Reliability and Repeatability of the Motor and Sensory Examination of the International Standards for Neurological Classification of Spinal Cord Injury

Abstract

Objective: To determine the reliability and repeatability of the motor and sensory examination of the International Standards for Classification of Spinal Cord Injury (SCI) in trained examiners.

Participants/Methods: Sixteen examiners (8 physicians, 8 physical therapists) with clinical SCI experience and 16 patients participated in a reliability study in preparation for a clinical trial involving individuals with acute SCI. After a training session on the standards, each examiner evaluated 3 patients for motor, light touch (LT), and pin prick (PP). The following day, 15 examiners reevaluated one patient. Interrater reliability was determined using intraclass correlation coefficients (1-way, random effects model). Intrarater reliability was determined using a 2-way random effects model. Repeatability was determined using the method of Bland and Altman.

Results: Patients were classified as complete tetraplegia (n = 5), incomplete tetraplegia (n = 5), complete paraplegia (n = 5), and incomplete paraplegia (n = 1). Overall, inter-rater reliability was high: motor = 0.97, LT = 0.96, PP = 0.88. Repeatability values were small in patients with complete SCI (motor < 2 points, sensory < 7 points) but large for patients with incomplete SCI. Intra-rater reliability values were > 0.98 for patients with complete SCI.

Conclusions: The summed scores for motor, LT, and PP in subjects with complete SCI have high interrater reliability and small repeatability values. These measures are appropriately reliable for use in clinical trials involving serial neurological examinations with multiple examiners. Further research in subjects with incomplete SCI is needed to determine whether repeatability is acceptably small.     

Inhibition of lymphocyte transformation by mepacrine and chloroquine

Mepacrine inhibited uptake and the incorporation of leucine, thymidine and uridine into acid-insoluble material in human lymphocytes stimulated by phytohaemagglutinin (PHA) in vitro. The IC50 for each uptake was of the order of 2 microM. Mepacrine was inhibitory if applied at any time up to 48 h after PHA. The inhibition differed from that produced by colchicine and prostaglandin E1. The dose-response curve was steep, nearly all incorporation being inhibited by 2 x IC50. Chloroquine also had a steep dose-response curve, was about one-fifth as potent as mepacrine and was maximally effective in the first 6 h after PHA.     

The Long‐Term Outcome of Transcutaneous Electrical Nerve Stimulation in the Treatment for Patients with Chronic Pain: A Randomized,Placebo‐Controlled Trial

Background: Transcutaneous electrical nerve stimulation (TENS) is an easy to use analgesic intervention. However, long‐term randomized placebo‐controlled studies with treatment periods of more than 3 months have not been executed to date. The aim of our study is to explore the long‐term (1 year) time course of the treatment effects of TENS compared to placebo (sham TENS). Method: We performed a randomized placebo‐controlled trial in patients with chronic pain (165), referred to a multidisciplinary pain center of a university hospital. Main outcome measures are the proportion of patients satisfied with treatment result and willing to continue treatment, pain intensity, pain disability, and perceived health status. Results: Survival analysis of time courses of proportions of satisfied patients revealed no significant differences (P = 0.79; log‐rank test) for TENS treatment compared to sham TENS. After 1 year, 30% (24/81) of the patients of the TENS group and 23% (19/82) of the sham TENS group were satisfied with treatment result. These patients experienced a mean overall improvement of 62.7% (n = 43). This effect was not significantly different between both groups. For satisfied patients, there were no differences in pain intensity or disability and perceived health status between the TENS and sham TENS group. Conclusions: Transcutaneous electrical nerve stimulation and sham TENS show similar effects in patients with chronic pain over a period of 1 year. We found support for a long sustained placebo effect.