Reintegration to Normal Living (RNL) Index

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Tool Description

  • Self-report questionnaire that assesses an individual’s satisfaction with performance in life activities.
  • Assesses mobility, self-care, daily activity, recreational activity, and family roles
  • Developed based on interviews with clinicians, patients and their significant others.

ICF Domain:


Number of Items:


Brief Instructions for Administration & Scoring


  • Self-report or interviewer.
  • Contains 11 items.
  • There are 3 alternate scoring systems: 1) a 10-point visual analogue scale, 2) a 3-point scale, and 3) a 4-point scale. We focus on the first scoring system here since it is most commonly used.  Each item 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.
  • Administration time is approximately 10 minutes.



  • Both the total score = sum (points all 11 items) and the adjusted score = (total score)/110 * 100 can be calculated.
  • A minimum adjusted score is 0 and a maximum adjusted score is 100.


MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI

  • No cut-points have been established for the SCI population.
  • Published data for the SCI population is available for comparison (see the Interpretability section of the Study Details sheet).


English and French.

Training Required:



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

Clinical Considerations

  • Although the RNL is commonly used as part of the national reporting system for individuals with SCI, there has been very little research conducted on the psychometric properties for this patient population.

Measurement Property Summary

# of studies reporting psychometric properties: 3


  • Internal consistency of the RNL Index is High (Cronbach’s a=0.87).
  • Total item correlations ranged from 0.37-0.67.

[Hitzig et al. 2012]


  • Correlation of the RNL Index is:
    • High with the Quality of Life Index (Pearson’s r=-0.654)
    • Moderate with the Functional Independence Measure (Pearson’s r=-0.348)
    • Moderate with the Rosenberg Self-Esteem Scale (Pearson’s r=-0.483)
    • Low with the American Spinal Injury Association (ASIA) – motor score (Pearson’s r=-0.196).

[Hitzig et al. 2012, May & Warren 2002, Gray et al. 2006]


No values have been reported for the responsiveness of the RNL Index for the SCI population at this time.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the RNL for the SCI population.


Dr. Ben Mortenson, John Zhu, Matthew Querée

Date Last Updated:

Mar 16, 2017

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Download Worksheet:

Worksheet Document
There are 11 items in the Reintegration to Normal Living Index. Each of these items is accompanied by a visual analog scale (VAS) anchored by phrases reflecting whether the statement describes the situation of the patient. It allows the patients to determine the extent to which the statement in question applies to their specific situation. Each VAS is scored out of 10 points: 1 = minimal reintegration, 10 = complete reintegration





Both the total score = sum (points all 11 items) and the adjusted score = (total score)/110 * 100 can be calculated.  A minimum adjusted score is 0 and a maximum adjusted score is 100.

Equipment Needed


Gray DB, Hollingsworth HH, Stark SL, Morgan KA. Participation Survey/Mobility: psychometric properties of a measure of participation for people with mobility impairments and limitations. Arch Phys Med Rehabil 2006;87: 189-97.

Hitzig SL, Romero Escobar EM, Noreau L, Craven BC. Validation of the Reintegration to Normal Living Index for community-dwelling persons with chronic spinal cord injury. Arch Phys Med Rehabil 2012;93:108-14.

May LA, Warren S. Measuring quality of life of persons with spinal cord injury: external and structural validity. Spinal Cord 2002;40:341-350.