• The Spinal Cord Ability Ruler provides clinician-administered interval scale to measure volitional performance after SCI. Specifically, it measures voluntary physical movements that contribute to independence in daily living including self-care, transfer and mobility items.
  • The SCAR uses a combination of existent spinal cord injury measures and is administered by a clinician. Items were selected and adjusted from the ISNCSCI and SCIM, allowing for good measurement properties and a validated linear interval-level measure with repeatable precision across a broad range of SCI levels and severities.
  • The SCAR changes the scoring options for the various SCIM items so that there are less scale numbers, making it easier for the patient to differentiate from the various scoring options.

ICF Domain

Body Function ▶ Performance

Administration

Volitional SCAR items were rated on a scale of 0 (complete dependence on assistance from others) to 3 (independence without devices), C5-C8 muscle contractions were scored from 0 (no muscle activity) to 2 (functional muscle activity).

Number of Items

24 Items

Equipment

None

Languages

English

Training Required

No advanced training required

Availability

Items are embedded in “Spinal cord ability ruler: an interval scale to measure volitional performance after spinal cord injury” on page 734.

# of studies reporting psychometric properties: 1

Interpretability

MCID: The range of MCID value of each subgroup was:

  • 4 with a range of 0.4 to 4.45 for individuals with C5–C8 AIS A, B and C.
  • 4 with a range of 0.39 to 4.35 for individuals with C1-C4 AIS A, B and C.
  • 4 with a range of 0.37 to 4.15 for individuals with AIS D at any injury level.
  • 2 with a range of 0.2 to 2.2 for individuals with T1- S3 AIS A, B and C.

SEM: not established in SCI
MDC: The MDC95 value of each subgroup was:

  • 10 for individuals with C5-8 AIS A, B and C.
  • 08 for individuals with C1–4 AIS A, B and C.
  • 03 for individuals with AIS D at any level.
  • 55 for individuals with T1–S3 AIS A, B and C.

(Chaidaroon et al. 2023, n=311; 224 males, 87 females; mean age: 47.7 age; 98 ASIA A, 46 ASIA B, 69 ASIA C, 98 ASIA D; 137 tetraplegia, 174 paraplegia; and median (IQR) time since injury: 84.4 (19-87) days)

Reliability

  • Internal consistency of the SCAR is high (α = 0.97)

(Reed et al. 2017; n=2777; 79% male; age range at injury: 13-94, 45% tetraplegia, 55% paraplegia)

  • Test-retest Reliability of the SCA is high (ICC = 0.998)

(Chaidaroon et al. 2023, n=311; 224 males, 87 females; mean age: 47.7 age; 98 ASIA A, 46 ASIA B, 69 ASIA C, 98 ASIA D; 137 tetraplegia, 174 paraplegia; and median (IQR) time since injury: 84.4 (19-87) days)  

Validity

No studies reporting validity data.

Responsiveness

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

Floor/Ceiling Effect

  • Ceiling effects of 3%
  • Floor effects of 2.4% observed in the data set

(Reed et al. 2017; n=2777; 79% male; age range at injury: 13-94, 45% tetraplegia, 55% paraplegia)

Reviewers

Dr. Vanessa Noonan, Dr. Carlos L. Cano-Herrera, Tyra Chu

Date Last Updated

31 December 2024

Chaidaroon C, Phinyo P, Pattanakuhar S, Tongprasert S. Minimal clinically important difference (MCID) and minimal detectable change (MDC) of Spinal Cord Ability Ruler (SCAR). Spinal Cord. 2023;61(12):652-657.
https://pubmed.ncbi.nlm.nih.gov/37752176/

Reed R, Mehra M, Kirshblum S, Maier D, Lammertse D, Blight A, Rupp R, Jones L, Abel R, Weidner N; EMSCI Study Group; SCOPE, Curt A, Steeves J. Spinal cord ability ruler: an interval scale to measure volitional performance after spinal cord. Spinal Cord. 2017 Aug;55(8):730-738. injury.
https://www.nature.com/articles/sc20171

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