Reply to “Letter on Spasticity Predicts Motor Recovery in Motor Complete Spinal Cord Injury”

Abstract

I read with great interest the recent work by Sangari et al, which delves into the correlation between spasticity and motor recovery in patients with subacute motor complete spinal cord injury (SCI). 1 Although the study makes a valuable contribution to the field, there are certain aspects that warrant further attention from the authors.First, the article does not specify who conducted the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examinations. The accuracy of these examinations is pivotal to the overall validity of the study. Previous research has indicated that the overall classification accuracy of ISNCSCI is only 74.6% among SCI professionals using the latest revision (2019), and training significantly enhances classification skills. 2,3 Therefore, it is imperative for the authors to disclose details about the assessors, including whether they are SCI professionals, general physiatrists, or residents undergoing training, despite the study being conducted in a reputable rehabilitation center.Second, there is a concern regarding the reliability of the Modified Ashworth Scale (MAS) as an intrarater tool, and its poor reliability in determining lower extremity spasticity between raters (interrater) or over time (intersession). 4 To provide a comprehensive understanding, the article should clarify whether the admission and discharge assessments were conducted by the same assessor or different assessors, the qualifications of the assessors, and whether they were blinded to the study conditions.Lastly, the potential impact of antispasticity treatments on the study's outcomes should not be underestimated. The article mentions the use of spasticity-modifying drugs by a substantial number of subjects. Considering the repeated-measures analysis of variance test results and the similarity in MAS scores between admission and discharge, it is crucial to acknowledge that the medication might have influenced these scores. A discussion of how the inclusion of these medications could have affected the study's findings would enhance the article's completeness.In conclusion, although this study by Sangari et al addresses a crucial clinical topic and proposes a convenient clinical tool, it is vital to interpret the results with caution due to the abovementioned limitations. A more detailed examination of these issues would contribute to a more robust and nuanced understanding of the study's implications.