Interrater Reliability of the Pediatric Neuromuscular Recovery Scale for Spinal Cord Injury

Abstract

Background: In synergy with the mounting scientific evidence for the capacity of recovery after spinal cord injury (SCI) and training, new evidence-based therapies advancing neuromuscular recovery are emerging. There is a parallel need for outcome instruments that specifically address recovery. The Pediatric Neuromuscular Recovery Scale (Pediatric NRS) is one example with established content validity to assess neuromuscular capacity within task performance. Objective: The objective of this study was to determine interrater reliability of the Pediatric NRS to classify motor capacity in children after SCI. Methods: Pediatric physicians (3), occupational therapists (5), and physical therapists (6) received standardized training in scoring the scale, then rated video assessments of 32 children post SCI, 2–12 years of age, 78% non-ambulatory. Interrater reliability was analyzed using Kendall coefficient of concordance for individual Pediatric NRS items and overall score. Results: The interrater reliability coefficient was determined to be near 1 for the overall Pediatric NRS score (ICC = 0.966; 95% CI, 0.89–0.98). Twelve of 16 individual items exhibited high concordance coefficients (Kendall's W ≥ 0.8) and four items demonstrated concordance coefficients, < 0.8 and > 0.69. Interrater reliability was equivalent among groups defined by age and neurological level, but lower among non-ambulatory individuals. Conclusion: Strong interrater reliability was demonstrated by pediatric clinicians who scored children with SCI using the Pediatric NRS.

Activity-Based Therapy Targeting Neuromuscular Capacity After Pediatric-Onset Spinal Cord Injury

“…14,18 The Pediatric NRS was adapted from the adult Neuromuscular Recovery Scale (NRS). 18,[40][41][42][43][44] Content validity 14 and good interrater reliability 45 have been determined for children 2-12 years old. It assesses neuromuscular capacity in the context of 10 tasks that may be performed in the clinical environment.…”

“…While responsiveness of the SATCo for the pediatric population post SCI has been established and shown to have a significantly larger effect size 16 compared to other typical trunk control and balance measures (eg, modified functional reach, Berg Balance Test), content validity 14 and interrater reliability 45 have been determined for the Pediatric NRS. The adult NRS, also applied to adolescents older than 13 years old, has been tested and determined to have good test-retest reliability, 40 good interrater reliability, 41 responsiveness in the outpatient setting, 43 and validity.…”

“…The National Institute of Neurological Disorders and Stroke Common Data Element Sets (CDES) 60 has designated both of these instruments, Pediatric NRS and SATCo, as exploratory for children with SCI. As published works further delineating the utility of each instrument 14,16,45 are published, we anticipate that the exploratory status will be reexamined.…”