Abstract
Study design
Prospective, observational study.
Objectives
The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) represent the gold standard for the assessment of patients with spinal cord injury (SCI) and their measurement properties have been evaluated in patients with traumatic lesions. Albeit the ISNCSCI are widely used also for the assessment and prognosis of patients with non-traumatic SCI, a validation of this grading system in this sample has never been performed. Therefore, the aim of this study is to evaluate the measurement properties of the ISNCSCI in a population of persons with non-traumatic SCI.
Setting
Three Italian rehabilitation hospitals.
Methods
The sample included 140 patients with non-traumatic SCI of different etiology, level and grade, for a total of 169 evaluations performed by two examiners. Cronbach’s Alpha was used to evaluate the internal consistency of the ISNCSCI various components. The agreement between two examiners of each center in the definition of different components was used to assess the inter-rater reliability. The construct validity was evaluated through the correlation of the ISNCSCI with the Spinal Cord Independence Measure (SCIM).
Results
The ISNCSCI showed substantial internal consistency, and substantial inter-rater agreement for AIS grade, cumulative motor and sensory scores. The motor scores for upper and lower extremity showed fair to moderate correlation with SCIM self-care and motility subscores, respectively. The ISNCSCI total motor score correlated with the total SCIM score.
Conclusions
Our study demonstrates that the ISNCSCI are a valid and reliable tool for the assessment of patients with non-traumatic SCI.
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Data availability
Data are available upon reasonable request.
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Acknowledgements
The authors would like to thank all patients who were willing to contribute to the database. The authors would also like to acknowledge the help and suggestions of Dr Carlotte Kiekens, Giulia Furlini, Francesco Coschignano, Floriana Pichiorri, Marco Molinari.
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GS, EL, CP, and IB were responsible for designing the conceptual framework of the study. GS, CP, and MVP conducted the statistical analysis. GS, CP, and IB prepared the paper. EL, GM, SV, MM, BA, and GF substantially contributed to the data recording and interpretation and the article preparation.
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The study was approved by the ethic committee of IRCCS Fondazione Santa Lucia. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers/animals were followed during the course of this research.
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The paper is partially supported by the ERANET-NEURON grant to Giorgio Scivoletto.
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The authors declare no competing interests.
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Lena, E., Baroncini, I., Pavese, C. et al. Reliability and validity of the international standards for neurological classification of spinal cord injury in patients with non-traumatic spinal cord lesions. Spinal Cord 60, 30–36 (2022). https://doi.org/10.1038/s41393-021-00675-9
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DOI: https://doi.org/10.1038/s41393-021-00675-9
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