Translation, cross-cultural adaptation, and psychometric validation of the Spinal Cord independence measure version IV for European Portuguese.

STUDY

DESIGN

Longitudinal prospective cohort study.

OBJECTIVES

This study aimed to translate, culturally adapt, and validate the Spinal Cord Independence Measure Version IV (SCIM-IV) for European Portuguese (EU-PT).

SETTING

Spinal Cord Injury (SCI) unit of a rehabilitation center in Portugal.

METHODS

The translation followed Beaton's guidelines and included cognitive debriefing by rehabilitation professionals. Psychometric validation complied with COSMIN standards, including internal consistency (Cronbach's α, item-total correlations), construct and structural validity, and responsiveness. Construct validity was tested via correlations with the motor domain of the Functional Independence Measure (FIM) and the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor scores. Confirmatory factor analysis was used to assess structural validity.

RESULTS

Sixty-six adults (81.8% male; median age 62.5 years) were assessed at admission and discharge during the subacute phase of SCI. The EU-PT version demonstrated strong semantic and conceptual equivalence. Cognitive debriefing improved the clarity and comprehension of the items. Internal consistency was high for the total scale (α = 0.86-0.91), although it was lower in the 'Respiration and Sphincter Management' subscale. Strong construct validity was supported by correlations with the motor FIM (r = 0.84-0.95) and motor scores (r = 0.63-0.77). Structural validity was suboptimal, particularly in the 'Respiration and Sphincter' domain. The scale was highly responsive (effect size=1.35) and correlated with functional gains (r = 0.77).

CONCLUSIONS

The EU-PT SCIM-IV version exhibited strong linguistic and psychometric properties. This enables standardized assessment in EU-PT-speaking contexts and supports international collaboration in SCI rehabilitation research and training.