Reliability and Validity of the Sensory Component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): A Systematic Review

Abstract

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.

Sensitivity and specificity of the ‘knee-up test’ for estimation of the American Spinal Injury Association Impairment Scale in patients with acute motor incomplete cervical spinal cord injury

“…Generally, intra-rater and inter-rater agreements among trained or experienced raters were acceptable; [17,[21][22][23] however, even for trained examiners, the agreements of sensory and/or motor examination were less reliable in patients with an incomplete SCI than in those with a complete SCI [19,22]. In addition, although several studies have reported that training improved accuracy of agreement [15,16,18,20,[24][25][26], efficacy was significantly lower in incomplete than in complete SCI [15,16,20,[24][25][26]. For example, Chafetz et al [20] reported that training improved correct classification of patients with AIS C from 29 to 54% and of those with AIS D from 37 to 84%, and stated clearly that accurate classification of AIS designation remained unacceptably low even after training.…”

“…Several studies reported the inter-rater and intra-rater reliability of ISNCSCI [15][16][17][18][19][20][21][22][23][24][25][26]. Generally, intra-rater and inter-rater agreements among trained or experienced raters were acceptable; [17,[21][22][23] however, even for trained examiners, the agreements of sensory and/or motor examination were less reliable in patients with an incomplete SCI than in those with a complete SCI [19,22].…”

“…In order to accurately assess AIS, it is mandatory to determine the sensory level, sensory scores, motor level and strength of the key muscles using the ISNCSCI classification [14]. The ISNCSCI method was tested for its inter-and intra-rater reliabilities [15][16][17][18][19][20][21][22][23][24][25][26]. This method is slightly complicated, and several studies illustrated that training and experience may be required for accurate agreement [15,20,21,25,26].…”

“…The ISNCSCI method was tested for its inter-and intra-rater reliabilities [15][16][17][18][19][20][21][22][23][24][25][26]. This method is slightly complicated, and several studies illustrated that training and experience may be required for accurate agreement [15,20,21,25,26]. Importantly, some studies reported that the reliability of sensory and motor components of ISNCSCI in patients with incomplete SCI was lower than that in patients with complete SCI [15,19,20,22,26].…”

“…This method is slightly complicated, and several studies illustrated that training and experience may be required for accurate agreement [15,20,21,25,26]. Importantly, some studies reported that the reliability of sensory and motor components of ISNCSCI in patients with incomplete SCI was lower than that in patients with complete SCI [15,19,20,22,26]. In the patients with motor incomplete SCI, the most complicated task even after training was to distinguish AIS B from AIS C/D based on the motor sparing of more than three segments below the motor level [20,24,27].…”