Spinal Cord Injury Secondary Conditions Scale (SCI-SCS)

Download Clinical Summary PDF

Tool Description

  • Specifically targets secondary conditions associated with SCI that directly and indirectly impact health and physical functioning.
  • Items were selected based on 3 criteria: (a) that they represent conditions that are physiologic in nature (vs psychological or environmental); (b) that they are measurable by patient history and physical examination, reported episodes, validated scales, or medical tests or interventions; and (c) those that can be either prevented or managed with medical intervention and/or health behaviors. Items represent problems in the areas of skin, musculoskeletal, pain, bowel/bladder, and cardiovascular.

ICF Domain:

Body Function – Subcategory: General Functions.

Number of Items:


Brief Instructions for Administration & Scoring


  • Self-report questionnaire.
  • The rating scale uses a 4-point ordinal scale ranging from 0 (not experienced/insignificant problem never limiting activity) to 3 (significant/chronic problem).

Equipment: None.


  • Total score is derived from the sum of the problem ratings.


MCID: not established for SCI
SEM: not established for SCI
MDC: not established for SCI

  • Total scores range from 0 to 48.
  • Higher scores indicate greater overall problems with secondary conditions.
  • No meaningful cut points, normative data or responsiveness data have been established at this time for the SCI population
  • Published data for the SCI population is available for comparison (see Interpretability section of the Study Details sheet).



Training Required:



See the ‘How-to use’ page for this tool.

Clinical Considerations

  • Only one study has assessed the psychometric properties of the SCI-SCS among the SCI population.

Measurement Property Summary

# of studies reporting psychometric properties: 1


  • The SCI-SCS was administered across 5 time-points, spanning 2 years post-intervention. The internal consistency across each of the time points was Moderate to High (Cronbach’s a=0.73 – 0.869). The test-retest reliability values across the time points ranged from Moderate to High (r=0.569-0.805).

[Kalpakjian et al. 2007, Conti et al. 2019, Arora et al. 2015]


  • The SCI-SCS total score has High correlations with the 6 items of the SF-12, Spearman’s r values range from 0.317 to 0.644, and Moderate correlations with the SF-8 Physical Component and Patient Health Questionnaire (r=0.36 and 0.43), and Low correlations with the Modified Barthel Index, SF-8 Mental Component, Generalized Anxiety Disorder-7, and Tetraplegia (r=0.20-0.30)

[Kalpakjian et al. 2007, Conti et al. 2019]


No values were reported for the responsiveness of the SCI-SCS for the SCI population.

Floor/ceiling effect:

  • There are ceiling effects on 3 categories of secondary conditions (>20% scored in the highest category):

-       Sexual dysfunction (26.2%)

-       Chronic pain (32.3%)

-       Joint and muscle pain (29.2%)

  • There are floor effects on all 16 categories of secondary conditions (>20% scored in the lowest category):

-       Pressure sore (76.9%)

-       Injury caused by loss of sensation (76.9%)

-       Muscle spasms (41.5%)

-       Contractures (67.7%)

-       Heterotopic bone ossification (89.2%)

-       Diabetes mellitus (87.7%)

-       Bladder dysfunction (36.9%)

-       Bowel dysfunction (40.0%)

-       Urinary tract infections (61.5%)

-       Sexual dysfunction (43.1%)

-       Autonomic dysreflexia (70.8%)

-       Postural hypotension (80.0%)

-       Circulatory problems (50.8%)

-       Respiratory problems (80.0%)

-       Chronic pain (33.8%)

-       Joint and muscle pain (29.2%)

[Kalpakjian et al. 2007]


Dr. Vanessa Noonan, John Zhu, Jeremy Mak, Matthew Querée, Risa Fox

Date Last Updated:

August 3, 2020

Download the measure

Download Worksheet:

Worksheet Document
For the following 16 health problems, please rate how much each one affected your activities and independence in the last 3 months. If you have not experienced a secondary condition in the last 3 months or if it is an insignificant problem for you, please circle ‘‘0.’’ Use the following scale to rate each of the secondary conditions.





Equipment Needed


Arora M, Harvey LA, Lavrencic L, Bowden JL, Nier L, Glinsky JV, Hayes AJ, Cameron ID. A telephone-based version of the spinal cord injury-secondary conditions scale: a reliability and validity study. Spinal Cord. 2016;54(5):402-5.

Kalpakjian CZ, Scelza WM, Forchheimer MB, Toussaint LL. Preliminary Reliability and Validity of a Spinal Cord Injury Secondary Conditions Scale. The Journal of Spinal Cord Medicine 2007; 30: 131-39.