Determining the most robust dimensional structure of ICF categories across subgroups of persons with spinal cord injury to build the basis for future clinical measures

Ballert, C., Stucki, S., Biering-Sørensen, F. and Cieza, A. (2014) Determining the most robust dimensional structure of ICF categories across subgroups of persons with spinal cord injury to build the basis for future clinical measures. Archives of Physical Medicine and Rehabilitation, 95 (11), 2111-2119. (doi:10.1016/j.apmr.2014.07.004).

Abstract

Objectives
To determine the most robust dimensional structure of the International Classification of Functioning, Disability and Health (ICF) categories relevant to spinal cord injury (SCI) across subgroups of [1] lesion level, [2] health care context, [3] gender, [4] age, and [5] the countries’ resources.

Design
A multidimensional between-item response Rasch model was used. The choice of the dimensions was conceptually driven using the ICF components from the functioning chapters and the splits of the Activity and Participation component described in the ICF.

Setting
Secondary analysis of data from an international, cross-sectional, multi-centric study for the ‘Development of ICF Core Sets for Spinal Cord Injury’.

Participants
1048 persons with SCI from the early post acute and long term living context from 14 middle/low and high resource countries.

Interventions
n.a.

Main outcome Measures
Ratings of categories of the ICF relevant for SCI were analysed.

Results
5 Models were tested on the complete sample and the 5 subgroups. The overall reliability of all models as well as the reliability within dimensions of the unidimensional and bidimensional models was good to excellent. The ICF categories spread well along the disability scale. The model fit improvement from the unidimensional to the bidimensional and from the bidimensional to the tridimensional model was significant in all groups (p-values < 0.0001). The improvement, however, from a unidimensional to a bidimensional structure was markedly better than from a bidimensional to a tridimensional one.

Conclusion
We propose, that a two dimensional structure separating body functions and body structures from activity and participation categories should serve as a basis for developing clinical measures in SCI in the future.

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