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Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)

Year, Volume, Issue, Page(s):

, 38, 3, 288-302


Article describes the development and psychometric characteristics of the Spinal Cord Injury – Quality of Life (SCI-QOL) Bowel Management Difficulties and Bladder Management Difficulties item banks, and a short scale to measure bladder complications. Using a mixed-methods design, a pool of items assessing bladder and bowel-related concerns were developed using interviews and focus groups with individuals with spinal cord injury (SCI) and SCI clinicians. Items were revised based on expert review and patient feedback and then field tested. Thirty-eight bladder items and 52 bowel items and other item pools related to physical-medical health were administered to 757 individuals with SCI. Analyses included confirmatory factor analysis (CFA), graded response IRT modeling and evaluation of differential item functioning (DIF). The final item banks demonstrated unidimensionality and acceptable fit to a graded response IRT model. The final calibrated Bladder Management Difficulties bank includes 15 items, and the final Bowel Management Difficulties item bank consists of 26 items. Additionally, 5 items related to urinary tract infections (UTI) did not fit with the larger Bladder Management Difficulties item bank but performed relatively well independently and were thus retained as a separate scale. Results indicate that the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks are psychometrically robust and are available as computer adaptive tests or short forms. The SCI-QOL Bladder Complications scale is a brief, fixed-length outcomes instrument for individuals with a UTI.


Tulsky, David S., Kisala, Pamela A., Tate, Denise G., Spungen, Ann M., Kirshblum, Steven C.