title: Reliability and Validity of S3 Pressure Sensation as an Alternative to Deep Anal Pressure in Neurologic Classification of Persons With Spinal Cord Injury.
abstract: OBJECTIVE
  To determine whether pressure sensation at the S3 dermatome (a new test) could be used in place of deep anal pressure (DAP) to determine completeness of injury as part of the International Standards for Neurological Classification of Spinal Cord Injury.
  
  
  METHODS
  Prospective, multicenter observational study.
  
  
  METHODS
  U.S. Spinal Cord Injury Model Systems.
  
  
  METHODS
  Persons (N=125) with acute traumatic spinal cord injury (SCI), neurologic levels T12 and above, were serially examined at 1 month (baseline), 3, 6, and 12 months postinjury. There were 80 subjects with tetraplegia and 45 with paraplegia.
  
  
  METHODS
  S3 pressure sensation at all time points, with a retest at the 1-month time point.
  
  
  METHODS
  Test-retest reliability and agreement (κ), sensitivity, specificity, positive and negative predictive values.
  
  
  RESULTS
  Test-retest reliability of S3 pressure at 1 month was almost perfect (κ=.98). Agreement of S3 pressure with DAP was substantial both at 1 month (κ=.73) and for all time points combined (κ=.76). The positive predictive value of S3 pressure for DAP was 89.3% at baseline and 90.3% for all time points. No pattern in outcomes was seen in those cases where S3 pressure and DAP differed at 1 month.
  
  
  CONCLUSIONS
  S3 pressure sensation is reliable and has substantial agreement with DAP in persons with SCI at least 1 month postinjury. We suggest S3 pressure as an alternative test of sensory sacral sparing for supraconus SCI, at least in cases where DAP cannot be tested. Further research is needed to determine whether S3 pressure could replace DAP for classification of SCI.
authors.affiliation: Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Electronic address: ralph.marino@jefferson.edu.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Marino
authors.affiliation: Magee Rehabilitation Hospital, Philadelphia, PA.
authors.forename: Mary
authors.initials: M
authors.lastname: Schmidt-Read
authors.affiliation: Kessler Institute for Rehabilitation, West Orange, NJ; Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Kirshblum
authors.affiliation: Rutgers New Jersey Medical School, Newark, NJ; Kessler Foundation Research Center, West Orange, NJ.
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Dyson-Hudson
authors.affiliation: Emory University School of Medicine, and Veterans Administration Medical Center, Atlanta, GA.
authors.forename: Keith
authors.initials: K
authors.lastname: Tansey
authors.affiliation: Spaulding Rehabilitation Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Morse
authors.affiliation: University of Louisville, Louisville, KY.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Graves
mesh_terms: D000328:Adult; D051517:Digital Rectal Examination / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008160:Lumbosacral Plexus / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D011312:Pressure; D011446:Prospective Studies; D011782:Quadriplegia / Q000534:rehabilitation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000145:classification* / Q000534:rehabilitation*; D015599:Trauma Severity Indices
keywords: Classification; Rehabilitation; Reproducibility of results; Sensitivity and specificity; Spinal cord injuries