Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards

Abstract

Study design: Prospective observational. Aim: To examine inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association (ASIA) standards. Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, UK. Material and method: Results of ASIA motor and sensory examinations performed by two experienced examiners on 45 patients with spinal cord injury (SCI) were compared. Results: Total ASIA scores showed very strong correlation between the two examiners, with Pearson correlation coefficients and intraclass correlation coefficients exceeding 0.96, P<0.01 for total motor, light touch and pin prick scores. The agreement for individual muscle testing of the 10 ASIA key muscles showed substantial agreement for majority of muscles, with the weighted Kappa coefficient range 0.649-0.993, P<0.05. The overall agreement in assignment of manual muscle testing grades (0-5) was 82% on the right and 84% on the left, with the strongest agreement for grade '0' and the weakest for grade '3'. The unweighted Kappa coefficient for agreement in motor and sensory levels ranged from 0.68 to 0.78 (P<0.01). There was no difference in ASIA impairment grades derived from the two examiners' results. Conclusions: Our study results showed very good levels of agreement in ASIA clinical examinations between two experienced examiners. The established degree of variability due to inter-rater differences should be taken into account in study design of clinical trials with more than one assessor. Sponsorship: Supported by the International Spinal Research Trust, UK, grant CLI001. © 2007 International Spinal Cord Society All rights reserved.