Reliability and repeatability of the motor and sensory examination of the International Standards for Neurological Classification of Spinal Cord Injury

Objective: To determine the reliability and repeatability of the motor and sensory examination of the International Standards for Classification of Spinal Cord Injury (SCI) in trained examiners. Participants/Methods: Sixteen examiners (8 physicians, 8 physical therapists) with clinical SCI experience and 16 patients participated in a reliability study in preparation for a clinical trial involving individuals with acute SCI. After a training session on the standards, each examiner evaluated 3 patients for motor, light touch (LT), and pin prick (PP). The following day, 15 examiners reevaluated one patient. Inter-rater reliability was determined using intraclass correlation coefficients (1-way, random effects model). Intra-rater reliability was determined using a 2-way random effects model. Repeatability was determined using the method of Bland and Altman. Results: Patients were classified as complete tetraplegia (n = 5), incomplete tetraplegia (n = 5), complete paraplegia (n = 5), and incomplete paraplegia (n = 1). Overall, inter-rater reliability was high: motor = 0.97, LT = 0.96, PP = 0.88. Repeatability values were small in patients with complete SCI (motor < 2 points, sensory < 7 points) but large for patients with incomplete SCI. Intra-rater reliability values were >= 0.98 for patients with complete SCI. Conclusions: The summed scores for motor, LT, and PP in subjects with complete SCI have high inter-rater reliability and small repeatability values. These measures are appropriately reliable for use in clinical trials involving serial neurological examinations with multiple examiners. Further research in subjects with incomplete SCI is needed to determine whether repeatability is acceptably small.