Spinal Cord Independence Measure, version III: applicability to the UK spinal cord injured population.

OBJECTIVE: To examine the validity, reliability and usefulness of the Spinal Cord Independence Measure for the UK spinal cord injury population. DESIGN: Multi-centre cohort study. SETTING: Four UK regional spinal cord injury centres. SUBJECTS: Eighty-six people with spinal cord injury. INTERVENTIONS: Spinal Cord Independence Measure and Functional Independence Measure on admission analysed using inferential statistics, and Rasch analysis of Spinal Cord Independence Measure. MAIN OUTCOME MEASURES: Internal consistency, inter-rater reliability, discriminant validity; Spinal Cord Independence Measure subscale match between distribution of item difficulty and patient ability measurements; reliability of patient ability measures; fit of data to Rasch model; unidimensionality of subscales; hierarchical ordering of categories within items; differential item functioning across patient groups. RESULTS: Scale reliability (kappa coefficients range 0.491-0.835; (p < 0.001)), internal consistency (Cronbach's alpha 0.770 and 0.780 for raters), and validity (Pearson correlation; p < 0.01) were all significant. Spinal Cord Independence Measure subscales compatible with stringent Rasch requirements; mean infit indices high; distinct strata of abilities identified; most thresholds ordered; item hierarchy stable across clinical groups and centres. Misfit and differences in item hierarchy identified. Difficulties assessing central cord injuries highlighted. CONCLUSION: Conventional statistical and Rasch analyses justify the use of the Spinal Cord Independence Measure in clinical practice and research in the UK. Cross-cultural validity may be further improved.

Quantitative sensory tests (perceptual thresholds) in patients with spinal cord injury.

This article was presented at the Premeeting Workshop on Outcome Measures at the American Spinal Injury Association (ASIA) Annual Scientific Meeting in Dallas, Texas, in May 2005. The article summarizes preliminary findings of three quantitative sensory tests that were evaluated as part of the International Spinal Research Trust Clinical Initiative study: perceptual thresholds to electrical, vibration, and thermal stimulation. The results gathered so far suggest that the three tests are simple, reproducible, and applicable in a clinical setting. The tests seem to add resolution and sensitivity to the standard clinical testing and could be useful adjuncts in longitudinal monitoring of spinal cord injury for research purposes.

The relation of thoracic and lumbar fracture configuration to the development of late deformity in childhood spinal cord injury.

STUDY DESIGN: A retrospective clinical observational study was conducted. OBJECTIVE: To assess the relation of spinal fracture type and its magnitude of distortion to subsequent long-term development of late spinal deformity in childhood onset spinal cord injury. SUMMARY OF BACKGROUND DATA: In this study, 76 adults who sustained spinal cord injury during childhood were examined clinically and radiographically alongside a retrospective review of case notes and radiographs. METHODS: The nature of the spinal injury and the progression of its displacement were defined from radiographs taken immediately after injury, then at 4 months and at 1 year. Eventual adult spinal deformity was defined from standardized erect long-plate radiographs. Scoliosis, kyphosis, and lordosis were measured using Cobb's method. RESULTS: There was no statistically significant difference in the severity of scoliosis, kyphosis, or lordosis between traumatic and nontraumatic injuries, nor between patients with and those without radiologically visible bony injury. Of the 14 patients with traumatic thoracic and lumbar injuries who had undergone no surgical intervention, 10 (71%) showed development of major scoliotic curves that did not include the fracture site. The patients with no angular displacement at the fracture site after 1 year went on to experience the development of more severe scoliosis (mean, 66 degrees) than those who had displaced fractures (mean, 38 degrees). In five, a low kyphotic curve and a compensatory lordosis above it developed. CONCLUSIONS: There is no evidence that the bony injury to the vertebral column itself in the child with spinal cord injury influences the development of late scoliosis or lordosis, but it may influence any eventual kyphosis.