Inter-Rater Reliability of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury

Abstract

The autonomic nervous system can be profoundly affected after spinal cord injury (SCI). Despite its importance to quality of life, autonomic function is rarely systematically assessed in the clinical setting. The International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) is an assessment designed to determine which autonomic functions are intact, impaired, or lost after SCI. The psychometric properties of the ISAFSCI have not yet been reported. The objective of this study was to describe the inter-rater reliability of the ISAFSCI. Participants with chronic traumatic SCI (greater than 1 year) able to remain on the same medications for the study period and communicate clearly with the assessor were recruited for the study. A standard protocol minimized variation between the sites. During the first assessment, neurologic examination (ISNCSCI) was performed and ISAFSCI completed. After 10-14 days, the ISAFSCI was repeated. Inter-rater reliability was calculated using percentage agreement, kappa, and weighted kappa statistics. Participants (n = 48) had an average age of 45 ± 12 years. Forty-one (85.4%) were male, 38 (79.2%) had a SCI at or above the T6 level, 24 (50.0%) had a complete SCI. Inter-rater reliability within the general autonomic component was moderate with kappa values ranging 0.41-0.6 (p < 0.05). Within the Lower Urinary Tract, Bowel, and Sexual Function component, agreement was good-strong with weighted kappa values 0.62-0.88 (p < 0.05). Given the results, we conclude that the ISAFSCI can be considered to have at least moderate and up to strong inter-rater reliability, especially in the bladder, bowel, and sexual function component of the assessment.

Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

“…This is the preferred method for describing the overall impact of SCI on sexual responses and has recently been found to have good interrater reliability. 20 The clinician documents the anatomic diagnosis (ie, whether the spinal cord lesion is supraconal, conal, or cauda equina) with this format. The clinician records the potential for psychogenic genital arousal, with 0 being no function, 1 being impaired, and 2 being normal.…”

Alarming blood pressure changes during routine bladder emptying in a woman with cervical spinal cord injury

“…As demonstrated by this case, AD is also a major complication that can result from manual pressure being Fig. 1 Autonomic standards assessment form according to the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) [8]. The form was completed following assessment and interview of this 58-year-old woman with C3 AIS B (motor complete, sensory incomplete) SCI.…”

“…In this clinical case, the ISAFSCI effectively collected crucial information related to the severity of Ms. X's AD. Although a novel tool, the ISAFSCI has demonstrated numerous clinical advantages and reliability for evaluating autonomic function after SCI: currently it is used to document the presence of conditions exhibited after SCI, such as AD or orthostatic hypotension [8,9]. The present form of ISAFSCI does not quantify severity of autonomic dysfunction (i.e.…”

Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management

“…55 The Autonomic Standards allow for documentation of general autonomic function, urinary bladder, bowel, and sexual function. Recent evaluations have shown moderate to good inter-rater reliability of the ISAFSCI (Kappa 0.41-0.88 for its various subscales), 56 although planned revisions are ongoing. 57 Previous versions of these standards 58 also contained guidelines for documenting urodynamic evaluations, though this is not currently included in the required forms.…”