Development, Validity, and Reliability of the Spinal Cord Injury Instrumental Activities of Daily Living Measure (SCI-IADLM).

BACKGROUND

Instrumental activities of daily living (IADLs) determine community participation and independence after spinal cord injury (SCI) but are seldom measured with culturally relevant, SCI-specific instruments in India.

OBJECTIVES

To develop the Spinal Cord Injury Instrumental Activities of Daily Living Measure (SCI-IADLM) for adults with SCI in India and to examine its preliminary content validity, internal consistency, and reliability.

METHODS

This methodological instrument development study was conducted at the Indian Spinal Injuries Centre, Vasant Kunj, New Delhi. Item generation combined a focused literature review and semi-structured interviews with stakeholders (n = 15). A 3-round content validation using Lawshe's method was conducted with 17 panellists (9 clinicians, 8 individuals with SCI). The final 33-item instrument was pilot-tested in 30 purposively sampled adults with SCI. Internal consistency (Cronbach's α), inter-item correlations, and "α if item deleted" analyses were performed. Scale-level content validity index (CVI) was computed. Reliability was calculated by item analysis and test-retest reliability.

RESULTS

The SCI-IADLM comprises 33 items across 12 domains including household management, community mobility, communication, financial management, and health management. All retained items exceeded the Lawshe content validity ratio (CVR) threshold for N = 17 (CVR ≥ 0.529); scale-level CVI = 1.00. Pilot testing (n = 30) yielded Cronbach's α = 0.857. Inter-item correlations ranged from -0.426 to 0.852. Deletion of items 4 (care of pets) or 24 (educational participation) would minimally increase α to 0.865; these items were retained for theoretical importance. Participant feedback indicated clarity and acceptability. Test-retest reliability analysis demonstrated high preliminary stability, with an intraclass correlation coefficient (ICC) of 1.00 (95% confidence interval: lower bound 0.99, upper bound 1.00) in the pilot sample.

CONCLUSION

The SCI-IADLM demonstrates strong preliminary content validity and good internal consistency in a pilot sample of adults with SCI in India. Further large-scale multisite psychometric validation (test-retest reliability, factor structure/Rasch analysis, responsiveness, and cross-linguistic adaptation) is necessary.