Spinal Cord Independence Measure III (SCIM III)

A functional independence measure designed specifically for spinal cord injury.

Clinician-rated, from observation or interview. 30 minutes by observation, 10 to 15 by interview.
17 items across 3 subscales. Two items are scored in two parts, so there are 19 questions to answer.
Self-care 0 to 20. Respiration and sphincter management 0 to 40. Mobility 0 to 40.
Total 0 to 100; higher scores indicate greater independence.

Psychometrics

Inter-rater reliabilityICC 0.95 to 0.98

Internal consistencyα 0.83 to 0.89

Self-report against clinician ratingρ 0.87 to 0.95

Inter-rater reliability and internal consistency from the SCIM III multi-centre international study (Itzkovich and colleagues, 2007), 425 patients in six countries. Self-report agreement from Fekete and colleagues (2013). Higher is better.

What does the SCIM measure?

The SCIM III covers three functional domains. Self-care includes feeding, bathing, dressing, and grooming. Respiration and sphincter management covers breathing, bladder, bowel, and use of the toilet. Mobility covers bed mobility and transfers, then locomotion in the room, indoors, and outdoors. Items are weighted to reflect how much each task matters to daily life after a spinal cord injury.

How is the SCIM calculated?

Each question is scored on its own scale, and the scales are deliberately unequal. The shortest run 0 to 2. Bladder management runs 0 to 15. Add the questions inside a subscale to get the subscale score, then add the three subscales to get the total.

SCIM III subscales, what each covers, and its score range
Subscale	What it covers	Range
Self-care	Feeding, bathing, dressing, grooming	0 to 20
Respiration and sphincter management	Respiration, bladder, bowel, use of toilet	0 to 40
Mobility	Bed mobility and transfers, indoor and outdoor locomotion, stairs	0 to 40
Total	The three subscales added together	0 to 100

Because the weights are unequal, a point is not a point. Fifteen of the 100 available points sit in bladder management alone, and the whole self-care subscale is worth 20.

What does a SCIM score mean?

Higher totals mean greater independence, and the subscale scores show where the difficulty sits. There are no published severity bands. What is published is what people at each level of injury typically score. These are median SCIM III totals at admission to and discharge from rehabilitation, in a cohort of 114 people reported in the SCIRE clinician summary.

Median SCIM III total scores at rehabilitation admission and discharge, by level of injury
Level of injury	Median at admission	Median at discharge
C1 to C4	19.0	19.0
C5	21.5	23.5
C6	25.5	34.5
C7 to C8	39.5	50.0
T1 to T6	53.5	63.0
T7 to T12	61.0	66.0

A change of 4.2 points on the total is the smallest that is clinically meaningful, and 8.2 points is the smallest change that exceeds measurement error. The score is reference information for the care team, tracked over time.

How the SCIM is administered

Administered by: A clinician, scoring from observation of the tasks or from an interview
Time to administer: 30 minutes by observation, 10 to 15 minutes by interview
Cost: Free to take here.
Published by: SCIRE Project
Self-report version: The SCIM-SR, which agrees with clinician scoring at rho 0.87 to 0.95
Available languages: SCIM III in English, Italian, Chinese, Korean, Persian, Greek, Thai, Turkish, Brazilian Portuguese, and Spanish

Which conditions is the SCIM used for?

Spinal cord injury

Related instruments

SCIM questions, answered

How do you calculate a SCIM score?

Score each question on its own scale, then add. Self-care sums to a maximum of 20, respiration and sphincter management to 40, and mobility to 40. The three subscales add to a total out of 100. The scales are unequal by design, from 0 to 2 at the shortest up to 0 to 15 for bladder management, so the total already carries the weighting.

What is a good SCIM score?

There are no published severity bands, and what counts as a good score depends on the level of injury. In one rehabilitation cohort, people with a C1 to C4 injury had a median total of 19 at discharge, people with a C7 to C8 injury a median of 50, and people with a T7 to T12 injury a median of 66.

How long does the SCIM take?

About 30 minutes if the clinician observes the tasks, or 10 to 15 minutes by interview.

Who can administer the SCIM?

A clinician, scoring from observation or interview. There is also a validated self-report version, the SCIM-SR, which agrees closely with clinician scoring.

Is the SCIM free?

Yes. It is free to take here. The full instrument is published in the SCIRE SCIM Toolkit by the SCIRE Project.

How much change on the SCIM is meaningful?

4.2 points on the total is the smallest clinically important difference. 8.2 points is the smallest change that can be distinguished from measurement error.

How does the SCIM compare with the Barthel Index and the FIM?

It correlates highly with both, 0.88 with the Modified Barthel Index and 0.80 to 0.84 with the Functional Independence Measure. It was built for spinal cord injury, so it weights respiration and sphincter management, which the general scales do not.

Evidence, psychometrics and provenance

Created by Amiram Catz, Malka Itzkovich, and colleagues in 1997. The current edition is SCIM III, validated across 425 patients in 13 units in six countries.

Agreement with the Functional Independence Measure: r 0.80 to 0.84
Agreement with the Modified Barthel Index: r 0.88
Minimal clinically important difference: 4.20 points on the total (Scivoletto 2013, via the SCIRE clinician summary)
Minimal detectable change: 8.20 points on the total (Scivoletto 2013, via the SCIRE clinician summary)

References

This assessment uses a validated instrument and is reference information, not a diagnosis.