• The Quadriplegia Index of Function (QIF) assesses functional performance by observing people with cervical SCI complete activities of daily living (ADLs) like transfers, dressing, bathing, and feeding.
  • The QIF is scored on a scale of 0-4 (0=totally dependent; 4=totally independent)
  • The QIF may be more sensitive than other measures of function (e.g., Barthel Index, SCIM) as it was developed specifically to detect small but clinically significant gains made by people with quadriplegia throughout inpatient rehabilitation.
  • Versions of the QIF that can be completed more quickly have been developed, including the QIF-Modified (10 minutes; questionnaire) and the QIF-Short version (observing only 6 ADLs instead of 37 in the original version – wash/dry hair, turn supine to side in bed, lower extremity dressing, open carton/jar, transfer from bed to wheelchair and lock wheelchair).

QIF

  • The QIF assesses 37 activities by observing the person perform ADLs in 10 categories of function, including:
    1. Transfers
    2. Grooming
    3. Bathing
    4. Feeding
    5. Dressing
    6. Wheelchair mobility
    7. Bed activities
    8. Bowel program
    9. Bladder program
    10. Understanding of personal care (a questionnaire asking for the client’s understanding of skin care, nutrition, equipment, medications and infections).

QIF-Modified

  • The QIF-Modified comprises 3 of the 10 domains originally included in the QIF.
  • Includes the categories of grooming, bathing and feeding.
  • This version of the QIF includes the categories that relate directly to the upper extremity motor score assessment of ASIA.

QIF-SF

  • The clinician observes and assesses patient performance on only 6 ADLs to reduce redundancies.
  • Items include: wash/dry hair, turn supine to side in bed, lower extremity dressing, open carton/jar, transfer from bed to wheelchair and lock wheelchair.

Clinical Considerations

  • The QIF and its versions were designed for individuals with quadriplegia/ cervical SCI.
  • ASIA motor scores are strongly correlated to performance improvement on QIF scores.
  • It is not a comprehensive measure of upper extremity function or a predictor of independence in ADLs upon discharge.
  • It reflects small gains in function.
  • The QIF-SF is more practical to use than the original QIF, as the number of items has been reduced.

ICF Domain

Activity ▶ Self-Care

Administration

  • Clinicians observe the patient perform 37 ADLs like dressing, feeding, and bathing.
  • Scores are provided to give credit for level of assistance required, as well as being able to complete a portion of the task.
  • Administration takes less than 30 minutes when the assessor is familiar with the measure.

Number of Items

37

Equipment

None

Scoring

  • The functional performance categories are scored on a 5 point scale from 0 (dependent) to 4 (independent).
  • Each category of functional performance is calculated according to weighted scores – Functional performance categories:  /180; Understanding of personal care: /20;
  • Total score of 200 can be divided by 2 to yield a score out of 100.

Languages

English

Training Required

Does not require advanced training

Availability

The QIF worksheet can be found here.

Measurement Property Summary

Number of studies reporting psychometric properties: 4

Interpretability

  • Higher scores indicate greater independence in key activities of daily living.
  • No cut scores or normative data have been established for the SCI population.
  • However, published data for the SCI population is available for comparison (see the Interpretability section of the Research Summary sheet).
  • MCID: not established in SCI population
  • SEM: not established in SCI population
  • MDC: not established in SCI population

Reliability – Moderate to High

Number of studies reporting reliability data: 1

Moderate to High inter-rater reliability: r = 0.55-0.95

(Gresham et al. 1986; n=30; injury details not reported)

Validity – High

Number of studies reporting validity data: 3

  • High correlation with the Functional Independence Measure: r = 0.97 (p<0.001)
  • High correlation with the Functional Independence Measure (FIM)- Self-Care Items – Bathing, Grooming, and Feeding:
    • r = 0.91-0.96 (p<0.001)

(Yavuz et al. 1998: N = 29, 20M; mean age 37 years, age range 14-66years; C3-T1 tetraplegic (18 ASIA complete, 11 ASIA incomplete); mean time since injury to admission 20wks (range 2-72wks), average length of stay in rehab centre: 18±10.29 wks)

    • r = 0.75-0.94

(Marino et al. 1993; n=22; C4-C7, Frankel A-D patients with SCI between 3 and 12 months post-injury)

  • High correlation with the Functional Independence Measure (FIM)- Dressing, Transfers, Mobility, and Bowel/Bladder items: r = 0.87-0.99 (p<0.001)

(Yavuz et al. 1998: N = 29, 20M; mean age 37 years, age range 14-66years; C3-T1 tetraplegic (18 ASIA complete, 11 ASIA incomplete); mean time since injury to admission 20wks (range 2-72wks); average length of stay in rehab centre: 18±10.29 wks)

  • High correlation with the American Spinal Injury Association (ASIA)- Motor subscale: r = 0.91 (p<0.001)
  • High correlation with the ASIA-light touch: r = 0.64 (p<0.001)
  • High correlation with the ASIA-pinprick: r = 0.65 (p<0.01)

(Yavuz et al. 1998: N=29, 20M, mean age 37 years, age range 14-66years, C3-T1 tetraplegic (18 ASIA complete, 11 ASIA incomplete), mean time since injury to admission 20wks (range 2-72wks), average length of stay in rehab centre: 18±10.29 wks)

  • High correlation with the American Spinal Injury Association (ASIA)- Upper Extremity Motor subscale (UEMS):
    • r= 0.75-0.85 (p<0.001)

(Yavuz et al. 1998: N=29, 20M; mean age 37 years, age range 14-66years; C3-T1 tetraplegic (18 ASIA complete, 11 ASIA incomplete); mean time since injury to admission 20wks (range 2-72wks); average length of stay in rehab centre: 18±10.29 wks)

    • r= 0.84-0.90

(Marino et al. 1993: 22 C4-C7, Frankel A-D spinal cord injury patients between 3 and 12 months post-injury)

Responsiveness

QIF is sensitive in documenting functional improvements in quadriplegics – average improvements detected by QIF was 46%, while Barthel Index detected 20%.

(Gresham et al. 1986; n=30, injury details not reported)

Floor/Ceiling Effect

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

Reviewers

Dr. Carlos L. Cano-Herrera, Elsa Sun

Date Last Updated

December 31, 2024

 Administration

  • Clinician-administered; interview format
  • Scored on a 5 point scale from 0 (dependent) to 4 (independent).
  • Administration time is 5-10 minutes

Number of Items

6

Equipment

None

Scoring

Scores from the 6 items are summed and scores range from 0 to 24.

Languages

English

Training Required

Does not require advanced training

Availability

The QIF-SF worksheet can be found here.

The file above contains item details and scoring instructions, as well as a ready-to-use worksheet for data collection.

Measurement Property Summary

Number of studies reporting psychometric properties: 4

Interpretability

  • Higher scores indicate greater independence in key ADLs.
  • No cut-points or normative data for the SCI population have been established
  • Published data for the SCI population is available for comparison (see the Interpretability section of the Research Summary sheet).
  • MCID: not established in SCI population
  • SEM: not established in SCI population
  • MDC: not established in SCI population

Reliability – High

Number of studies reporting reliability data: 1

High internal consistency: α = 0.89

(Marino & Goin 1999; n=95; 85 males, 10 females; tetraplegia; mean age (SD): 32.1 (13.2) years; non-ambulatory @ 6 months)

Validity – Moderate to High

Number of studies reporting validity data: 3

  • High correlation with Quadriplegia Index of Function (QIF): r = 0.987 (p = 0.987)
  • High correlation with ASIA Upper Extremity Motor Score (UEMS): ρ = 0.824

(Marino & Goin 1999: N = 95 (85 male), tetraplegia; mean age (SD): 32.1 (13.2); non-ambulatory at 6 months)

  • Moderate correlation with health state related to upper-extremity impairment of participants: r = 0.313 (p = 0.03)

(Snoek et al. 2005: N = 47 tetraplegics (38M, 9F); mean age (SD): 42 (13); mean duration of injury (SD): 11 (9); 44% AIS A, 31% AIS B, 9% AIS C, 16% AIS D)

Responsiveness

Number of studies reporting responsiveness data: 1

There is a significant difference in QIF-SF scores across the 3 measurement times (start of rehab, 3 months after start of rehab, and discharge) for groups C3-C6 and C7-T1.

(Marino & Goin 1999, Spooren et al. 2006)

Floor/Ceiling Effect

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

Reviewers

Dr. Ben Mortenson, Dr. Carlos L. Cano-Herrera

Date Last Updated

December 31, 2024

 Administration

  • Clinician-administered; interview format
  • Administration time is approximately 10 minutes
  • The functional performance categories are scored 0-4 in order of increasing independence

Number of Items

14

Equipment

None

Scoring

Each category of functional performance is calculated according to weighted scores.

Languages

N/A

Training Required

Does not require advanced training.

Availability

Can be found in the appendix of the following article: https://pubmed.ncbi.nlm.nih.gov/8493037/

# of studies reporting psychometric properties: 1

Interpretability

  • Scores are provided to give credit for being able to complete a portion of the task rather than the entire task
  • The scores represent functional performance in activities rather than performance in component parts

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

Reliability – Moderate to High

Inter-correlations of items within the same category for each domain:

  • Grooming: r = 0.65-0.70
  • Bathing: r = 0.67-0.93
  • Feeding: r = 0.44-0.88

(Marino et al. 1993; n=22; 22 males; mean age 33 years; traumatic quadriplegia C4-C7 injury)

Validity – High

  • Correlation of the modified QIF and its subscales with the Functional Independence Measure (FIM) subscales and the Upper Extremity Motor Score (UEMS) subscales measuring the constructs were High
    • QIF-modified and FIM: r = 0.93
      • Subscale – Grooming: r = 0.94
      • Subscale – Bathing: r = 0.92
      • Subscale – Feeding:  r = 0.75
    • QIF-modified and UEMS: r = 0.91
      • Subscale – Grooming: r = 0.90
      • Subscale – Bathing: r = 0.84
      • Subscale – Feeding: r = 0.90
  • Feeding ability was assessed by the QIF significantly better than by the FIM (P<.01)

(Marino et al. 1993; n=22; 22 males; mean age 33 years; traumatic quadriplegia C4-C7 injury)

Responsiveness

No data on responsiveness was available for the QIF-modified.

Reviewers

Dr. Carlos L. Cano-Herrera, Elsa Sun

Date Last Updated

31 December 2024

Gresham GE, Labi ML, Dittmar SS, Hicks JT, Joyce SZ, Stehlik MA. The Quadriplegia Index of Function (QIF): sensitivity and reliability demonstrated in a study of thirty quadriplegic patients. Paraplegia 1986;24:38-44
http://www.ncbi.nlm.nih.gov/pubmed/3960588

Marino RJ, Goin JE. Development of a short-form Quadriplegia Index of Function scale. Spinal Cord 1999;37:289-296.
http://www.ncbi.nlm.nih.gov/pubmed/10338351

Marino RJ, Huang M, Knight P, Herbison GJ, Ditunno JF Jr, Segal M. Assessing selfcare status in quadriplegia: comparison of the quadriplegia index of function (QIF) and the functional independence measure (FIM). Paraplegia, 1993; 31:225-233.
http://www.ncbi.nlm.nih.gov/pubmed/8493037

Marino RJ, Rider-foster D, Maissel G, Ditunno JF. Superiority of motor level over single neurological level in categorizing tetraplegia. Paraplegia. 1995;33(9):510-3.
http://www.ncbi.nlm.nih.gov/pubmed/8524603

Spooren AI, Janssen-Potten YJ, Post MW, Kerckhofs E, Nene A, Seelen HA. Measuring change in arm hand skilled performance in persons with a cervical spinal cord injury: responsiveness of the Van Lieshout Test. Spinal Cord 2006; 44: 772-779.
http://www.ncbi.nlm.nih.gov/pubmed/16819555

Yavuz N, Tezyurek M, Akyuz M. A comparison of two functional tests in quadriplegia: the quadriplegia index of function and the functional independence measure. Spinal Cord 1998;36:832-837.
http://www.ncbi.nlm.nih.gov/pubmed/9881732

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