Quality of Life Concepts

Secondary Health Conditions

Reintegration to Normal Living (RNL) Index

Description: A measure of community reintegration, which covers areas such as participation in recreational and social activities, movement within the community and the degree of comfort the individual has in his/her role in the family and with other relationships [1].

Format: 11 items measuring satisfaction regarding perceived physical functioning, and social and emotional life.

Scoring: There are different scoring algorithms for this measure.  There is a 1) visual analog scale ranging from 0 to 10; 2) a three-point scoring system; and 3) a four-point scoring system. Regardless of the scoring system used, higher scores represent higher levels of participation.

Administration and Burden: Self-administered; Interviewer-administered;

Psychometrics for SCI: Internal consistency from a sample of persons with acute mobility impairments (including persons with spinal cord injury), yielded a Cronbach α = .91.  The RNL Index has been found to have good construct validity [2].

Languages: English; French.

QoL Concept: The RNL Index measures Participation/Community Reintegration, which corresponds to Boxes C (achievements; participation/community reintegration), and E (subjective evaluations and reactions) of Dijker’s Model.

Permissions/Where to Obtain: Public Domain; A copy of the RNL Index may be obtained at the Stroke Engine website at: http://www.medicine.mcgill.ca/strokengine-assess/module_rnli_family-en.html

References:

  1. Wood-Dauphinée SL, Opzoomer MA, Williams JI, Marchand B, Spitzer WO. Assessment of global function: The reintegration to normal living index. Arch Phys Med Rehabil 1988;69:583-90.

  2. Stark SL, Edwards DF, Hollingsworth H, Gray DB. Validation of the reintegration to normal living index in a population of community-dwelling people with mobility limitations. Arch Phys Med Rehabil 2005;86:344-5.

CLICK ON THE LISTED SECONDARY HEALTH CONDITIONS ON THE LEFT TO READ HOW THE RNL HAS BEEN USED WITH A PARTICULAR CONDITION


Pain SCI Studies: One prospective and cross-sectional study, one cross-sectional survey.

  1. Donnelly C, Eng JJ. Pain following spinal cord injury: the impact on community integration. Spinal Cord 2005; 43:278-82.  

  2. Tonack M, Hitzig SL, Craven BC, Campell KA, Boschen KA, McgGillivray CF. Predicting life satisfaction after spinal cord injury in a Canadian sample. Spinal Cord 2008;46:380-5.

Sensitivity to Impact: Donnelly and Eng (2005) used a non-standardized study-specific questionnaire and the Reintegration to Normal Living (RNL) Index to (1) describe how pain changes over recovery from a spinal cord injury (SCI) from admission to rehabilitation, discharge, and after 6 months of community living, and (2) determine the relationship between pain and community integration at 6 months of community living in patients with SCI (N = 66). On admission, 92% of patients reported pain, compared to 86% at 6 months of community living. Nearly a third of the patients reported that pain had an impact on most of their activities. Increased reports of pain were related to poorer reintegration at 6 months of community living, as shown by a fair to moderate correlation of the study-specific questionnaire with the RNL.

Tonack and colleagues (2008) used the RNL along with the Satisfaction with Life Scale (SWLS) and a non-standardized study-specific questionnaire to examine the effects of chronic pain on life satisfaction and community participation in patients with SCI (N = 781). Results showed that persons with chronic pain had lower scores on the RNL and SWLS than persons without chronic pain.

Suggestions for Use: The development of the RNL Index is a significant achievement since the tool attempts to measure reintegration by expanding the scope of outcome measures of rehabilitation beyond physical functioning [1]. In addition, several different stakeholders (e.g., consumers, family members, health care professionals) were involved in its formation [2].  Preliminary use demonstrates promise [3, 4] but further work is required to validate this tool for the SCI population. 

Additional References:

  1. Yasui NY, Berven NL. Community integration: conceptualisation and measurement. Disabil Rehabil 2009:31:761-71.

  2. Wood-Dauphinée SL, Opzoomer MA, Williams JI, Marchand B, Spitzer WO. Assessment of global function: The reintegration to normal living index. Arch Phys Med Rehabil 1988;69:583-90.

  3. Stark SL, Edwards DF, Hollingsworth H, Gray DB. Validation of the reintegration to normal living index in a population of community-dwelling people with mobility limitations. Arch Phys Med Rehabil 2005;86:344-5.

  4. Daverat P, Petit H, Kemoun G, Dartigues JF, Barat M.  The long term outcome in 149 patients with spinal cord injury. Paraplegia 1995;33:665-8.

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