Lecture to ISCoS (International Spinal Cord Society Hellenic Society Physical Medicine & Rehabilitation) Outcome Measures, Athens, Greece – 26-29/09/2004

Reliability Levels of the ASIA Motor and Sensory Examination in Physician versus Physical Therapist Examiners

Linda Jones, PT, MS, Ralph J. Marino, MD, Steven Kirshblum, MD, Joseph Tal, PhD

Objectives: 1) Assess reliability of motor and sensory examination of the International Standards for Classification of Spinal Cord Injury (SCI), 2) Assess differences in reliability between physician and physical therapist examiners.

Methods:  Sixteen examiners (8 physicians, 8 physical therapists), with a minimum of two years clinical SCI experience, examined three in a pool of 16 SCI patients. The study was done in preparation for Proneuron’s Phase II autologous incubated macrophage study for treatment of acute SCI patients. Inter-rater reliabilities were assessed using intraclass correlations (Model 1).

Results:  The intraclass correlations were high: 0.97 for motor scores; 0.96 for light touch scores; and 0.88 for pinprick scores. Computing individual examiner intraclass reliabilities (across three patients) we obtained coefficients of 0.91-1.00 for motor; 0.62-1.00 for light touch; and 0.56-0.99 for pin prick. Differences between physicians and physical therapists were non-significant. The correlation between light touch and pin prick reliabilities was 0.70 (p = 0.003).

Conclusions: 1) The scales are generally reliable, exceeding normally recommended reliability values, and appropriate for clinical trials, 2) The few low examiner reliabilities observed are not attributable to professional training (physician versus physical therapist), 3) Examiners who were reliable on light touch tended to be reliable on pin prick and vice versa.