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Reintegration to Normal Living Index

The clinical team discusses the merits of the Reintegration to Normal Living (RNL) Index for patient assessment.
What does the RNL Index test?
1. The RNL Index is a self-report questionnaire that assesses an individual’s satisfaction with performance in life activities. The RNL assesses mobility, self-care, daily activity, recreational activity, and family roles. It was developed based on interviews with clinicians, patients and their significant others. The RNL evaluates the overall function of individuals who have received rehabilitation by assessing the degree to which they are able to return to a normal life. The RNL is currently part of the NRS and is being administered at follow-up to various patient populations, including SCI.
Describe the RNL Index.
1. It contains 11 items and each one is scored using a 10 cm visual analogue scale anchored with phrases (0=no reintegration and 10=complete reintegration). Wheelchairs or other assistive/adaptive aids may be used when considering how to answer the questions. The CIHI National Rehabilitation Reporting System (NRS) uses a 3 point ordinal scale (0=does not describe my situation; 1=partially describes my situation; and 3=fully describes my situation).
Describe RNL Index numerical rating system.
The questionnaire is completed by self-report or by interviewer. The total score = sum (points all 11 items) and the adjusted score = (total score)/110 * 100. A minimum adjusted score is 0 and a maximum adjusted score is 100. No information was obtained on how the CIHI NRS scores the RNL.
What are the advantages of the RNL Index?
1.  The RNL is a short measure of participation that has been used in various patient populations. It is currently part of the CIHI NRS and is collected at the time of follow-up. Since the RNL is widely used with various patient populations it is possible to compare results.
What are the disadvantages of the RNL Index?
1. Although the RNL is commonly used as part of the NRS for individuals with SCI, there has been very little research conducted on the psychometric properties for this patient population. In the literature the concepts of participation and quality of life are not always clearly defined and the RNL has been classified as a proxy measure of quality of life which may cause some confusion regarding the construct being measured.
Summary – RNL Index (see table 1)

Interpretability – The RNL provides a measure of the individual’s perceived re-integration to life activities. Data is available on the CIHI website for individuals with SCI. Results can also be compared to other research studies.

Acceptability – The RNL is easy to understand and does not take long to complete (i.e. 11 items).

Feasibility – A copy of the RNL is available at no cost and can be found on the internet. It does not require any special training to administer or score.

 

 

Table 1. Psychometric summary.

Reliability

Validity

Responsiveness

Rigor

Results

Rigor

Results

Rigor

Results

Floor/ceiling

N/A

N/A

++

Construct ++

N/A

N/A

N/A

Note: +++ = Excellent; ++ = Adequate; + = Poor; N/A=Insufficient information

For more information please see: Reintegration to Normal Living (RNL)