We have read the letter by Sharif-Alhoseini et al. with great interest. The authors highlighted an important point about measures of functional improvement in patients with spinal cord injury (SCI) and advocated the use of the latest version of spinal cord independence measure (SCIM III) instead of the functional independence measure (FIM). We would like to thank the authors for their precious contribution.

First of all, the FIM is currently presumably the most widely used clinical assessment tool for functional independence in various disabilities including SCI. Besides, the FIM was found to be valid and reliable for SCI as well as the SCIM III.1 However, there are some limitations of the FIM regarding with its use in SCI such as, insensitivity to small but functionally significant amount of change in neurologic recovery, ceiling and floor effects. The SCIM is the only outcome measure designed specifically for functional ability in SCI. Even there are some ceiling and floor effects noted for the SCIM III as well,2 we agree with the authors that the SCIM III is the most appropriate measure for functional assessment of persons with SCI. We could not include it in the study protocol, because Turkish adaptation of the SCIM III had not been studied. So the FIM was used as second best option. Unluckily, Turkish adaptation of the SCIM III was published after beginning of the study.3

To conclude, the SCIM III should be preferred as a more selective outcome measure for functional improvement in future SCI studies if cross-cultural validation has been done for the subjects.