016\u0026ndash;2020: A retrospective registry-based study. Neuroepidemiology. 2024; https://doi.org/10.1159/000540818.\u003c/li\u003e\n\u003cli\u003eMoschovou M, Antepohl W, Halvorsen A, Pettersen AL, Divanoglou A. Temporal changes in demographic and injury characteristics of traumatic spinal cord injuries in Nordic countries - a systematic review with meta-analysis. Spinal Cord, 2022; 60(9):765-773. https://doi.org/10.1038/s41393-022-00772-3 \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Participant distribution across different phases of rehabilitation\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhase of rehabilitation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eInpatient rehabilitation* \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e43 (42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eOutpatient rehabilitation*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e17 (16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eClinical appointment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e19 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eFollow-up visit/Annual check-up\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e17 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eOther**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e5 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Includes both primary and secondary rehabilitation; ** Not specified\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Sociodemographics and injury characteristics of the participants (n=101)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eSex, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e83 (82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e18 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eAge, median (IQR) [min-max], years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e62.0 (23) [22-86]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 368px;\"\u003e\n \u003cp\u003eTime since injury, median (IQR) [min-max], n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e2.0 (8) [0-54]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 368px;\"\u003e\n \u003cp\u003e\u0026lt;1 year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e27 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 368px;\"\u003e\n \u003cp\u003e1-4 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e38 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 368px;\"\u003e\n \u003cp\u003e5-9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e16 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 368px;\"\u003e\n \u003cp\u003e10-19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e9 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 368px;\"\u003e\n \u003cp\u003e20-29 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 368px;\"\u003e\n \u003cp\u003e30-39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e4 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 368px;\"\u003e\n \u003cp\u003e40-54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e5 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eCause of injury, (missing=1), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eTraumatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e66 (66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eNon-traumatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e34 (34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eLevel and severity of injury (missing=1), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eC1-4; AIS A, B, and C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e25 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eC5-8; AIS A, B, and C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e6 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eT1-S3; AIS A, B, and C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e25 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eAIS D at any neurological level of injury\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e44 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eMain mode of mobility, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eManual Wheelchair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e67 (66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003ePower wheelchair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e8 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eWalking device (e.g. crutches, walking frame)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e12 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eNo assistive devices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e14 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eEducation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eElementary school (9 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e18 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eGymnasium/Vocational training (12 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e52 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e28 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Several options where possible to choose for each participant\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e \u003cstrong\u003eTotal and subscale scores of s-SCIM IV and s-SCIM-SR\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eTotal score (0-100)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSubscale Self-care (0-20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eSubscale Respiration \u0026amp; Sphincter Management (0-40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSubscale Mobility (0-40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003es-SCIM IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003es-SCIM SR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003es-SCIM IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003es-SCIM SR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003es-SCIM IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003es-SCIM SR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003es-SCIM IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003es-SCIM SR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eTotal, \u003cem\u003en\u0026nbsp;\u003c/em\u003e(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e101 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e93 (92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e101 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e101 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e101 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e96 (95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e101 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e98 (97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMissing, \u003cem\u003en\u0026nbsp;\u003c/em\u003e(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e8 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e5 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e3 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMean (s.d.)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e53.67 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e54.97 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e11.87 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e12.39 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e25.81 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e26.22 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e15.99 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e16.98 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMedian\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e59.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e59.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp; 27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e43.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eRange scoring\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(min-max)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0-100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e5-100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e5-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0-40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIQR: Inter-quartile range\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5949503/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5949503/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e: Psychometric study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e: To evaluate the data completeness, targeting, internal consistency reliability and convergent validity of the Swedish versions of the Spinal Cord Independence Measure IV (s-SCIM IV) and the Spinal Cord Independence Measure Self-report (s-SCIM-SR).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting:\u003c/strong\u003e Inpatient and outpatient spinal cord injury (SCI) rehabilitation in Sweden.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn total, 101 participants (82% men)\u003cstrong\u003e \u003c/strong\u003ewere included. The translation process was based on established guidelines and involved researchers, clinicians and consumers.\u003cstrong\u003e \u003c/strong\u003es-SCIM IV and FIM\u003csup\u003eTM\u003c/sup\u003e assessments were performed by observation and/or interview. Data for s-SCIM-SR were collected through self-report using paper forms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e There were no missing data for the s-SCIM IV and 92% had answered all items in the s-SCIM-SR. No ceiling or floor effects were observed. Cronbach´s alpha for the total s-SCIM IV scale was 0.91 (subscales 0.68–0.93) and for the total s-SCIM-SR scale 0.91 (subscales 0.62-0.93), with the lowest alphas for the subscale Respiration and Sphincter management in both outcome measures. The s-SCIM IV and s-SCIM-SR correlated strongly with each other and with FIM\u003csup\u003eTM\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Our results support the data completeness, targeting, internal consistency reliability and convergent validity of the s-SCIM IV and s-SCIM-SR. These outcome measures can thus be considered suitable to assess physical independence in inpatient and outpatient rehabilitation and long-term follow-up after SCI, for both clinical and research purposes. The available and psychometrically sound Swedish versions will now enable a uniform national assessment of SCI-specific physical independence and facilitate research and international collaborations and comparisons.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSponsorship\u003c/strong\u003e: Not applicable\u003c/p\u003e","manuscriptTitle":"Psychometric properties of the Swedish versions of Spinal Cord Independence Measure IV (SCIM IV) and Self-report (SCIM-SR) in inpatient and outpatient rehabilitation settings","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-18 11:59:31","doi":"10.21203/rs.3.rs-5949503/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2025-04-09T15:41:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-03-06T08:06:28+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-02-18T04:30:00+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-02-15T21:25:41+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-02-11T12:27:08+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-02-11T10:20:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-10T15:01:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Spinal Cord","date":"2025-02-07T13:20:49+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2025-02-05T11:14:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-03T08:34:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2a5a37d8-c77d-4ec0-96c3-f0288a93bd4c","owner":[],"postedDate":"March 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":44161260,"name":"Health sciences/Neurology/Neurological disorders/Spinal cord diseases"},{"id":44161261,"name":"Health sciences/Medical research/Outcomes research"}],"tags":[],"updatedAt":"2026-01-23T08:21:00+00:00","versionOfRecord":{"articleIdentity":"rs-5949503","link":"https://doi.org/10.1038/s41393-026-01168-3","journal":{"identity":"spinal-cord","isVorOnly":false,"title":"Spinal Cord"},"publishedOn":"2026-01-22 05:00:00","publishedOnDateReadable":"January 22nd, 2026"},"versionCreatedAt":"2025-03-18 11:59:31","video":"","vorDoi":"10.1038/s41393-026-01168-3","vorDoiUrl":"https://doi.org/10.1038/s41393-026-01168-3","workflowStages":[]},"version":"v1","identity":"rs-5949503","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5949503","identity":"rs-5949503","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}