• The ISAFSCI is an assessment designed to determine which autonomic functions are intact, impaired or lost following SCI.
  • A revised version (ISAFSCI second edition) was developed in 2021 (Wecht et al. 2021).
  • The assessment form consists of 2 main sections: 1) general autonomic function, and 2) sacral autonomic function.

ICF Domain

Body Functions ▶ Self Care

Administration

The functional performance categories are scored on a 2-point scale from 0 (complete loss of control) to 2 (normal function).

Number of Items

11

Languages

English

Training Required

No additional training required

Availability

The ISAFSCI worksheet can be found here.

# of studies reporting psychometric properties: 1

Interpretability

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

Reliability – Moderate to High

Inter-rater reliability of the COPM is Moderate with the general autonomic component (κ=0.41-0.6) and High within the lower urinary tract, bowel, and sexual function component (κ=0.62-0.88).

(Davidson et al. 2017; n=65; 85.4% males; mean (SD) age: 45 (12) years; details of injury not reported, version 1)

Validity – Moderate to High

  • Moderate correlation between composite bladder score and Qualiveen Compositive:
    p < 0.0001
  • Moderate to High correlation between composite bladder score and ISNSCI composite pinprick score:
    rho = 0.69, p = 0.003
  • High correlation with ASP test for orthostatic hypotension:
    p=0.01

(Kurban et al. 2023; n=49, mean age: 45 years; injury level: cervical – thoracolumbar; mean time since injury 6 years; version 1)

Responsiveness

No values were reported for the responsiveness of the ISAFSCI for the SCI population.

Floor/Ceiling Effect

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

Reviewers

Dr. Vanessa Noonan, Elsa Sun

Date Last Updated

December 31, 2024

Davidson RA, Carlson M, Fallah N, Noonan VK,, Elliott SL, Joseph J, Smith KM, Krassioukov AV. Inter-Rater Reliability of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury. J Neurotrauma. 2017;34(3):552-558. https://www.liebertpub.com/doi/abs/10.1089/neu.2016.4489?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=neu

Kurban D, Davidson RA, Smith KM, Carlson M, Joseph J, Elliott S, Noonan VK, Fallah N, Krassioukow AV. Construct validity of the international standards to document remaining autonomic function after spinal cord injury (ISAFSCI) (1st edition). Spinal Cord. 2023;61(12):644-651
https://pubmed.ncbi.nlm.nih.gov/37814014/

Wecht JM, Krassioukov AV, Alexander M, Handrakis JP, McKenna SL, Kennelly M, Trbovich M, et al. International Standards to document Autonomic Function following SCI (ISAFSCI): Second Edition. 2021;27(2):23-49
https://pubmed.ncbi.nlm.nih.gov/34108833/

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