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Rehab Measures: Community Integration Measure

Link to instrument

 

Title of Assessment

Community Integration Measure 

Acronym

CIM

Instrument Reviewer(s)

Initially reviewed by Anna de Joya, PT, MS, NCS, Coby D Nirider, PT, DPT, and the TBI EDGE task force of the Neurology Section of the APTA in 8/2012

Summary Date

12/10/2012 

Purpose

A client-centered survey of perceived connections with the community in 4 dimensions (general assimilation, support, occupation and independent living) developed from the words and ideas of individuals with TBI.

Description

  • 10-item measure of community integration that makes no assumptions about the relative importance of particular activities or relationships
  • Can be administered either face-to-face, by telephone, or by the participant
  • It requires only a basic literacy level, and can be easily administered in 3 to 5 minutes
  • It has been used in practice with a broad range of clients with various disabilities
  • Results in a single summary score (between 10 and 50) that is the unweighted sum of the 10 items, each with 5 response options; Maximum score is 50; higher score reflect higher levels of community integration
  • Each declarative statement is rated on a 5-point Likert scale (5-always agree, 4-sometimes agree, 3-neutral, 2-sometimes disagree, 1-always disagree)

Area of Assessment

 

Body Part

 

ICF Domain

Participation 

Domain

 

Assessment Type

 

Length of Test

05 Minutes or Less 

Time to Administer

5 minutes

Number of Items

10 items 

Equipment Required

None

Training Required

No training required

Type of training required

No Training 

Cost

Free 

Actual Cost

None

Age Range

 

Administration Mode

 

Diagnosis

Traumatic Brain Injury 

Populations Tested

  • Traumatic Brain Injury

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Not Established

Test-retest Reliability

Not Established

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Acquired Brain Injury: (McColl, et al, 2001; total n=92, acquired brain injury=41, college students=15, family members=36; mean age of ABI=35.4 (10.7); gender=male 58%, female 42%)

  • Excellent internal consistency (Cronbach’s alpha=0.87)
  • Excellent internal consistency for ABI (Cronbach’s alpha=0.83)
  • Adequate for College students (Cronbach’s alpha=0.78)
  • Excellent internal consistency for Family members (Cronbach’s alpha=0.92)
  • All items correlated positively with each other and with the total score
  • Adequate internal consistency for item to total correlations (0.416-0.714)

Acquired Brain Injury (CVA, TBI, tumor, encephalitis, aneurysm): (Reistetter et al, 2005; total n=91, ABI n=51, normal n=40; ABI mean age=38.82 (14.99); ABI gender=male 72.5%, ABI time since injury=1 years, 41.2%, 2 years: 37.3%, > 3 years: 21.6%)

  • Excellent internal consistency (Cronbach’s alpha=0.81)
  • Slightly higher internal consistency for individuals who sustained a brain injury −0.83, as compared to 0.72 for individuals without brain injury
  • By living arrangement: living independently, Cronbach’s alpha=0.80; residing in family homes, Cronbach’s alpha=0.82
  • Across gender: male, Cronbach’s alpha=0.82; female, Cronbach’s alpha=0.81

Acquired Brain Injury (MVA, aneurysm/CVA, Trauma, Other): (Minnes et al, 2003; n=64; mean age=36.7)

  • All ten items correlated positively with each other, and item-total correlations were between 0.28–0.66

Traumatic Brain Injury: (Griffen et al, 2010; n=279; mean age at time of assessment=44.9 (13.60); gender: male 80.6%)

  • Internal consistency estimate (Cronbach’s aplha) for the entire sample was .87.
  • Internal consistency by time since injury (Cronbach’s alpha): 1 year = .86, 2 years = .85, 5 years =.87, 10 years =.86, and 15 years = .90.

Criterion Validity (Predictive/Concurrent)

Acquired Brain Injury: (McColl et al, 2001; total n=92, acquired brain injury=41, college students=36, family members=15; mean age of ABI=35.4 (10.7); gender=male 58%, female 42%)

  • A positive correlation between the Community Integration Questionnaire (CIQ) and CIM (r=0.34)
  • There is some common variance between the 2 measures (12%) but do not duplicate each other’s content; authors suggest that CIQ emphasizes on independence while the CIM does not

Construct Validity (Convergent/Discriminant)

Acquired Brain Injury: (McColl, et al, 2001; total n=92, acquired brain injury=41, college students=36, family members=15; mean age of ABI=35.4 (10.7); gender=male 58%, female 42%)

  • A significant difference between groups (F 91,2 : 5.5, p < .006), with most marked difference between the participants with ABI and college students
  • A significant correlation between CIM and Interpersonal Support Evaluation List (ISEL) total, ISEL informational and ISEL emotional (See table below)

CIM
CIQ
ISEL Total
ISEL Instrumental
ISEL Informational
ISEL Emotional
CIM
1.00
CIQ
.343
1.00
ISEL Total
.425*
.344
1.00
ISEL Instrumental
.055
.264
.656+
1.00
ISEL Informational
.380*
.313
.856+
.528+
1.00
ISEL Emotional
.480*
.287
.911+
.390*
.640+
1.00
*p<.05; + p<.01

Acquired Brain Injury (CVA, TBI, tumor, encephalitis, aneurysm): (Reistetter et al, 2005; total n=91, ABI n=51, normal n=40; ABI mean age=38.82 (14.99); ABI gender=male 72.5%, ABI time since injury=1 years, 41.2%, 2 years: 37.3%, > 3 years: 21.6%)

  • Community Integration Questionnaire (CIQ-R): significant positive correlation was found (r = 0.343, n = 91, p = 0.001), indicating that there is 12% shared variance between the two community integration instruments
  • Satisfaction With Life Scale (SWLS): 27% shared variance was found with the SWLS (r = 0.515, n = 91, p < 0.001), showing a good correlation between the CIM and life satisfaction as measured by the SWLS
  • Of the ten items for the CIM, eight produced significant positive correlations with the SWLS total score
  • Significantly discriminate between samples (t(89) = 2.30, p = 0.024, CI 5.5–0.40)
  • The factor loading solution revealed a three-factor model that explained 63.72 % of the variance

CIM
SWLS
CIQ-Revised
Home
Social
CIM
SWLS
0.515**
CIQ-Revised
0.343**
0.327**
Home
0.096
0.070
0.805**
Social
0.579**
0.499**
0.701**
0.267*
Productivity
0.108
0.208*
0.679**
0.331**
0.335**
**p<0.01; *p<.05; p>0.05

Acquired Brain Injury (MVA, aneurysm/CVA, Trauma, Other): (Minnes et al, 2003; n=64; mean age=36.7; gender=male 79.7%)

  • The one factor principal components factor solution explained 35% of the variance
  • Correlations among reduced sub-scales and quality of life: The Assimilation, Integration, Marginalization, Segregation (AIMS) is negatively correlated with the two other scales, although only significantly with the CIQ-R; remaining correlations are all positive, but not statistically significant; none of the scales correlated with quality of life

AIMS
CIM
CIQ-R
QOL
AIMS
1.00
CIM
-0.180
1.00
CIQ-R
-0.291 (p<0.023)
0.045
1.00
QOL
-0.044
0.226
-0.006
1.00

Traumatic Brain Injury: (Griffen et al, 2010; n=279; mean age at time of assessment=44.9 (13.60); gender: male 80.6%)

  • Most strongly correlated with the SPS, a measure of social support (r = .51, p <.01)
  • Poor to Adequate correlations observed between the CIM and psychological and affective distress, the BSI-18 (rs from –.23 to –.37, p <.01), the SF-12 mental composite score (r =.37, p< .01), and the SWLS (r =.32, p <.01)
  • Poor correlations with the subscales of the CHART including Social Integration (r =.18, p <.01), Cognitive Independence (r = .14, p <.05), Mobility (r =.14, p< .05), and Occupation (r= .23, p <.01), as well as with the SF-12 physical composite score (r =.14, p < .05)
  • Not significantly correlated with the Physical Independence subscale of the Craig Handicap Assessment and Reporting Technique—short form (CHART) (r = .04, p<.49)
  • Poor to Adequate correlations at one year post-injury between the Occupation and Social Integration subscales of the CHART and the CIM (r = .44, p <.01; r = .33, p <.01, respectively); no significant correlations existed between the CIM and the Cognitive Independence and Mobility subscales
  • At 2 years post-injury: CIM did not correlate significantly with any of the CHART subscales, similarly, at 5 and 10 years
  • Post-injury, the CIM did not significantly correlate with the CHART, with the exception of the Cognitive Independence subscale (r =.31, p < .05; r =.28, p <.05, respectively)
  • At 5 and 15 years post-injury: the CIM was not significantly correlated with the SWLS, but it was at every other year.
  • CIM was significantly correlated with the SF-12 mental composite score for each year except year 5.
  • SF-12 physical composite score was significantly correlated with the CIM in years 2 and 5.
  • Until year 10, the CIM significantly correlated with each of the subscales and GSI of the Brief Symptom Inventory-18 (BSI-18)
  • At 15 years post-injury: the significant correlations with the CIM were the Mobility and Occupation subscales of the CHART, the SF-12 mental composite score, and the Social Provision Scale (SPS)
  • The CIM had significant correlations with the Social Provision Scale (SPS) at each time frame post-injury.

Content Validity

Acquired Brain Injury: (McColl et al, 2001; total n=92, acquired brain injury=41, college students=36, family members=15; mean age of ABI=35.4 (10.7); gender=male 58%, female 42%)

  • The empirical, qualitative process leading to model development was well conceived and exhaustive
  • The items on the CIM have a 1-to-1 relationship with concepts in the model
  • The items on the CIM were constructed by using the words of participants themselves, ensuring authenticity and credibility authenticity and credibility.

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

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 (VEDGE) 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 based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

NR

NR

NR

LS

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

 

 

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)

TBI EDGE

No

No

No

Not reported

Considerations

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Bibliography

Griffen, J. A., Hanks, R. A., et al. (2010). "The reliability and validity of the Community Integration Measure in persons with traumatic brain injury." Rehabil Psychol 55(3): 292-297. Find it on PubMed

McColl, M. A., Davies, D., et al. (2001). "The community integration measure: development and preliminary validation." Arch Phys Med Rehabil 82(4): 429-434. Find it on PubMed

Minnes, P., Carlson, P., et al. (2003). "Community integration: a useful construct, but what does it really mean?" Brain Inj 17(2): 149-159. Find it on PubMed

Reistetter, T. A., Spencer, J. C., et al. (2005). "Examining the Community Integration Measure (CIM): a replication study with life satisfaction." NeuroRehabilitation 20(2): 139-148. Find it on PubMed

Year published

 

Instrument in PDF Format

No 
Approval Status Approved 
 
Attachments
Created at 12/10/2012 4:07 PM  by Jason Raad 
Last modified at 9/3/2014 10:02 AM  by Jason Raad