title: Reliability and Validity of the Sensory Component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): A Systematic Review.
abstract: BACKGROUND
  Since 1982, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) has been used to classify sensation of spinal cord injury (SCI) through pinprick and light touch scores. The absence of proprioception, pain, and temperature within this scale creates questions about its validity and accuracy.
  
  
  OBJECTIVE
  To assess whether the sensory component of the ISNCSCI represents a reliable and valid measure of classification of SCI.
  
  
  METHODS
  A systematic review of studies examining the reliability and validity of the sensory component of the ISNCSCI published between 1982 and February 2013 was conducted. The electronic databases MEDLINE via Ovid, CINAHL, PEDro, and Scopus were searched for relevant articles. A secondary search of reference lists was also completed. Chosen articles were assessed according to the Oxford Centre for Evidence-Based Medicine hierarchy of evidence and critically appraised using the McMasters Critical Review Form. A statistical analysis was conducted to investigate the variability of the results given by reliability studies.
  
  
  RESULTS
  Twelve studies were identified: 9 reviewed reliability and 3 reviewed validity. All studies demonstrated low levels of evidence and moderate critical appraisal scores. The majority of the articles (~67%; 6/9) assessing the reliability suggested that training was positively associated with better posttest results. The results of the 3 studies that assessed the validity of the ISNCSCI scale were confounding.
  
  
  CONCLUSIONS
  Due to the low to moderate quality of the current literature, the sensory component of the ISNCSCI requires further revision and investigation if it is to be a useful tool in clinical trials.
authors.affiliation: Discipline of Physiotherapy, James Cook University, Townsville, Queensland, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Hales
authors.affiliation: Discipline of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Biros
authors.affiliation: Discipline of Physiotherapy, James Cook University, Townsville, Queensland, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Reznik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010264:Paraplegia / Q000145:classification; D011782:Quadriplegia / Q000145:classification; D015203:Reproducibility of Results; D012678:Sensation Disorders / Q000145:classification*; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000145:classification*; D055815:Young Adult
keywords: ISNCSCI; assessment; reliability; sensory testing; validity