title: Prediction and stratification of upper limb function and self-care in acute cervical spinal cord injury with the graded redefined assessment of strength, sensibility, and prehension (GRASSP).
abstract: BACKGROUND
  There is inherent heterogeneity within individuals suffering from cervical spinal cord injury (SCI), and early prediction of upper limb function and self-care is challenging. As a result, considerable uncertainty exists regarding the prediction of functional outcome following cervical SCI within 1 year of injury.
  
  
  OBJECTIVE
  To evaluate the value of Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) in predicting upper limb function and self-care outcomes in individuals with cervical SCI.
  
  
  METHODS
  A prospective longitudinal multicenter study was performed. Data from the GRASSP, the Spinal Cord Independence Measure (SCIM III), and the American Spinal Injury Association (ASIA) Impairment Scale were recorded at 1, 6, and 12 months after cervical SCI. For prediction of functional outcome at 6 and 12 months, a logistic regression model, receiver operating characteristics (ROC), and unbiased recursive partitioning conditional inference tree (URP-CTREE) were used with 8 different predictor variables.
  
  
  RESULTS
  Logistic regression analysis, ROC analysis, and URP-CTREE all revealed that the strength subtest within GRASSP is the strongest predictor for upper limb function and self-care outcomes. URP-CTREE provides useful information on the distribution of different outcomes in acute cervical SCI and can be used to predict cohorts with homogeneous outcomes.
  
  
  CONCLUSIONS
  The GRASSP at 1 month can accurately predict upper limb function and self-care outcomes even in a heterogeneous group of individuals across a wide spectrum of neurological recovery. The application of URP-CTREE can reveal the distribution of outcome categories and, based on this, inform trial protocols with respect to outcomes analysis and patient stratification.
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland inge-marie.velstra@paraplegie.ch.
authors.forename: Inge-Marie
authors.initials: IM
authors.lastname: Velstra
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland European Multicenter Study about Human Spinal Cord Injury (EMSCI).
authors.forename: Marc
authors.initials: M
authors.lastname: Bolliger
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.
authors.forename: Lorenzo Giuseppe
authors.initials: LG
authors.lastname: Tanadini
authors.affiliation: Department of Acute and Rehabilitation Medicine, Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Baumberger
authors.affiliation: Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Abel
authors.affiliation: Roessingh Research and Development, Lab of Biomechanical Engineering, University of Twente, Enschede, Netherlands.
authors.forename: Johan S
authors.initials: JS
authors.lastname: Rietman
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland European Multicenter Study about Human Spinal Cord Injury (EMSCI).
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012648:Self Care; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000534:rehabilitation*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*; D055815:Young Adult
keywords: ISNCSCI; activities of daily living; outcome measures; prediction; spinal cord injury; tetraplegia; upper limb function