A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury

Dawson, Jill; Shamley, Delva; Jamous, Mohammed

doi:10.1038/sc.2008.50

Cited by 43 publications

(27 citation statements)

References 59 publications

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“…2 However, the assessment of reliability at that stage required consensus on the number and types of aids and assistants with which the person was walking; further, there are claims that further evidence of reliability and responsiveness is needed. 15,[20][21][22] Nevertheless, reliability studies on the WISCI are available only in chronic SCI patients. 8,9 Recently, Marino et al 8 reported that for chronic SCI patients, the IRR and intrarater reliability was 1.00 for SS WISCI II.…”

Section: Discussionmentioning

confidence: 99%

Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility

et al. 2013

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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. Spinal Cord (2014) 52, 65-69; doi:10.1038/sc.2013.127; published online 22 October 2013Keywords: spinal cord injury; walking; WISCI II; reliability; reproducibility INTRODUCTIONValid and reliable outcome measures in clinical trials on spinal cord injuries (SCIs) must be generated to develop effective treatment interventions-a necessity that is particularly true for walking function, which is a principal goal for subjects with SCIs. 1 Thus, it is conceivable that many clinical trials will be geared toward walking recovery and require valid outcome measures. Outcome measures that are related to walking function include measures of walking capacity, such as short-distance timed walk, long distance (6-min walk) and the walking index for SCI (WISCI II).The WISCI was introduced in 2000 2 and modified in 2001 (WISCI II) 3 as a measure of the capacity to walk for use in clinical trials, incorporating the use of walking aids, braces and physical assistance on a 21-point scale. The WISCI was ranked by an international group of SCI clinicians and investigators from most impaired to least impaired, and has demonstrated theoretical construct and face validity. It was subsequently compared with four scales in a clinical population of mixed SCI and spinal cord lesions to validate its retrospective criteria (versus other scales). 4 In 2006, the WISCI was used in a multicenter, randomized clinical trial, as assessed by blinded observers, and correlated well with lower extremity motor score, balance, walking speed, 6-min walking distance and locomotor functional independence measure score, validating its prospective criteria. 5 Since then, the WISCI ...

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Section: Discussionmentioning

confidence: 99%

Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility

et al. 2013

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“…The FIM shows good evidence of reliability and validity and is routinely used in spinal rehabilitation. 12 The depression, anxiety and stress scales (DASS-21) 13 were administered on an individual's admission to the Unit. This 21-item questionnaire, derived from the original 42-item DASS, consists of three subscales designed to measure the emotional states of depression, anxiety and stress.…”

Section: Participantsmentioning

confidence: 99%

Psychological intervention during spinal rehabilitation: a preliminary study

2009

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Study design: A repeated measures, non-randomised controlled trial. Objective: To examine the effectiveness of individualised cognitive behaviour therapy (CBT) on the psychological adjustment of patients undergoing rehabilitation for newly acquired spinal cord injury. Setting: South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, South Australia, Australia. Methods: Eleven participants received individual CBT as part of their spinal rehabilitation. Selfreported levels of depression, anxiety and stress were assessed before the intervention, at week 12 of rehabilitation and at 3 months post-discharge, using the depression, anxiety and stress scales (DASS-21). Functional independence was also assessed, using the Functional Independence Measure (FIM). Responses were compared with 13 participants, closely matched on demographic and injury variables, who received standard psychological care (that is, assessment and monitoring only). Results: Depression scores for treatment participants showed a significant time effect, with worsening symptoms reported at three-month follow-up, after CBT was discontinued. In contrast, the DASS-21 scores of standard care participants remained at subclinical levels throughout the study. Clinical improvements in symptoms of anxiety and stress were also reported by the treatment group as inpatient therapy progressed. Conclusion: Targeted, individualised psychological treatment contributed to short-term, meaningful improvements in emotional outcomes for individuals reporting psychological morbidity after recent spinal injury. The results also highlight the need for ongoing access to specialised, psychological services post-discharge. Replication of these results with a larger sample is required before definitive conclusions can be drawn.

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“…Research has demonstrated the NAC to be a psychometrically reliable and valid assessment tool 24,25 and a recent review found it to be one of the best measures of outcomes in SCI rehabilitation. 26 This study will observe and compare rehabilitation outcomes, in the ten aforementioned domains of the NAC, between patients with T-SCI and NT-SCI undergoing the same rehabilitation programme at a SIC. This study aims to draw conclusions regarding whether NT-SCI patients benefit from the same rehabilitation programme as T-SCI patients and, therefore, whether it is advisable for them to be admitted and treated similarly.…”

Section: Introductionmentioning

confidence: 99%

Traumatic versus non-traumatic spinal cord injuries: are there differential rehabilitation outcomes?

Kennedy

Chessell

2013

Spinal Cord

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Study design: Retrospective case review. Objectives: To compare the rehabilitation outcomes between patients with traumatic spinal cord injuries and patients with nontraumatic spinal cord injuries, using The Needs Assessment Checklist (NAC), to observe if both the groups benefit from the same rehabilitation programme. Setting: Tertiary care, spinal cord injury rehabilitation unit (National Spinal Injuries Centre), Stoke Mandeville Hospital, UK. Methods: Information obtained with the NAC at two time points during patients' rehabilitation was examined. Statistical analysis investigated the rehabilitation outcomes both between and within groups. Results: Initial differences were observed on admission between patients with traumatic and non-traumatic spinal cord injuries in five of the ten rehabilitation domains measured, with patients with non-traumatic injuries presenting with better outcomes. At a later stage in patients' rehabilitation, however, differences between the groups had lessened. Furthermore, the results demonstrated that the whole cohort made significant improvements in all the ten rehabilitation domains, with the same finding evident for both patients with traumatic and patients with non-traumatic spinal cord injuries. Conclusion: Patients with traumatic spinal cord injuries and patients with non-traumatic spinal cord injuries benefitted from the same rehabilitation programme in a spinal injury centre, making significant improvements in all ten rehabilitation domains measured, suggesting that it is effective to admit and rehabilitate patients with injuries resulting from both traumatic and non-traumatic aetiologies in the same specialised setting.

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A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury

Cited by 43 publications

References 59 publications

Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility

Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility

Psychological intervention during spinal rehabilitation: a preliminary study

Traumatic versus non-traumatic spinal cord injuries: are there differential rehabilitation outcomes?

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