1
|
Armstrong AJ, Clark JM, Ho DT, Payne CJ, Nolan S, Goodes LM, Harvey LA, Marshall R, Galea MP, Dunlop SA. Achieving assessor accuracy on the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord 2017. [DOI: 10.1038/sc.2017.67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
2
|
Hales M, Biros E, Reznik JE. Reliability and Validity of the Sensory Component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): A Systematic Review. Top Spinal Cord Inj Rehabil 2015; 21:241-9. [PMID: 26363591 DOI: 10.1310/sci2103-241] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Since 1982, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) has been used to classify sensation of spinal cord injury (SCI) through pinprick and light touch scores. The absence of proprioception, pain, and temperature within this scale creates questions about its validity and accuracy. OBJECTIVE To assess whether the sensory component of the ISNCSCI represents a reliable and valid measure of classification of SCI. METHODS A systematic review of studies examining the reliability and validity of the sensory component of the ISNCSCI published between 1982 and February 2013 was conducted. The electronic databases MEDLINE via Ovid, CINAHL, PEDro, and Scopus were searched for relevant articles. A secondary search of reference lists was also completed. Chosen articles were assessed according to the Oxford Centre for Evidence-Based Medicine hierarchy of evidence and critically appraised using the McMasters Critical Review Form. A statistical analysis was conducted to investigate the variability of the results given by reliability studies. RESULTS Twelve studies were identified: 9 reviewed reliability and 3 reviewed validity. All studies demonstrated low levels of evidence and moderate critical appraisal scores. The majority of the articles (~67%; 6/9) assessing the reliability suggested that training was positively associated with better posttest results. The results of the 3 studies that assessed the validity of the ISNCSCI scale were confounding. CONCLUSIONS Due to the low to moderate quality of the current literature, the sensory component of the ISNCSCI requires further revision and investigation if it is to be a useful tool in clinical trials.
Collapse
Affiliation(s)
- M Hales
- Discipline of Physiotherapy, James Cook University, Townsville, Queensland, Australia
| | - E Biros
- Discipline of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - J E Reznik
- Discipline of Physiotherapy, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
3
|
|
4
|
Li YL, Li LT, Yu M, Wang YZ, Ge HY, Song CQ. Beneficial Effects of the Herbal Medicine Di Huang Yin Zi in Patients with Spinal Cord Injury: A Randomized, Placebo-controlled Clinical Study. J Int Med Res 2012. [PMID: 23206453 DOI: 10.1177/030006051204000510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This study investigated the safety and therapeutic efficacy of Di Huang Yin Zi (DHYZ), a traditional Chinese decoction used to treat neurological disorders, in spinal cord injury (SCI). Methods: In this doubleblind, placebo-controlled study, patients with traumatic SCI and American Spinal Injury Association (ASIA) impairment grades B - D were randomized to receive DHYZ ( n = 30) or placebo ( n = 30) for 12 weeks. Both groups also received rehabilitation therapy during the study period. Motor and sensory function and activities of daily living (ADL) were assessed before treatment and at 4-week intervals. Results: Significantly more patients in the DHYZ group showed an improved ASIA impairment grade during the treatment period (32.1%) compared with the placebo group (10.3%), and scores for sensory and motor function and ADL at the end of the treatment period were significantly higher in the DHYZ group than in the placebo group. No serious side-effects were reported. Conclusions: DHYZ was found to improve neurological function in patients with SCI and may be an effective adjuvant therapy to enhance functional recovery.
Collapse
Affiliation(s)
- YL Li
- Second Affiliated Hospital of Shandong University, Jinan, China
| | - LT Li
- Shandong Medical College, Jinan, China
| | - M Yu
- Shandong Medical College, Jinan, China
| | - YZ Wang
- Second Affiliated Hospital of Shandong University, Jinan, China
| | - HY Ge
- Laboratory for Experimental Pain Research, Centre for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - CQ Song
- Shandong Medical College, Jinan, China
| |
Collapse
|
5
|
Furlan JC, Noonan V, Singh A, Fehlings MG. Assessment of impairment in patients with acute traumatic spinal cord injury: a systematic review of the literature. J Neurotrauma 2011; 28:1445-77. [PMID: 20030559 PMCID: PMC3143408 DOI: 10.1089/neu.2009.1152] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The most common primary end-point of the trial on treatment of traumatic spinal cord injury (SCI) is the degree of impairment. The American Spinal Injury Association (ASIA) Standards have been widely used to assess motor function and pin-prick and light-touch sensory function. In addition, pain assessment is another clinically relevant aspect of the impairment in individuals with SCI. Given this, we sought to systematically review the studies that focused on the psychometric properties of ASIA Standards and all previously used outcome measures of pain in the SCI population in the acute care setting. For the primary literature search strategy, the MEDLINE, CINAHL, EMBASE, and Cochrane databases were sought out. Subsequently, a secondary search strategy was carried out using the articles listed in the references of meta-analysis, systematic, and non-systematic review articles. Two reviewers (JCF and VN) independently selected the articles that fulfill the inclusion and exclusion, assessed the level of evidence of each article, and appraised the psychometric properties of each instrument. Divergences during those steps were solved by consensus between both reviewers. Of 400 abstracts captured in our primary search strategy on the ASIA Standards, 16 full articles fulfilled the inclusion and exclusion criteria. An additional 40 references were obtained from two prior systematic reviews on ASIA Standards. While 45 of 56 of the studies on ASIA Standards provided level 4 evidence, there were 11 level 2b evidence studies. Convergent construct validity (n = 34), reliability (n = 12), and responsiveness (n = 10) were the most commonly studied psychometric properties of the ASIA Standards, but two prior studies examined their content validity. Of the 267 abstracts yielded in our primary search on pain assessment, 24 articles with level 4 evidence fulfilled the inclusion and exclusion criteria. There was no study that examined pain assessment in the acute care setting. While 18 of 24 articles studied an instrument for assessment of pain intensity, the remaining six studies were focused on classifications of pain in the SCI population. In conclusion, the ASIA Standards represent an appropriate instrument to categorize and evaluate spinal cord injured adults over time with respect to their motor and sensory function. Nevertheless, further investigation of the psychometric properties of the ASIA Standards is recommended due to a lack of studies focused on some key elements of responsiveness, including minimal clinically important difference. The visual analog scale (VAS) is the most commonly studied instrument of assessment of pain intensity in the SCI population. However, further investigation is required with regard to its reliability and responsiveness in the SCI population. Our results also suggest that there is no instrument with appropriate psychometric properties for this particular population.
Collapse
Affiliation(s)
- Julio C. Furlan
- Department of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Neuroscience Centre, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vanessa Noonan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Anoushka Singh
- Department of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Neuroscience Centre, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Department of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Neuroscience Centre, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Division of Neurosurgery and Spinal Program University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Il’yasevich IA, Soshnikova EV, Vishnevskii АА, Duloub ОI, Koul’chitskii VA. Electrophysiological Analysis of Transmission Via Spinal Pathways After Vertebral Trauma. NEUROPHYSIOLOGY+ 2009. [DOI: 10.1007/s11062-009-9097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Furlan JC, Fehlings MG, Tator CH, Davis AM. Motor and Sensory Assessment of Patients in Clinical Trials for Pharmacological Therapy of Acute Spinal Cord Injury: Psychometric Properties of the ASIA Standards. J Neurotrauma 2008; 25:1273-301. [DOI: 10.1089/neu.2008.0617] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Julio C. Furlan
- Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Canada
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada
| | - Michael G. Fehlings
- Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Canada
- Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, and Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Charles H. Tator
- Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Canada
- Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, and Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Aileen M. Davis
- Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy and Surgery, and Departments of Rehabilitation Science, Health Policy, Management and Evaluation (Clinical Epidemiology), and Institute of Medical Science, University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Savic G, Bergström EMK, Frankel HL, Jamous MA, Jones PW. Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards. Spinal Cord 2007; 45:444-51. [PMID: 17387316 DOI: 10.1038/sj.sc.3102044] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective observational. AIM To examine inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association (ASIA) standards. SETTING National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, UK. MATERIAL AND METHOD Results of ASIA motor and sensory examinations performed by two experienced examiners on 45 patients with spinal cord injury (SCI) were compared. RESULTS Total ASIA scores showed very strong correlation between the two examiners, with Pearson correlation coefficients and intraclass correlation coefficients exceeding 0.96, P<0.01 for total motor, light touch and pin prick scores. The agreement for individual muscle testing of the 10 ASIA key muscles showed substantial agreement for majority of muscles, with the weighted Kappa coefficient range 0.649-0.993, P<0.05. The overall agreement in assignment of manual muscle testing grades (0-5) was 82% on the right and 84% on the left, with the strongest agreement for grade '0' and the weakest for grade '3'. The unweighted Kappa coefficient for agreement in motor and sensory levels ranged from 0.68 to 0.78 (P<0.01). There was no difference in ASIA impairment grades derived from the two examiners' results. CONCLUSIONS Our study results showed very good levels of agreement in ASIA clinical examinations between two experienced examiners. The established degree of variability due to inter-rater differences should be taken into account in study design of clinical trials with more than one assessor..
Collapse
Affiliation(s)
- G Savic
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, Aylesbury, Bucks, UK
| | | | | | | | | |
Collapse
|
9
|
Kirshblum S, Millis S, McKinley W, Tulsky D. Late neurologic recovery after traumatic spinal cord injury11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:1811-7. [PMID: 15520976 DOI: 10.1016/j.apmr.2004.03.015] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To present Model Spinal Cord Injury System (MSCIS) data on late neurologic recovery after 1 year after spinal cord injury (SCI). DESIGN Longitudinal study of neurologic status as determined by annual evaluations at 1 and 5 years postinjury. SETTING MSCIS centers contributing data on people with traumatic SCI to the National Spinal Cord Injury Statistical Center database. PARTICIPANTS People with traumatic SCI (N=987) admitted to an MSCIS between 1988 and 1997 with 1- and 5-year follow-up examinations. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification, motor index scores (MIS), motor level, and neurologic level of injury (NLI), measured and compared for changes over time. RESULTS The majority of subjects (94.4%) who had a neurologically complete injury at 1 year remained complete at 5 years postinjury, with 3.5% improving to AIS grade B, and up to 1.05% each improving to AIS grades C and D. There was a statistically significant change noted for MIS. There were no significant changes for the motor level and NLI over 4 years; however, approximately 20% of subjects improved their motor level and NLI. People with complete and incomplete injuries had similar improvements in motor level, but subjects with an incomplete injury had a greater chance of improvement in NLI and MIS. CONCLUSIONS There was a small degree of neurologic recovery (between 1 and 5 y postinjury) after a traumatic SCI. Late conversion, between 1 and 5 years, from a neurologically complete to an incomplete injury occurred in 5.6% of cases, but in only up to 2.1% was there a conversion from motor complete to motor incomplete status. Limitations of this study included changes in the ASIA classification during the study and in the intra- and interrater reliability typically seen in longitudinal studies of the ASIA standards. Functional changes were not studied. Knowledge of the degree of late recovery may help in analyzing newer interventions to enhance recovery.
Collapse
Affiliation(s)
- Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA.
| | | | | | | |
Collapse
|
10
|
Ellaway PH, Anand P, Bergstrom EMK, Catley M, Davey NJ, Frankel HL, Jamous A, Mathias C, Nicotra A, Savic G, Short D, Theodorou S. Towards improved clinical and physiological assessments of recovery in spinal cord injury: a clinical initiative. Spinal Cord 2004; 42:325-37. [PMID: 14968107 DOI: 10.1038/sj.sc.3101596] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical practice and scientific research may soon lead to treatments designed to repair spinal cord injury. Repair is likely to be partial in the first trials, extending only one or two segments below the original injury. Furthermore, treatments that are becoming available are likely to be applied to the thoracic spinal cord to minimise loss of function resulting from damage to surviving connections. These provisos have prompted research into the improvement of clinical and physiological tests designed (1) to determine the level and density of a spinal cord injury, (2) to provide reliable monitoring of recovery over one or two spinal cord segments, and (3) to provide indices of function provided by thoracic spinal root innervation, presently largely ignored in assessment of spinal cord injury. This article reviews progress of the Clinical Initiative, sponsored by the International Spinal Research Trust, to advance the clinical and physiological tests of sensory, motor and autonomic function needed to achieve these aims.
Collapse
Affiliation(s)
- P H Ellaway
- Division of Neuroscience and Psychological Medicine, Imperial College, London, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Calancie B, Molano MR, Broton JG. Neural plasticity as revealed by the natural progression of movement expression--both voluntary and involuntary--in humans after spinal cord injury. PROGRESS IN BRAIN RESEARCH 2001; 128:71-88. [PMID: 11105670 DOI: 10.1016/s0079-6123(00)28008-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- B Calancie
- Miami Project to Cure Paralysis, University of Miami School of Medicine, FL 33136, USA.
| | | | | |
Collapse
|