title: Rater agreement on the ISCSCI motor and sensory scores obtained before and after formal training in testing technique.
abstract: OBJECTIVE
  The purpose of this study is to report the results of rater agreement for the International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) motor and sensory scores before and after training in the testing technique.
  
  
  METHODS
  Six raters performed sequential motor and sensory examinations on 5 adolescents with SCI according to the ISCSCI manual. After completion of the first examinations, all raters were provided with a half-day formal training session on testing techniques, after which the raters repeated the examinations. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were calculated to provide parameters for ICC interpretation: > 0.90 = high agreement; 0.75 to 0.90 = moderate agreement; < 0.75 = poor agreement.
  
  
  RESULTS
  After training, there was improvement in rater agreement of summed motor scores (MS) from ICC -0.809 to 0.862 and discrimination scores from ICC = 0.786 to 0.892. There was moderate rater agreement for light touch scores (LTS) before and after training. After training, there was improvement in 95% CIs except for ICCs for LTS, but for all ICCs, the lower 95% CI value remained less than 0.75.
  
  
  CONCLUSIONS
  Training improved rater agreement on MS and discrimination, but 95% CIs remained unacceptably wide. The positive effect of training in motor and sensory testing techniques is supported by the study data. Unlike previous studies that have suggested the ISCSCI has acceptable reliability for clinical trials, the results of this study do not fully support the use of the ISCSCI for clinical trials without better standardization to establish a lower 95% CI value of at least 0.75.
authors.affiliation: Rehabilitation Services and Clinical Research, Shriners Hospitals for Children, 3551 North Broad Street, Philadelphia, PA 19140, USA. mmulcahey@shrinenet.org
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Mulcahey
authors.forename: John
authors.initials: J
authors.lastname: Gaughan
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Vogel
mesh_terms: D000293:Adolescent; D000328:Adult; D003951:Diagnostic Errors / Q000517:prevention & control; D004185:Disability Evaluation; D006801:Humans; D038801:International Classification of Diseases / Q000592:standards* / Q000706:statistics & numerical data; D009069:Movement Disorders / Q000145:classification / Q000175:diagnosis*; D012015:Reference Standards; D015203:Reproducibility of Results; D012678:Sensation Disorders / Q000145:classification / Q000175:diagnosis*; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000503:physiopathology*