Reintegration to Normal Living Index (RNLI)

Evidence Reviewed as of before: 19-08-2008
Author(s): Elissa Sitcoff, BA BSc
Editor(s): Nicol Korner-Bitensky, PhD OT; Lisa Zeltzer, MSc OT

Purpose

The Reintegration to Normal Living Index (RNLI) was developed to assess, quantitatively, the degree to which individuals who have experienced traumatic or incapacitating illness achieve reintegration into normal social activities (e.g. recreation, movement in the community, and interaction in family or other relationships). Reintegration to normal living was defined by the scale authors as the “reorganization of physical, psychological, and social characteristics of an individual into a harmonious whole so that one can resume well-adjusted living after incapacitating illness or trauma” (Wood-Dauphinee & Williams, 1987).

The RNLI has been tested for use with individuals with stroke, malignant tumors, degenerative heart disease, central nervous system disorders, arthritis, fractures and amputations; spinal cord injury; traumatic brain injury; rheumatoid arthritis; subarachnoid hemorrhage; hip fracture; physical disability; and community-dwelling elderly.

In-Depth Review

Purpose of the measure

The Reintegration to Normal Living Index (RNLI) was developed to assess, quantitatively, the degree to which individuals who have experienced traumatic or incapacitating illness achieve reintegration into normal social activities (e.g. recreation, movement in the community, and interaction in family or other relationships). Reintegration to normal living was defined by the scale authors as the “reorganization of physical, psychological, and social characteristics of an individual into a harmonious whole so that one can resume well-adjusted living after incapacitating illness or trauma” (Wood-Dauphinee & Williams, 1987).

The RNLI has been tested for use with individuals with stroke, malignant tumors, degenerative heart disease, central nervous system disorders, arthritis, fractures and amputations; spinal cord injury; traumatic brain injury; rheumatoid arthritis; subarachnoid hemorrhage; hip fracture; physical disability; and community-dwelling elderly.

Available versions

The RNLI was developed by Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer in 1988.

Features of the measure

Items:

The RNLI index is made up of 11 declarative statements (e.g. I move around my living quarters as I feel necessary), including the following domains: indoor, community, and distance mobility; self-care; daily activity (work and school); recreational and social activities;; family role(s); personal relationships; presentation of self to others and general coping skills. The first 8 items represent ‘daily functioning’ and the remaining 3 items represent ‘perception of self’.

Scoring:

Each domain is accompanied by a visual analogue scale (VAS) (0 to 10 cm). The VAS is anchored by the statements “does not describe my situation” (1 or minimal integration) and “fully describes my situation” (10 or complete integration). Individual item scores are summed to provide a total score out of 110 points that is proportionally converted to create a score out of 100.

Three- and 4-point categorical scoring systems were also developed (Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer, 1988), and the 3-point categorical system has been used in the evaluation of stroke patients (Mayo et al., 2000; Mayo et al., 2002). In the 3-point system, an additional category is inserted between the two anchor points (“partially describes my situation”) and the respondent selects the most applicable of the three categories. This option yields total scale scores from 22-0, with higher scores indicating poorer reintegration (Mayo et al., 2000, Mayo et al., 2002).

Time:

The time to administer depends on the mode of administration (e.g. self-administration, interviewer-administration, proxy, postal, etc.) and the participant’s abilities, but typically takes less than 10 minutes to complete.

Subscales:

There are two subscales to the RNLI: Daily Functioning (indoor, community, and distance mobility; self-care; daily activity (work and school); recreational and social activities; general coping skills) and Perception of Self (family role(s); personal relationships; and presentation of self to others.).

Equipment:

Only the test and a pencil are required to complete the RNLI.

Training:

The RNLI requires no training to administer.

Alternative forms of the Reintegration to Normal Living Index

  • Reintegration to Normal Living Index – Postal Version (RNLI-P) was developed by Daneski, Coshall, Tilling, and Wolfe in 2003.
    This measure modified the original RNLI in phrasing and scoring for use by post with stroke patients. The RNLI – P uses an agree/disagree format (0=disagree, 1= agree).
  • There are also versions created with minor modifications in wording to the original RNLI for: individuals who use adaptive devices motor aids or human assistance where the use of equipment and resources are clarified; use by health care professionals; and use by significant others (Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer,1988).

Client suitability

Can be used with:

Patients with stroke.

Should not be used with:

The use of a visual analogue scale may not be appropriate for the assessment of some stroke patients (i.e. those with attentional deficits or visual impairments or difficulty comprehending the meaning of a VAS). Instead, the use of the 3- or 4-point categorical scoring system is recommended.

In what languages is the measure available?

The RNLI is available in Canadian English and Canadian French (Wood-Dauphinee & Williams, 1987; Wood-Dauphinee, Opzoomer, Williams, Marchand, & Spitzer, 1988).

Please click here to access the french language version. A research version is also available.

Summary

What does the tool measure? The degree to which individuals who have experienced traumatic or incapacitating illness achieve reintegration into normal social activities.
What types of clients can the tool be used for? The RNLI has been tested for use with individuals with stroke, malignant tumors, degenerative heart disease, central nervous system disorders, arthritis, fractures and amputations; spinal cord injury; traumatic brain injury; rheumatoid arthritis; subarachnoid hemorrhage; hip fracture; physical disability; and community-dwelling elderly.
Is this a screening or assessment tool? Assessment
Time to administer The amount of time it takes to administer the RNLI is dependent upon mode of administration and participant’s abilities but should take approximately 10 minutes.
Versions
  • Reintegration to Normal Living Index ( RNLI)
  • Reintegration to Normal Living Index- Postal Version (RNLI-P).
  • There are also versions created with minor modifications in wording to the original RNLI for: individuals who use adaptive devices motor aids or human assistance where the use of equipment and resources are clarified; use by health care professionals; and use by significant others.
  • The original RNLI index is made up of 11 declarative statements Three- and 4-point categorical scoring systems are also available.
Other Languages Canadian French (Please click here to access the french language version. A research version is also available.)
Measurement Properties
Reliability

Internal consistency:

Six studies have examined the internal consistency of the RNLI. Four reported excellent Cronbach’s alphas. One reported excellent Cronbach alphas for the total RNLI patient and significant other score as well as for the patient score on the Perception of Self subscale, adequate Cronbach alphas for the Daily Functioning subscale for both patient and significant other score, as well as on the significant other score on the Perception of Self subscale. One study reported adequate to excellent Cronbach alphas.

Test-retest:

Three studies have examined the test-retest reliability of the RNLI and reported adequate test-retest agreement between items using kappa statistics, and excellent test-retest on the global score using correlation coefficients.

Intra-rater:

No studies have examined the intra-rater reliability of the RNLI.

Inter-rater:

No studies have examined the inter-rater reliability of the RNLI.

Validity

Construct:

Convergent/Discriminant:

Excellent correlations between the total score of the RNLI-P and the Frenchay Activities Index (FAI), the Short Form 36 Health Survey (SF-36) and with the Hospital Anxiety and Depression Scale-Depression subscale (HADS). Excellent correlations between the Daily Function subscale of the RNLI-P and the FAI and the SF-36. Poor correlations between the RNLI-P Daily Functioning subscale and the HADS-Anxiety subscale as well as between the Perceptions of Self subscale and both the FAI and the Barthel Index.

Excellent correlation between the RNLI and the Quality of Life Index (QL) and with a measure of psychological wellbeing. Excellent correlation between Daily Functioning subscale and with Quality of Life Index items Activity and Daily Living. Adequate correlations between Perceptions of Self subscale and Support and Outlook items from the Quality of Life Index. Strong correlation between the RNLI and the Participation Survey/Mobility (PARTS/M). A positive relationship between the Health Options Scale and the RNLI for stroke survivors well as a positive relationship between the Herth Hope Index and the RNLI for both stroke survivors and their spouses.

Adequate correlation between the RNLI and items on the subscale related to physical performance of the Prosthetic Profile of the Amputee (PPA) with the exception of the item “active use of the prosthesis indoors” which was poor. No correlation between items of the Perception of Self subscale of the RNLI with items on the subscale related to physical performance of the PPA with the exception of prosthetic wear which was adequate. Adequate to excellent correlations between items of the total RNLI with items in the subscale related to Physical performance of the PPA with the exception of items “Active use indoors” and “Active use outdoors” which had non-significant correlations.

Poor to adequate correlations between items of the total RNLI, and its two subscales with items on the PPA subscale related to acceptance of amputation and prosthesis.

Significant correlations between the RNLI and the Functional Independence Measure (FIM).

Adequate to excellent correlations between scores the total RNLI and the Daily Functioning subscale with patient (with Rheumatoid arthritis) age, number of affected joints, the Functional Independence Measure (FIM), the Lee Index (pain, fatigue, and stiffness), and the American Rheumatism Association Classification. The total RNLI was also adequately correlated to disease duration.

Acceptability The use of the 3 or 4 point categorical scoring system may be more appropriate for the assessment of some stroke patients than the visual analogue scale
Feasibility The administration of the RNLI is quick and simple and requires no training to administer. The RNLI index is made up of 11 declarative statements representing the domains ‘daily functioning’ (indoor, community, and distance mobility; self-care; daily activity (work and school); recreational and social activities;; family role(s); personal relationships; and ‘perception of self'(presentation of self to others, general coping skills. Each domain is accompanied by a visual analogue scale (VAS) (0 to 10 cm). The VAS is anchored by the statements “does not describe my situation” (1 or minimal integration) and “fully describes my situation” (10 or complete integration). Individual item scores are summed to provide a total score out of 110 points that is proportionally converted to create a score out of 100.
How to obtain the tool? The RNLI is available by clicking here.

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Reintegration to Normal Living Index (RNLI).

Floor/Ceiling Effects

Not yet examined.

Reliability

Internal consistency:

Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer (1988) administered the RNLI to three samples of patients with varied diagnoses to determine internal consistency. The RNLI was completed by patients, significant others, and healthcare professionals. The Cronbach’s alphas were excellent for patients, significant others, and health care professionals (alpha = 0.90, 0.92, and 0.95, respectively). Corrected item to total correlations ranged from 0.39 (patient assessment of “comfort with self-care needs”) to 0.75 for patients, 0.61 to 0.87 for significant others, and 0.70 to 0.90 for health professionals.

Tooth, McKenna, Smith, and O’Rourke (2003) administered the RNLI to 57 pairs of patients and significant others six months after stroke rehabilitation. Cronbach’s alphas were excellent for the total RNLI patient and significant other scores (alpha = 0.80 and 0.81, respectively). For the Daily Functioning subscale, adequate Cronbach’s alphas were found for both patient and significant other scores (alpha = 0.71 and 0.73, respectively). For the Perception of Self subscale, Cronbach’s alpha was excellent for patient scores (alpha = 0.84) and adequate for significant other scores (alpha = 0.76).

Steiner et al. (1996) examined the internal consistency of the RNLI in two samples of community-dwelling persons aged 75 and over (n=414, n=50). Cronbach’s alphas were adequate (0.76) to excellent (0.83).

Daneski, Coshall, Tilling, and Wolfe (2002) examined the internal consistency of a postal version of the RNLI (the RNLI-P) administered to 76 patients with stroke (at one-year). The Cronbach’s alpha was excellent (0.84).

Stark, Edwards, Hollingsworth, and Gray (2005) administered the RNLI to 604 people between the ages of 18 and 80 years who had a mobility limitation (including patients with spinal cord injury, Multiple Sclerosis, stroke, cerebral palsy, and polio), lived in the community, and had been discharged from rehabilitation for at least 1 year. The Cronbach’s alpha for this sample was excellent (0.91).

Bluvol and Ford-Gilboe (2004) administered the RNLI to both spouses in 40 families in which one of the partners had experienced a stroke with moderate to severe functional impairments (6 months to 5 years post-stroke). The internal consistency of the measure was excellent for both the partners with stroke (alpha = 0.92) and their spouses (alpha = 0.85).

Test-retest:

Steiner et al. (1996) examined the test-retest reliability of the RNLI in 50 community-dwelling persons aged 75 and over interviewed twice, by the same interviewer, with 7 to 14 days between interviews. Test-retest for the total sample of community-dwelling elderly was excellent (r = 0.83). When examined by age group, correlations were excellent for the 75 to 79 age group (r = 0.82), 80 to 84 age group (r = 0.93), and for the 85+ age group (r = 0.76).

Daneski, Coshall, Tilling and Wolfe (2002) examined the test-retest reliability of a postal version of the RNLI (the RNLI-P) in 26 patients with stroke (3-12 months post-stroke) who completed the test twice within a 2-week interval. All 11 items demonstrated agreement between the two occasions above that expected by chance. Kappa values ranged from poor to excellent agreement (kappa = 0.38 for the item “embarrassed when with others”, to 0.92 for the item “getting around outside”).

Korner-Bitensky, Wood-Dauphinee, Siemiatycki, Shapiro, and Becker (1994) examined the test-retest reliability of the RNLI in 366 patients with a diagnosis of stroke or orthopedic condition discharged from a rehabilitation hospital. The test was administered twice – once by face-to-face interview and once by a structured telephone interview to either a self or proxy respondent. The interclass coefficient (ICC) for the RNL Index was 0.80 indicating excellent agreement between the two modes of interview. However, for the self-respondents, poor community reintegration was reported more often during the home interview than the interview conducted over the telephone.

Type of rater:

Korner – Bitensky, Wood Dauphinee, Shapiro, and Becker (1994) analyzed the reliability of RNLI scores of 366 participants (with stroke or an orthopedic condition post discharge from a rehabilitation hospital) who completed both a home interview (conducted by a health professional only) and a telephone interview (conducted by either a lay person or health professional). Results revealed that there were no significant differences on the comparison of kappa scores when patients were interviewed by lay interviewers or health professionals. When a dichotomized score of 40 was used (0-40 = no disability, scores of >40 equals disability), the group interviewed by phone by a layperson was significantly more likely to report difficulties in community reintegration compared to when interviewed face-to-face.

Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer (1988) analyzed the reliability of RNLI scores between patients and relatives and between patients and health professionals. Using Pearson’s correlation coefficient to measure reliability they reported adequate significant other to patient correlations of r = 0.62 and r = 0.65 in two different patient/significant other samples. They also reported poor to adequate health professional to patient correlations of r = 0.39 and r = 0.43. Based on these results, the authors stated that patients or significant others could complete the RNLI but that the use of health professionals as proxies should be avoided.

Trombly, Radomski, and Davis (1998) administered the RNLI to 16 adults with traumatic brain injury and their significant others. At admission to a treatment program, patients’ and proxies’ scores did not differ significantly, however at discharge and follow-up, they differed significantly

Tooth, McKenna, Smith, and O’Rourke (2003) examined patient proxy reliability of RNLI scores in 57 subacute patients paired with a significant other 6 months post stroke rehabilitation. Intra-class Correlation Coefficients were poor for the total RNLI score (0.36) and the Daily Functioning subscale (0.24). Adequate reliability was found for the Perception of Self subscale (0.55.).

Validity

Content:

The RNLI was developed based on literature reviews, incorporation of experiences of investigators, and open- and closed-ended questionnaires given to patients with myocardial infarction, cancer, and other chronic diseases, health professionals (physicians, social workers, physical and occupational therapists, psychologists), significant others of patients; and clergy and other lay people.

Construct:

Convergent/Discriminant:

Daneski, Coshall, Tilling and Wolfe (2003) examined the construct validity of a postal version of the RNLI (RNLI-P) with other similar measures in 76 patients with stroke. Excellent correlations were found between the total score on the RNLI-P and the Frenchay Activities Index (FAI – Holbrook & Skilbeck, 1983) (r = 0.69), the Short Form 36 Health Survey (SF-36 – Ware, Snow, Kosinski & Gandek, 1993) (r = 0.74), and with the Hospital Anxiety and Depression Scale-Depression subscale (HADS – Zigmond & Snaith, 1983) (r = -0.61). Excellent correlations were reported between the Daily Function subscale of the RNLI-P and the FAI (r = 0.74) and the SF-36 (r = 0.73). The RNLI-P Daily Function subscale correlated poorly with the HADS-Anxiety subscale(r=-0.30). The Perceptions of Self subscale correlated poorly with the FAI (r = 0.26) and with the Barthel Index (Mahoney & Barthel, 1965), (r = 0.06).

Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer (1988) administered the RNLI to 70 patients with myocardial infarct or cancer and reported excellent correlation with scores on the Quality of Life (QL) Index (Spitzer, Dobson, Hall, Chesterman, Levi, Shepherd, Battista & Catchlove, 1981) (r = 0.68) and with a measure of psychological well-being (r = 0.32 for positive wellbeing, -0.41 for negative wellbeing, and 0.41 for overall). Daily Functioning subscale scores showed excellent correlation with QL Index items Activity and Daily Living (r = 0.67) while Perceptions of Self scores correlated adequately with Support and Outlook from the QL Index (r = 0.36).Items on the QL Index that reflected dimensions not included on the RNLI, correlated less strongly (r < 0.20).

In a study describing the development and psychometric properties of the Participation Survey/Mobility (PARTS/M), Gray, Hollingsworth, Stark and Morgan (2006) administered the RNLI to 604 people with mobility limitations due to a diagnosis of spinal cord injury, Multiple Sclerosis, cerebral palsy, stroke or post poliomyelitis and reported a strong correlation between the two indices (canonical correlation =0.71).

Bluvol and Ford-Gilboe (2004) administered the Herth Hope Index (measure of hope – Herth, 1992), the Health Options Scale (measure of health work – Ford-Gilboe, 1997, 2002b) and the RNLI to both spouses in 40 families in which one of the partners had experienced a stroke with moderate to severe functional impairments (6 months to 5 years post-stroke). They found a positive relationship between the Health Options Scale (health work) and the RNLI for stroke survivors (r = 0.50) but not for their spouses(r = 0.06) as well as a positive relationship between the Herth Hope Index (hope) and the RNLI (quality of life) for both stroke survivors (r = 0.59) and spouses (r = 0.32).

Note: Health work is defined as “an active process through which families learn ways of coping and developing that are conducive to healthy living over time” Ford-Gilboa 2002a.

Gauthier-Gagnon, and Grise (1994) administered the RNLI and the Prosthetic Profile of the Amputee (PPA) questionnaire (Grise, Gauthier-Gagnon, 1993) to 89 people with a lower limb amputation. Items on the Daily Activities subscale of the RNLI correlated adequately (r = 0.36 to 0.56) with items on the subscale related to physical performance of the PPA with the exception of the item “active use of the prosthesis indoors” which was poor ( r = 0.28).

In this same study, items of the Perception of Self subscale of the RNLI failed to correlate with items on the subscale related to physical performance of the PPA with the exception of prosthetic wear which was adequate (r = 0.32).

Items of the total RNLI had adequate to excellent correlations (r = 0.36 to 0.53) with items in the subscale related to Physical performance of the PPA with the exception of items “Active use indoors” and “Active use outdoors” which had non-significant correlations.

Items of the total RNLI, and its two subscales revealed poor to adequate correlations (r = 0.53 to 0.30) with items on the subscale related to acceptance of amputation and prosthesis.

Daverat, Petit, Kemoun, Dartigues, and Barat (1995) conducted a longitudinal study of 149 individuals with long-standing spinal cord injury. The univariate analysis showed that the RNLI significantly correlated with the Functional Independence Measure (FIM) (Hamilton, Granger, & Sherwin, 1987) FIM. The multivariate analysis determined that the following significant seven independent variables contributed to 72% of the RNLI variance. They included the FIM, the Yale Scale Score (Chehrazi, Wagner, Collins, Freedman, 1981) the Centre for Epidemiological Studies Depression Scale (CES-D – Radloff, 1977), living conditions, relationship, sexual life and age.

Calmels, Pereira, Domenach, Pallot-Prades, Alexandre, and Minaire (1994) administered the RNLI to 57 individuals with rheumatoid arthritis, with a mean disease duration of 15 years. In this study, scores on the total RNLI and the Daily Function subscale had adequate to excellent correlations with patient age, number of affected joints, the Functional Independence Measure (FIM), the Lee Index (pain, fatigue, and stiffness), and the American Rheumatism Association Classification (r = 0.38 to 0.84). The total RNLI was also adequately correlated to disease duration (r = 0.31).

McColl, Paterson, Davies, Doubt, and Law (2000) administered the RNLI to 61 community-dwelling individuals with a disability and found that RNLI scores were adequately correlated with the satisfaction subscale of the Canadian Occupational Performance Measure (COPM – Law et al., 1991, 1994, 1998) (r = 0.38) but only poorly correlated with the Performance subscale (r = 0.22). The RNLI had excellent correlations with the Life Satisfaction Scale (Michalos, 1980) (r = 0.71) and with the Satisfaction with Performance Scaled Questionnaire (Yerxa, Burnett-Beaulieu, Stocking & Azen, 1988) (r = 0.72).

Steiner et al. (1996) evaluated the performance of the RNLI in an elderly community-based population (n = 414). The RNLI demonstrated adequate positive correlations with instrumental activities of daily living scale (Lawton, Moss, Fulcomer & Klegan, 1982) (r = 0.47) and perceived health (r = 0.45). Poor to adequate negative correlations were reported for living alone (r = -0.14) and number of both bed days (r = -0.16) and chronic conditions(r = -0.32). There was an unpredicted negative correlation between age and RNLI (r = -0.11).

May and Warren (2002) examined the external and structural components of validity of the spinal cord injury version of the Ferrans and Powers Quality of Life Index (Ferrans & Powers, 1992) in a sample of 98 individuals with spinal cord injury living in the community and reported an excellent correlation with the RNLI (r = -0.65).

Patrick, Perugini, and Leclerc (2002) reported that in a study of 48 consecutive referrals for neuropsychological evaluation following admission to a geriatric rehabilitation inpatient service (for various diagnosis including: orthopedic injury, stroke, functional deconditioning, Parkinson’s disease and other various medical conditions) that the RNLI was significantly correlated to the number of falls sustained and functional status at 6 months. Results of the partial correlations coefficients revealed significant relationships between the RNL and the California Verbal Learning Test (CVLT) (measures memory functioning) and Hooper Visual Organization Test (HVOT – measures spatial skills).

Note: The authors did not report the actual r scores.

Known groups:

Clarke, Black, Badley, Lawrence & Williams, (1999) divided subjects at 3 months and 1 year post-stroke by level of impairment (mild-moderate-severe according to Adam’s Hemispheric Stroke Scale), by the presence or absence of depression (Zung Self-Rating Depression scale), by levels of physical disability (independent-moderately dependent-dependent according to the Functional Independence Measure), RNLI scores for these known groups demonstrated expected gradients and were significantly different as analyzed by analysis of variance. The difference in mean RLNI scores between categories in these analyses ranged from 12% to 62%.

Responsiveness

Wood-Dauphinee, Opzoomer, Williams, Marchand, and Spitzer (1988) administered the RNLI to a sample 70 patients to determine the responsiveness of the RNLI. They concluded that the scale is sensitive to change but the use of subscales provides a more accurate reflection as change (improvement or worsening) in specific domains could be hidden within the total score.

References

  • Bluvol, A., Ford-Gilboe, M. (2004). Hope, health work and quality of life in families of stroke survivors. Journal of Advanced Nursing, 48(4) 322-332.
  • Calmels, P., Pereira, A., Domenach, M., Pallot-Prades, B., Alexandre, C., Minaire, P. (1994). Functional ability and quality of life in rheumatoid arthritis: Evaluation using the Functional Independence Measure and the Reintegration to Normal Living Index. Revue Du Rhumatisme, 61(11), 723-731.
  • Clarke, P. A., Black, S. E., Badley, E. M., Lawrence, J. M., Williams, J. L. (1999). Handicap in stroke survivors. Disability and Rehabilitation, 21(3), 116-123.
  • Daneski, K., Coshall, C., Tilling, K., Wolfe, C.D.A. (2003). Reliability and validity of a postal version of the Reintegration to Normal Living Index, modified for use with stroke patients. Clinical Rehabilitation, 17, 835-839.
  • Daverat, P., Petit, H., Kemoun, G., Dartigues, J. F., Barat, M. (1995). The long term outcome in 149 patients with spinal cord injury. Paraplegia, 33, 665-668.
  • Dawson, D. R., Levine, B., Schwartz, M., Stuss, D. T. (2000). Quality of life following traumatic brain injury: A prospective study. Brain and Cognition, 44, 35-39.
  • Friedland, J. F., Dawson, D. R. (2001). Function after motor vehicle accidents: A prospective study of mild head injury and posttraumatic stress. The Journal of Nervous and Mental Disease, 189(7), 426-434.
  • Gauthier-Gagnon, C., Grise, M-C. (1994). Prosthetic Profile of the Amputee Questionnaire: Validity and reliability. Archives of Physical Medicine and Rehabilitation, 75, 1309-1314.
  • Gray, D. B., Hollingsworth, H. H., Stark, S. L., Morgan, K. A. (2006). Participation Survey/Mobility: Psychometric properties of a measure of participation for people with mobility impairments and limitations. Archives of Physical Medicine and Rehabilitation, 87(2), 189-197
  • Korner – Bitensky, N., Wood Dauphinee, S., Shapiro, S., Becker, R. (1994). Eliciting health status information by telephone after discharge from hospital: Health professionals versus trained lay persons. Canadian Journal of Rehabilitation, 8(1) 23-34.
  • Korner-Bitensky, N., Wood-Dauphinee, S., Siemiatycki, J., Shapiro, S., Becker, R. (1994). Health related information postdischarge: Telephone versus face-to-face interviewing. Archives of Physical Medicine and Rehabilitation, 75, 1287-1296.
  • May, L. A, Warren, S. (2002). Measuring quality of life of persons with spinal cord injury: external and structural validity. Spinal Cord, 40, 341-350.
  • Mayo, N. E., Wood-Dauphinee S., Cote, R., Gayton, D., Carlton, J., Buttery, J., Tamblyn, R. (2000). There is no place like home: An evaluation of early supported discharge for stroke. Stroke, 31, 1016-1023.
  • Mayo N., Wood-Dauphinee S., Cote R., Durcan L., Carlton J. (2002). Activity, participation & quality of life 6 months post-stroke. Archives of Physical Medicine & Rehabilitation, 83, 1035-1042.
  • McColl, M. A., Paterson, M., Davies, D., Doubt, L., Law, M. (2000). Validity and community utility of the Canadian Occupational Performance Measure. Canadian Journal of Occupational Therapy, 67(1), 22-33.
  • Patrick, L., Perugini, M. Leclerc, C. ( 2002). Neuropsychological assessment and competency for independent living among geriatric patients. Topics in Geriatric Rehabilitation, 14(4) 65-77.
  • Stark, D. L., Edwards, D. F., Hollingsworth, H., Grey, D. B. (2005).Validation of the Reintegration to Normal Living Index in a population of community-dwelling people with mobility limitations. Archives of Physical Medicine & Rehabilitation, 86(2), 344-345.
  • Steiner, A., Raube, K., Stuck, A. E., Aronow, H. U., Draper, D., Rubenstein, L. Z., Beck, J. C. (1996). Measuring psychosocial aspects of well-being in older community residents: Performance of four short scales. The Gerontologist, 36(1), 54-62.
  • Tooth, L.R., McKenna, KT., Smith, M., O’Rourke, P.K. (2003). Reliability of scores between stroke patients and significant others on the Reintegration to Normal Living (RNL) Index. Disability and Rehabilitation, 25(9), 433-440.
  • Trombly, C. A., Radomski, M. V., Davis, E. S. (1998). Achievement of self identified goals by adults with traumatic brain injury: Phase 1. The American Journal of Occupational Therapy, 52(10), 810-818.
  • Wood-Dauphinee, S. L., Opzoomer, M. A., Williams, J. I., Marchand, B., Spitzer, W. O. (1988). Assessment of global function: The Reintegration to Normal Living Index. Archives of Physical Medicine and Rehabilitation, 69, 583-590.
  • Wood-Dauphinee, S., Williams, J. I. (1987). Reintegration to normal living as a proxy to quality of life. Journal of Chronic Diseases, 40(6), 491-499.

See The Measure

You can obtain the RNLI here.

Please click here to access the french language version. A research version is also available.

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