Validation of estimating American Spinal Injury Association Impairment Scale grade with a self-administered questionnaire for assessment of sacral sparing after spinal cord injury_West China Medical Journal

Authors：

XING Huayi ,  LIU Nan , ZHOU Mouwang

Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing 100191, P. R. China;

Corresponding author：

LIU Nan, Email: puth_liunan@outlook.com

Keywords：

Spinal cord injury; Sacral sparing; Self-report questionnaire; Validity

DOI：

10.7507/1002-0179.202002353

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Objective To investigate the validity of estimating American Spinal Injury Association Impairment Scale (AIS) grade with a bowel-routine based self-administered questionnaire for assessment of sacral sparing after spinal cord injury (SCI).Methods The 5-item SCI sacral sparing self-report questionnaire was administrated to SCI inpatients from August 2014 to July 2016, followed by an standardized digital rectal examination. Question 1 (perceiving the tissue), Question 2 (identifying the water temperature as warm or cold), Question 3 (perceiving the inserted finger), and Question 4 (perceiving the inserted enema tube) tested the sensory sacral sparing, and Question 5 (holding the enema for more than 1 min) evaluated the voluntary anal sphincter contraction. Based on the answers from each participant, the sensory and motor sacral sparing was implied, and an estimated AIS grade (AIS A, AIS B, or AIS C/D) was recorded. Agreement of the estimated AIS grade and the actual AIS grade according to the physical examination was analyzed. Sensitivity, specificity, and Youden’s index of the questionnaire for estimating completeness of injury were calculated.Results A total of 102 SCI patients were enrolled. The general agreement of estimated and actual AIS grades was good (κ=0.681, P<0.001). For the estimation of a complete injury, both the sensitivity (87.10%) and the specificity (100.00%) of this questionnaire were high, with a Youden’s index of 0.87. For the estimation of a motor complete injury, the sensitivity increased (92.00%) while the specificity decreased slightly (75.00%), with a Youden’s index of 0.67.Conclusions The validity of this self-report questionnaire for estimation of AIS grade is good. In some situations, it could be considered as an alternative tool for the estimation of sacral sparing as well as the AIS grades within SCI individuals, especially when repeated anorectal examinations are not feasible.

Citation： XING Huayi, LIU Nan, ZHOU Mouwang. Validation of estimating American Spinal Injury Association Impairment Scale grade with a self-administered questionnaire for assessment of sacral sparing after spinal cord injury. West China Medical Journal, 2020, 35(5): 538-543. doi: 10.7507/1002-0179.202002353 Copy

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2.	Kirshblum SC, Waring W, Biering-Sorensen F, et al. Reference for the 2011 revision of the international standards for neurological classification of spinal cord injury. J Spinal Cord Med, 2011, 34(6): 547-554.
3.	Kirshblum SC, Botticello AL, Dyson-Hudson TA, et al. Patterns of sacral sparing components on neurologic recovery in newly injured persons with traumatic spinal cord injury. Arch Phys Med Rehabil, 2016, 97(10): 1647-1655.
4.	Samdani A, Chafetz RS, Vogel LC, et al. The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing. Spinal Cord, 2011, 49(3): 352-356.
5.	Marino RJ, Schmidt-Read M, Kirshblum SC, et al. Reliability and validity of S3 pressure sensation as an alternative to deep anal pressure in neurologic classification of persons with spinal cord injury. Arch Phys Med Rehabil, 2016, 97(10): 1642-1646.
6.	Harvey LA, Weber G, Heriseanu R, et al. The diagnostic accuracy of self-report for determining S4–5 sensory and motor function in people with spinal cord injury. Spinal Cord, 2012, 50(2): 119-122.
7.	Fekete C, Eriks-Hoogland I, Baumberger M, et al. Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord, 2013, 51(1): 40-47.
8.	Liu N, Xing H, Zhou MW, et al. Development and validation of a bowel-routine-based self-report questionnaire for sacral sparing after spinal cord injury. Spinal Cord, 2017, 55(11): 1010-1015.
9.	Hobart JC, Cano SJ, Warner TT, et al. What sample sizes for reliability and validity studies in neurology?. J Neurol, 2012, 259(12): 2681-2694.
10.	Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics, 1977, 33(1): 159-174.
11.	DeVivo M, Biering-Sørensen F, Charlifue S, et al. International Spinal Cord Injury Core Data Set. Spinal Cord, 2006, 44(9): 535-540.
12.	Buehner JJ, Forrest GF, Schmidt-Read M, et al. Relationship between ASIA examination and functional outcomes in the Neuro Recovery Network Locomotor Training Program. Arch Phys Med Rehabil, 2012, 93(9): 1530-1540.
13.	Walden K, Bélanger LM, Biering-Sørensen F, et al. Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Spinal Cord, 2016, 54(3): 197-203.
14.	Scivoletto G, Tamburella F, Laurenza L, et al. Distribution-based estimates of clinically significant changes in the International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores. Eur J Phys Rehabil Med, 2013, 49(3): 373-384.
15.	Lauschke JL, Grace WL, Rutkowski SB, et al. Changes in electrical perceptual threshold in the first 6 months following spinal cord injury. J Spinal Cord Med, 2011, 34(5): 473-481.
16.	van Middendorp JJ, Hosman AJF, Pouw MH, et al. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients. Spinal Cord, 2009, 47(11): 809-816.
17.	Zariffa J, Kramer JK, Linda AJ, et al. Sacral sparing in SCI: beyond the S4-S5 and anorectal examination. Spine J, 2012, 12(5): 389-400.
18.	Chun A, Delgado AD, Tsai CY, et al. An interview based approach to the anorectal portion of the International Standards of Neurological Classification of Spinal Cord Injury Exam (I-A-ISNCSCI): a pilot study. Spinal Cord, 2020, 58: 553-559.
19.	Yozbatiran N, Harness ET, Le V, et al. A tele-assessment system for monitoring treatment effects in subjects with spinal cord injury. J Telemed Telecare, 2010, 16(3): 152-157.
20.	Biering-Sørensen F, Devivo MJ, Charlifue S, et al. International spinal cord injury core data set (version 2.0)—including standardization of reporting. Spinal Cord, 2017, 55(8): 759-764.
21.	Katzan IL, Thompson NR, Lapin B, et al. Added value of patient-reported outcome measures in stroke clinical practice. J Am Heart Assoc, 2017, 6(7): e005356.

1. Kirshblum SC, Burns SP, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med, 2011, 34(6): 535-546.
2. Kirshblum SC, Waring W, Biering-Sorensen F, et al. Reference for the 2011 revision of the international standards for neurological classification of spinal cord injury. J Spinal Cord Med, 2011, 34(6): 547-554.
3. Kirshblum SC, Botticello AL, Dyson-Hudson TA, et al. Patterns of sacral sparing components on neurologic recovery in newly injured persons with traumatic spinal cord injury. Arch Phys Med Rehabil, 2016, 97(10): 1647-1655.
4. Samdani A, Chafetz RS, Vogel LC, et al. The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing. Spinal Cord, 2011, 49(3): 352-356.
5. Marino RJ, Schmidt-Read M, Kirshblum SC, et al. Reliability and validity of S3 pressure sensation as an alternative to deep anal pressure in neurologic classification of persons with spinal cord injury. Arch Phys Med Rehabil, 2016, 97(10): 1642-1646.
6. Harvey LA, Weber G, Heriseanu R, et al. The diagnostic accuracy of self-report for determining S4–5 sensory and motor function in people with spinal cord injury. Spinal Cord, 2012, 50(2): 119-122.
7. Fekete C, Eriks-Hoogland I, Baumberger M, et al. Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord, 2013, 51(1): 40-47.
8. Liu N, Xing H, Zhou MW, et al. Development and validation of a bowel-routine-based self-report questionnaire for sacral sparing after spinal cord injury. Spinal Cord, 2017, 55(11): 1010-1015.
9. Hobart JC, Cano SJ, Warner TT, et al. What sample sizes for reliability and validity studies in neurology?. J Neurol, 2012, 259(12): 2681-2694.
10. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics, 1977, 33(1): 159-174.
11. DeVivo M, Biering-Sørensen F, Charlifue S, et al. International Spinal Cord Injury Core Data Set. Spinal Cord, 2006, 44(9): 535-540.
12. Buehner JJ, Forrest GF, Schmidt-Read M, et al. Relationship between ASIA examination and functional outcomes in the Neuro Recovery Network Locomotor Training Program. Arch Phys Med Rehabil, 2012, 93(9): 1530-1540.
13. Walden K, Bélanger LM, Biering-Sørensen F, et al. Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Spinal Cord, 2016, 54(3): 197-203.
14. Scivoletto G, Tamburella F, Laurenza L, et al. Distribution-based estimates of clinically significant changes in the International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores. Eur J Phys Rehabil Med, 2013, 49(3): 373-384.
15. Lauschke JL, Grace WL, Rutkowski SB, et al. Changes in electrical perceptual threshold in the first 6 months following spinal cord injury. J Spinal Cord Med, 2011, 34(5): 473-481.
16. van Middendorp JJ, Hosman AJF, Pouw MH, et al. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients. Spinal Cord, 2009, 47(11): 809-816.
17. Zariffa J, Kramer JK, Linda AJ, et al. Sacral sparing in SCI: beyond the S4-S5 and anorectal examination. Spine J, 2012, 12(5): 389-400.
18. Chun A, Delgado AD, Tsai CY, et al. An interview based approach to the anorectal portion of the International Standards of Neurological Classification of Spinal Cord Injury Exam (I-A-ISNCSCI): a pilot study. Spinal Cord, 2020, 58: 553-559.
19. Yozbatiran N, Harness ET, Le V, et al. A tele-assessment system for monitoring treatment effects in subjects with spinal cord injury. J Telemed Telecare, 2010, 16(3): 152-157.
20. Biering-Sørensen F, Devivo MJ, Charlifue S, et al. International spinal cord injury core data set (version 2.0)—including standardization of reporting. Spinal Cord, 2017, 55(8): 759-764.
21. Katzan IL, Thompson NR, Lapin B, et al. Added value of patient-reported outcome measures in stroke clinical practice. J Am Heart Assoc, 2017, 6(7): e005356.

West China Medical Journal

Validation of estimating American Spinal Injury Association Impairment Scale grade with a self-administered questionnaire for assessment of sacral sparing after spinal cord injury

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