Abstract
Study design:
Administration of the walking index for SCI (WISCI) II is recommended to assess walking in spinal cord injury (SCI) patients. Determining the reliability and reproducibility of the WISCI II in acute SCI would be invaluable.
Objectives:
The objective of this study is to assess the reliability and reproducibility of the WISCI II in patients with traumatic, acute SCI.
Design:
Test–retest analysis and calculation of reliability and smallest real difference (SRD).
Setting:
SCI unit of a rehabilitation hospital.
Methods:
Thirty-three patients, median age 44 years, median time since onset of SCI 40 days. Level: 20 cervical, 8 thoracic, 5 lumbar; ASIA (American Spinal Injury Association) impairment scale (AIS) grade: 32 D/1 C. Assessment of maximum WISCI II levels by two trained, blinded raters to evaluate interrater (IRR) and intrarater reliability.
Results:
The intrarater reliability was 0.999 for therapists A and 0.979 for therapists B, for the maximum WISCI II level. The IRR for the maximum WISCI II score was 0.996 on day 1 and 0.975 on day 2. The SRD for the maximum WISCI II score was 1.147 for tetraplegics and 1.682 for paraplegics. These results suggest that a change of two WISCI II levels could be considered real.
Conclusions:
The WISCI II has high IRR and intrarater reliability and good reproducibility in the acute and subacute phase when administered by trained raters.
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References
Ditunno PL, Patrick M, Stineman M, Morganti B, Townson AF, Ditunno JF . Cross-cultural differences in preference for recovery of mobility among spinal cord injury rehabilitation professionals. Spinal Cord 2006; 44: 567–575.
Ditunno JF Jr, Ditunno PL, Graziani V, Scivoletto G, Bernardi M, Castellano V et al. Walking index for spinal cord injury (WISCI): an international multicenter validity and reliability study. Spinal Cord 2000; 38: 234–243.
Dittuno PL, Ditunno JF Jr . Walking index for spinal cord injury (WISCI II): scale revision. Spinal Cord 2001; 39: 654–656.
Morganti B, Scivoletto G, Ditunno P, Ditunno JF, Molinari M . Walking index for spinal cord injury (WISCI): criterion validation. Spinal Cord 2005; 43: 27–33.
Ditunno JF Jr, Barbeau H, Dobkin BH, Elashoff R, Harkema S, Marino RJ et al. Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial. Neurorehabil Neural Repair 2007; 21: 539–550.
Jackson AB, Carnel CT, Ditunno JF, Read MS, Boninger ML, Schmeler MR et al. Outcome measures for gait and ambulation in the spinal cord injury population. J Spinal Cord Med 2008; 31: 487–499.
Ditunno JF Jr, Ditunno PL, Scivoletto G, Patrick M, Dijkers M, Barbeau H et al. The walking index for spinal cord injury (WISCI/WISCI II): nature, metric properties, use and misuse. Spinal Cord 2013; 51: 346–355.
Marino RJ, Scivoletto G, Patrick M, Tamburella F, Read MS, Burns AS et al. Walking index for spinal cord injury version 2 (WISCI-II) with repeatability of the 10-m walk time: Inter- and intrarater reliabilities. Am J Phys MedRehabil 2010; 89: 7–15.
Burns AS, Delparte JJ, Patrick M, Marino RJ, Ditunno JF . The reproducibility and convergent validity of the walking index for spinal cord injury (WISCI) in chronic spinal cord injury. Neurorehabil Neural Repair 2011; 25: 149–157.
Scivoletto G, Tamburella F, Foti C, Marco Molinari M, John F, Ditunno JF . Walking index for spinal cord injury (WISCI) reliability in patients with acute spinal cord injury (SCI). Abstract Book of the International Congress on Spinal Cord Medicine and Rehabilitation., Washington, DC, USA, 6–8 June, 2011 p 61.
American Spinal Injury Association. International Standards for Neurological Classifications of Spinal Cord Injury (revised). American Spinal Injury Association: Chicago, IL, USA. 2000.
Kimberlin CL, Winterstein AG . Validity and reliability of measurement instruments used in research. Am J Health Syst Pharm 2008; 65: 2276–2284.
Fawcett JW, Curt A, Steeves JD, Coleman WP, Tuszynski MH, Lammertse D et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord 2007; 45: 190–205.
Beckerman H, Roebroeck ME, Lankhorst GJ, Becher JG, Bezemer PD, Verbeek AL . Smallest real difference, a link between reproducibility and responsiveness. Qual Life Res 2001; 10: 571–578.
Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. Int J Nurs Stud 2011; 48: 661–671.
Domholdt E . Rehabilitation Research: Principles and Applications 3rd edn. Elsevier Saunders: Philadelphia, PA, USA. 2005.
Steeves JD, Lammertse D, Curt A, Fawcett JW, Tuszynski MH, Ditunno JF et al. Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures. Spinal Cord 2007; 45: 206–221.
Curt A, Van Hedel HJ, Klaus D, Dietz V . Recovery from a spinal cord injury: significance of compensation, neural plasticity, and repair. J Neurotrauma 2008; 25: 677–685.
van Hedel HJ, Wirz M, Dietz V . Standardized assessment of walking capacity after spinal cord injury: the European network approach. Neurol Res 2008; 30: 61–73.
Kim MO, Burns AS, Ditunno JF Jr, Marino RJ . The assessment of walking capacity using the walking index for spinal cord injury: self-selected versus maximal levels. Arch Phys Med Rehabil 2007; 88: 762–767.
Lam T, Noonan VK, Eng JJ . A systematic review of functional ambulation outcome measures in spinal cord injury. Spinal Cord 2008; 46: 246–254.
Dawson J, Shamley D, Jamous MA . A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury. Spinal Cord 2008; 46: 768–780.
van Hedel HJ, Wirz M, Curt A . Improving walking assessment in subjects with an incomplete spinal cord injury: responsiveness. Spinal Cord 2006; 44: 352–356.
Chen HM, Chen CC, Hsueh IP, Huang SL, Hsieh CL . Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke. Neurorehabil Neural Repair 2009; 23: 435–440.
Vaz S, Falkmer T, Passmore AE, Parsons R, Andreou P . The case for using the repeatability coefficient when calculating test-retest reliability. PLoS One 2013; 8: e73990.
Barrett B, Brown D, Mundt M, Brown R . Sufficiently important difference: expanding the framework of clinical significance. Med Decis Making 2005; 25: 250–261.
Acknowledgements
We would like to thank MA and RC, the physical therapists who performed the assessments of the WISCI. The suggestions and corrections of Professor Ralph Marino (Thomas Jefferson University, Philadelphia, PA, USA) are gratefully acknowledged. This work has been funded by a grant of the International Foundation for Research in Paraplegie (IRP, P133) to GS.
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Scivoletto, G., Tamburella, F., Laurenza, L. et al. Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility. Spinal Cord 52, 65–69 (2014). https://doi.org/10.1038/sc.2013.127
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DOI: https://doi.org/10.1038/sc.2013.127
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