The aim of this systematic review is to identify, evaluate and interpret all the available research relevant to the reliability and validity of the sensory testing component in the ISNCSCI and AIS.
The following Databases will be searched: Medline via Ovid, CINAHL, PEDro and Scopus.To ensure all relevant articles have been obtained other subsequent search methods will be employed, such as MeSH (Medical Subject Heading) terms, manual searching (pearling reference lists), contacting key authors, and utilizing the ‘related articles’ feature within databases. Search terms will reflect the spinal cord population, the ISNCSCI and the reliability and validity properties.
Limitations include: Assessment of at least the sensory portion of the ASIA scale, articles written in English and participants with a traumatic spinal cord injuries – (ASIA A-E). Articles will be excluded if they are a systematic review, case study, have participants below the age of 18 or participants that have a spinal cord injury with associated head Injuries/multi-trauma. No publication period has been applied.
Types of study to be included
Included in the review will be randomised controlled trials along with observational studies such as cohort and case controlled studies. These have been included due to current limited literature.
Condition or domain being studied
The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and American Spinal Injury Association Impairment Scale (AIS) are an internationally recognised classification tool for spinal cord injuries. Developed from the Frankel Scale and first published in 1982 by the American Spinal Injury Association (ASIA) it classifies the degree of neurological impairment. The ISNCSCI has two components, sensory and motor and uses common clinical measures that can be performed with minimal equipment within a clinical setting. The motor examination requires the testing of key muscle functions corresponding to 10 myotomes. The sensory examination is tested by assessing a key sensory point on each of the 28 dermatomes, on both sides.
Inclusion Criteria:Participants with a traumatic Spinal Cord Injury (ASIA - A-E). Exclusion Criteria: Participants under the ages of 18. Participants who have associated head injuries.
Reliability is the extent to which a measuring procedure is able to deliver the same result on repeated trials. It does not only involve the test itself but also the independent observers ability to replicate the procedure, or their ability to use the research tools in order to replicate measurements. Validity is the degree to which a measurement procedure is able to accurately reflect or assess the measurement. There are many types of validity but within this review construct validity will be most relevant. Construct validity can be defined as the degree to which an instrument measures what it intends to measure. Without reliability and validity researchers will be unable to draw significant conclusions from studies. Research is crucial in the world of health and medicine and contributes to evidence based practice.
Against other classification measurement. For example the Graded Redefined Assessment of Strength and Sensibility and Prehension.
To contribute high level evidence to a field where literature is scarce and conflicting. Therefore allowing health professionals to carry out evidence based practice, a crucial component in modern medical treatment. Also, this review allows researchers with the evidence to support whether they choose the ISNCSCI and AIS as an outcome measure to support a trial.
Future research proposals and recommendations are expected from the study.
Risk of bias (quality) assessment
Bias and quality will be assessed in the articles by both the review authors.Two tools have been chosen for the rating and critical appraisal of the articles. Firstly, the Oxford Centre for Evidence Based Medicine (OCEBM) hierarchy of evidence has been nominated to allocate a particular international level of evidence. The second tool is used to critically appraise the articles and ensure all sources of bias have been covered. The Crowe Critical Appraisal Tool was chosen since it has been proven as a viable tool that can be used across a comprehensive range of research designs.
Strategy for data synthesis
Tables with the extraction of data from the articles will include; level of evidence, CCAT score, study characteristics (eg. study size, population, follow up, outcome measures, etc), the risk of bias of each study and results of individual studies. These tables will be analyzed and themes identified within the results of the review.There will be limited scope for the application of a meta-analysis due to the range of study designs and different outcome measurements being applied.
Analysis of subgroups or subsets
The final paper will be submitted to a journal within the relevant field.
Contact details for further information
36 Benedore Street Rasmussen, Townsville, QLD, 4815
Organisational affiliation of the review
James Cook University
Miss Marita Hales, Student Ms Jackie Reznik, Lecturer
Anticipated or actual start date
14 December 2012
Anticipated completion date
01 September 2013
James Cook University - School of Public Health, Tropical Medicine and Rehabilitation Sciences - (Physiotherapy)
Conflicts of interest
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Humans; International Classification of Diseases; Spinal Cord Injuries;
Date of registration in PROSPERO
14 September 2012
Date of publication of this revision
14 September 2012
Stage of review at time of this submission
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.