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Development of the tele-neurological assessment for the level, severity, and completeness of spinal cord injury (TNASCI): reliability and validity

Spinal Cord volume 63, pages 499–507 (2025)Cite this article

Subjects

Abstract

Study design

Psychometric study.

Objectives

To introduce a novel, simple, tele-assessment tool designed to report the level and severity of spinal cord injury (SCI) and to assess its reliability and validity.

Setting

Two academic-affiliated rehabilitation facilities in Thailand.

Methods

The Tele-Neurological Assessment for the level, severity, and completeness of Spinal Cord Injury (TNASCI) was designed to assess the SCI level and severity according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) using telecommunication. This study comprised three phases: (1) the development process involving three experts using the Delphi method, (2) a face validity examination of each TNASCI item’s comprehension and suitability, and (3) an evaluation of the concurrent validity, intra-rater reliability, and inter-rater reliability using data from 40 participants with chronic SCI (>12 months post-injury).

Results

The Thai version of TNASCI, was developed to contain four sections, including sensory, motor, anorectal function, and summary sections to determine the SCI level and severity grade. The assessment tool exhibited good face validity. When compared with the ISNCSCI, the TNASCI showed good to excellent inter-rater and intra-rater reliability, with an intraclass correlation coefficient (ICC) (2,1) of 0.791–0.941 and an ICC (3,1) of 0.785–1.00, and good to excellent validity in almost all sections except for the sensory-related components (r = 0.764–0.986).

Conclusions

Our TNASCI tool, which was assessed by trained clinicians, demonstrated acceptable inter-rater and intra-rater reliability, face validity, and concurrent validity. It serves as an alternative tool to evaluate the SCI level and severity predominantly in people with chronic, motor-complete SCI who cannot be evaluated using the hands-on ISNCSCI in person. However, this study is an initial step in validating a novel tele-assessment tool, with future studies needed to confirm its utility in other conditions and settings.

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Data availability

The data that support the findings of this study are available on request from the corresponding author (PW). The data are not publicly available because of ethical restrictions.

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Acknowledgements

The authors wish to thank all staff members at the Department of Rehabilitation Medicine, Chiang Mai University for their support and assistance in the data collection. We would like to express our sincere gratitude to Chayaporn Chotiyarnwong, MD, Siam Tongprasert, MD and Pratchayapon Kammuang-lue, MD, for their comments and suggestions during the tool development process. We thank Lisa Kreiner, PhD, from Edanz (www.edanz.com/ac) for editing the English text of a draft of this manuscript.

Funding

This research project was supported by Chulabhorn Royal Academy (Project code RI-02-2565/006).

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand

    Phantira Techaworarak

  2. Accessibility and Assistive Technology Research Team, Assistive Technology and Medical Devices Research Center, National Science and Technology Development Agency, Pathum Thani, Thailand

    Aitthanatt C. Eitivipart

  3. Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Sintip Pattanakuhar

  4. Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, UK

    Sintip Pattanakuhar

  5. Faculty of Health Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand

    Pooriput Waongenngarm

Authors
  1. Phantira Techaworarak
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  2. Aitthanatt C. Eitivipart
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  4. Pooriput Waongenngarm
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Contributions

The authors have contributed in the following ways: PT was responsible for the Conceptualization, Methodology, Investigation, Data Curation, Writing - Review & Editing. AE contributed to the Conceptualization, Methodology, Investigation, Data Curation, Supervision, Writing - Review & Editing. SP contributed to the Concept/Research Design, Investigation, Resources, Supervision, Writing - Review & Editing. PW was responsible for the Conceptualization, Methodology, Formal Analysis, Data Curation, Project Administration, Funding Acquisition, Writing - Original Draft, Review & Editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Pooriput Waongenngarm.

Ethics declarations

Ethical approval

The study was approved by the Human Research Ethics Committee of Chulabhorn Research Institute (No. 129/2564) and Research Ethics Committee Panel 5, Faculty of Medicine, Chiang Mai University, Thailand (No. 391/2022) based on the Declaration of Helsinki. Written and verbal explanations of the contents of this study were provided to the participants and informed consent was obtained. We declare that all applicable institutional and governmental regulations regarding the ethical use of human volunteers were followed during the course of this research.

Competing interests

The authors declare no competing interests.

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Techaworarak, P., Eitivipart, A.C., Pattanakuhar, S. et al. Development of the tele-neurological assessment for the level, severity, and completeness of spinal cord injury (TNASCI): reliability and validity. Spinal Cord 63, 499–507 (2025). https://doi.org/10.1038/s41393-025-01109-6

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