TY - JOUR
T1 - Reliability and Validity of S3 Pressure Sensation as an Alternative to Deep Anal Pressure in Neurologic Classification of Persons With Spinal Cord Injury
AU - Marino, Ralph J.
AU - Schmidt-Read, Mary
AU - Kirshblum, Steven C.
AU - Dyson-Hudson, Trevor A.
AU - Tansey, Keith
AU - Morse, Leslie R.
AU - Graves, Daniel E.
N1 - Publisher Copyright:
© 2016 American Congress of Rehabilitation Medicine
PY - 2016/10
Y1 - 2016/10
N2 - 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. Design: Prospective, multicenter observational study. Setting: U.S. Spinal Cord Injury Model Systems. Participants: 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. Interventions: S3 pressure sensation at all time points, with a retest at the 1-month time point. Main Outcome Measures: 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.
AB - 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. Design: Prospective, multicenter observational study. Setting: U.S. Spinal Cord Injury Model Systems. Participants: 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. Interventions: S3 pressure sensation at all time points, with a retest at the 1-month time point. Main Outcome Measures: 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.
KW - Classification
KW - Rehabilitation
KW - Reproducibility of results
KW - Sensitivity and specificity
KW - Spinal cord injuries
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U2 - 10.1016/j.apmr.2016.02.006
DO - 10.1016/j.apmr.2016.02.006
M3 - Article
C2 - 26921681
AN - SCOPUS:84963959706
SN - 0003-9993
VL - 97
SP - 1642
EP - 1646
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 10
ER -