• Developed in 1980 to provide a functional assessment that would be useful in documenting the small but clinically significant gains made by quadriplegics throughout in-patient rehabilitation.
  • Assesses 10 ADLs:

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.
These represent functional performance activities.

  • The final area is a questionnaire – designed to assess the client’s understanding of skin care, nutrition, equipment medications and infections.

Clinical Considerations

The QIF was designed for individuals with tetraplegia due to SCI.

ICF Domain

Activity ▶ Self-Care

Administration

  • Clinician-administered; interview format.
  • Scores are provided to give credit for being able to complete a portion of the task rather than the entire 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

Can be found by contacting the author (Dr. Glen E Gresham at Erie County Medical Centre) or within the following article: The quadriplegia index of function (QIF): sensitivity and reliability demonstrated in a study of thirty quadriplegic patients | Spinal Cord (nature.com).

# of studies reporting psychometric properties: 2

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

Reliability

Inter-rater reliability ranges from Moderate to High (r = 0.55-0.95).

(Gresham et al. 1986)

Validity

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

(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)

p = 0.75-0.94

(Marino et al. 1993: 22 C4-C7; Frankel A-D spinal cord injury patients 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
    p = 0.64
  • High Correlation with the ASIA-light touch p = 0.64
  • High Correlation with the ASIA-pinprick p = 0.65

(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)
    p= 0.75-0.85

(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)

       p= 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)

Floor/Ceiling Effect

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

Reviewers

Dr. Ben Mortenson, Kyle Diab, Gita Manhas

Date Last Updated

22 July 2020

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, 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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