• Developed to provide clinically useful information pertinent to the different levels of the disablement process
  • Suitable for people with SCI and was designed to correspond closely in wording, format, and scoring to the Functional Independence Measure (FIM)
    • While the FIM provides seven levels of measurement of 13 motor functions (basic activities of daily living (ADL)) and measurements of cognitive and communication functions, the SRFM has four-level response categories to 13 items of basic ADL and 5 items of instrumental ADL. The cognitive and communications domains were excluded due to difficulties with accurate self-report of these items
  • Covers personal functioning such as moving around indoors and personal hygiene
  • Scores of the SRFM can indicate the amount of assistance (burden of care) an individual requires. This may be useful when monitoring treatment efficacy after rehabilitation or when the individual has returned to the community.

Clinical Considerations

  • The SRFM is comprehensible to persons with a fourth grade reading level
  • This scale has been adapted specifically for the SCI population from the FIM

ICF Domain

Activity ▶ Self-Care

Administration

Self-report or interview; can be administered either in person or by mail.

Number of Items

13 items of basic ADL, 5 items of instrumental ADL, 8 items of disease severity, and 1 item of resource utilization.

Equipment

None

Scoring

  • The 4-point scale is as follows: 4 = no extra time or help, 3 = extra time or special tool, 2 = some help, and 1 = total help or never do
  • Questions are asked based on an average day and the individual’s usual way of doing the activity
  • Total scores (13-52) are derived by summing the scores from each question

Languages

English

Training Required

No advanced training is required.

Availability

The Self-Reported Functional Measure worksheet can be found here.

# of studies reporting psychometric properties: 3

Interpretability

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

  • Lower scores indicate greater need for assistance.

Typical Values

  • Odds Ratios for Health Care Utilization of Lowest SRFM Quartile Patients (SRFM 13-22) vs. Highest SRFM Quartile Patients (SRFM 43-52) (95% CI):
    Hospitalized: 1.91 (1.71-2.13)
    *Died in hospital: 2.41 (1.62-3.58)
    *Hospital length of stay >7 days: 2.18 (1.85-2.57)
    *Discharged to institution: 2.86 (2.00-4.08)

*Of those hospitalized

(Hoenig et al. 2001; N=8150 (3.7% female); data from SCD National Veterans Survey; N=6361 SCI (2.4% female), N=1789 MS (8.5% female); mean age: 52.9 years, mean duration of diagnosis: 20 years)

  • Interpretability: Relation between hours of personal assistance and SRFM score:

Hours of personal assistance per day:

Total [% (n)]

Lowest SRFM Tertile [% of tertile (n)]

Middle SRFM Tertile [% of tertile (n)]

Highest SRFM Tertile [% of tertile (n)]

No help 40.6 (2580) 7.5 26.3 66.2

≤ 2 hrs/day

 15.9 (1010) 14.0 55.9 30.1

2 – 4 hrs/day

 19.4 (1234) 47.8 42.4 9.8

> 4 hrs/ day

 21.1 (1340) 83.6 14.1 2.3

Total [% overall (n)]

100 (6361) 32.1 (2045) 30.7 (1956) 34.0 (2163)

(Hoenig et al. 1999: n=6361; from the SCD National Veterans Survey Traumatic SCI)

Reliability

  • Moderate to High Kappa coefficients:
    ≥0.65 for all but one item:
    Mobility at Home = 0.052 (p = 0.003).
  • High Intraclass correlation (95% CI):
    Answered every SRFM item = 0.90 (0.88).
    Traumatic injury = 0.92 (0.91).
    Disease = 0.87 (0.84).
    Trauma & disease = 0.92 (0.89).
    Memory deficits = 0.86 (0.80).
    Memory intact = 0.91 (0.89).
    History of head injury = 0.85 (0.80).
    No head injury = 0.91 (0.89).

(Hoenig et al. 1998; N=725 (dual respondents); 48.14% Traumatic, 26.90% Disease, 23.86% Disease & Trauma; data from veterans discharged from a VA medical center <5 years OR included on lists from the Paralyzed Veterans of America)

Validity

  • High correlation with Spinal Cord Injury – Functional Index (SCI-FI):
    r = 0.69 – 0.89 (p < 0.01)

(Tyner et al. 2022; N=269; 193 male; mean (SD) age 43.8 (15.5) years; mean (SD) time since injury 6.8 (8.7) years)

Responsiveness

No values were reported for the reliability of the SRFM for the SCI population.

Floor/Ceiling Effect

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

Reviewer

Dr. William Miller, Dr. Carlos L. Cano-Herrera, Tyra Chu

Date Last Updated

31 December 2024

Hoenig H, Mclntyre L, Sloane R, Branch LG, Truncali A, Homer RD. The Reliability of a Self-Reported Measure of Disease, Impairment, and Function in Persons With Spinal Cord Dysfunction. Arch Phys Med Rehabil. 1998; 79.
https://pubmed.ncbi.nlm.nih.gov/9552102/

Hoenig H, Branch LG, McIntyre L, Hoff J, Horner RD. The validity in persons with spinal cord injury of a self-reported functional measure derived from the Functional Independence Measure. Spine, 1999; 24(6):539-543.
http://www.ncbi.nlm.nih.gov/pubmed/10101817

Hoenig H, Hoff J, McIntyre L, Branch LG. The Self-Reported Functional Measure: Predictive Validity for Health Care Utilization in Multiple Sclerosis and Spinal Cord Injury. Arch Phys Med Rehabil. 2001; 82.
https://pubmed.ncbi.nlm.nih.gov/11346837/

Tyner C, Kisala PA, Heiemann AW, Fyffe D, Tate DG, Slavi MD, Jette AM, Tulsky DS. Validation of the Spinal Cord Injury-Functional Index for Use in Community-Dwelling Individuals With SCI. Arch Phys Med Rehabil. 2022;103(2):191-198
https://pubmed.ncbi.nlm.nih.gov/33453193/

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