Quadriplegia Index of Function

Last Updated

January 17, 2013

Purpose

Assesses ADL's performed with the hands among non-ambulatory individuals with cervical SCI.

Link to Instrument

Instrument details

Acronym QIF

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

Spinal Cord Injury

Spinal Injuries

The Quadriplegia Index of Function (QIF) was developed because the Barthel Index was found to be insensitive to small functional gains made by tetraplegics during rehabilitation.
The QIF can be administered by interview or observation.
The QIF is assesses 10 ADL's:
1) Transfers
2) Grooming
3) Bathing
4) Dressing
5) Feeding
6) Mobility
7) Bed activities
8) Bladder program
9) Bowel program
10) Understanding of Personal care
Each motor task is scored from 0 to 4 in order of increasing independence. The bladder and bowel program have separate sets of scoring criteria.
The maximal total score of 200 added from the functional categories (180 points) and personal care (20 points) is divided by 2 for a score out of 100 points.
Each category score is weighed to contribute a different percentage to the total score.

Number of Items

up to 30 minutes

Required Training

No Training

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated by Eileen Tseng, PT, DPT, NCS, Rachel Tappan, PT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 4/2012

Body Part

Upper Extremity

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
*LS / UR*	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations for use based on acuity level of the patient:

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

Recommendations based on SCI AIS Classification:

	AIS A/B	AIS C/D
SCI EDGE	LS	LS

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
SCI EDGE	No	No	Yes	Not reported

Considerations

The QIF has been used in several cultures including: Turkey, Serbia, USA and New Zealand. (Anderson, et al., 2008)
The QIF is available in its original form and a shorter 6-item form (see Marino & Goin, 1999)
The QIF includes items that may not be applicable throughout all rehab programs (Marino & Goin, 1999)

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Interrater/Intrarater Reliability

The QIF was specifically designed for SCI patients and is focused on persons with tetraplegia

SCI: (Gresham et al., 1986; n= 30 subjects with complete tetraplegia; 3 raters assessing 20 subjects)

Adequate to Excellent interrater reliability of each category (r = 0.55 - 0.95)

Criterion Validity (Predictive/Concurrent)

Traumatic SCI: (Yavuz et al, 1998; n = 29; mean age = 37 [range = 14 to 66] years; average hospital stay = 20 weeks)

Excellent correlation of total scores for QIF and FIM (r = 0.97)

Construct Validity

Chronic SCI: (Marino et al., 1995; n = 50; age range = 16 to 68 years; completeness of injury: Frankel grade A = 36 subjects, Frankel grade B = 14 subjects; assessed at 12 months post injury)

QIF feeding scores have Excellent correlation with AIS measures of motor impairment (r = 0.72-0.78) and Adequate correlation with neurological level (r = 0.56)

Traumatic SCI : (Yavuz et al, 1998)

Excellent correlation of QIF functional scores with AIS motor scores (r = 0.79 to 0.91), AIS light touch (r = 0.64), and AIS pinprick (r = 0.65)
Excellent correlation of QIF scores and UEMS scores in self care categories (r = 0.75 to 0.85)

Traumatic SCI: (Marino et al., 1993; n = 22; mean age = 33 years; completeness of injury: Frankel grade A = 4 subjects, Frankel grade B = 11 subjects, Frankel C = 2 subjects, and Frankel D = 5 subjects; assessed at 3, 6, and 12 months post injury)

UEMS score had excellent correlation with QIF grooming, bathing and feeding scores (0.84-0.90) and FIM grooming and bathing (0.75-0.91) however, adequate correlation with FIM feeding score (r = 0.53)

Face Validity

The QIF was developed by an experienced multidisciplinary SCI team (Grasham et al, 1986)

Floor/Ceiling Effects

Possible ceiling effect in individuals with good hand function and low cervical injury (Anderson et al, 2008)

Responsiveness

Traumatic SCI: (Yavuz et al, 1998)

AIS motor score had excellent correlation with percent gain in QIF (r = 0.68) while only adequate correlation with percent gain in FIM score (r = 0.38)

SCI: (Gresham et al, 1986)

The QIF was more sensitive (with 46% improvement during inpatient rehabilitation) than the Kenny Self Care Evaluation (30% improvement) or the Barthel Index (20% improvement).

Bibliography

Alexander, M. S., Anderson, K. D., et al. (2009). "Outcome measures in spinal cord injury: recent assessments and recommendations for future directions." Spinal Cord 47(8): 582-591. Find it on PubMed

Anderson, K., Aito, S., et al. (2008). "Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research." J Spinal Cord Med 31(2): 133-144. Find it on PubMed

Gresham, G. E., Labi, M. L., et al. (1986). "The Quadriplegia Index of Function (QIF): sensitivity and reliability demonstrated in a study of thirty quadriplegic patients." Paraplegia 24(1): 38-44. Find it on PubMed

Marino, R. J. and Goin, J. E. (1999). "Development of a short-form Quadriplegia Index of Function scale." Spinal Cord 37(4): 289-296. Find it on PubMed

Marino, R. J., Huang, M., et al. (1993). "Assessing selfcare status in quadriplegia: comparison of the quadriplegia index of function (QIF) and the functional independence measure (FIM)." Paraplegia 31(4): 225-233. Find it on PubMed

Marino, R. J., Rider-Foster, D., et al. (1995). "Superiority of motor level over single neurological level in categorizing tetraplegia." Paraplegia 33(9): 510-513. Find it on PubMed

Yavuz, N., Tezyurek, M., et al. (1998). "A comparison of two functional tests in quadriplegia: the quadriplegia index of function and the functional independence measure." Spinal Cord 36(12): 832-837. Find it on PubMed