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Construct validity of the international standards to document remaining autonomic function after spinal cord injury (ISAFSCI) (1st edition)

Spinal Cord volume 61, pages 644–651 (2023)Cite this article

Subjects

Abstract

Study design

Observational study.

Objectives

To assess the construct validity of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) (2012 1st Edition).

Setting

Two Canadian spinal cord injury (SCI) centers.

Methods

Data were collected between 2011–2014. Assessments included the ISAFSCI, standardized measures of autonomic function and a clinical examination. Construct validity of ISAFSCI was assessed by testing a priori hypotheses on expected ISAFSCI responses to standard measures (convergent hypotheses) and clinical variables (clinical hypotheses).

Results

Forty-nine participants with an average age of 45 ± 12 years were included, of which 42 (85.7%) were males, 37 (77.6%) had a neurological level of injury at or above T6, and 23 (46.9%) were assessed as having motor and sensory complete SCI. For the six General Autonomic Function component hypotheses, two hypotheses (1 clinical, 1 convergent) related to autonomic control of blood pressure and one clinical hypothesis for temperature regulation were statistically significant. In terms of the Lower Urinary Tract, Bowel and Sexual Function component of the ISAFSCI, all the hypotheses (5 convergent, 3 clinical) were statistically significant except for the hypotheses on female sexual items (2 convergent, 2 clinical), likely due to small sample size.

Conclusion

The construct validity of ISAFSCI (2012 1st Edition) for the General Autonomic Function component was considered to be weak while it was much stronger for the Lower Urinary Tract, Bowel and Sexual Function component based on a priori hypotheses. These results can inform future psychometric studies of the ISAFSCI (2021 2nd Edition).

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Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Krassioukov A. Autonomic function following cervical spinal cord injury. Respir Physiol Neurobiol. 2009;169:157–64.

    Article  PubMed  Google Scholar 

  2. Krassioukov A, Claydon VE. The clinical problems in cardiovascular control following spinal cord injury: an overview. Prog Brain Res. 2006;152:223–9.

    Article  PubMed  Google Scholar 

  3. Savic G, Bergstrom EM, Frankel HL, Jamous MA, Jones PW. Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards. Spinal Cord. 2007;45:444–51.

    Article  CAS  PubMed  Google Scholar 

  4. Marino RJ, Graves DE. Metric properties of the ASIA motor score: subscales improve correlation with functional activities. Arch Phys Med Rehabil. 2004;85:1804–10.

    Article  PubMed  Google Scholar 

  5. Krassioukov AV, Karlsson AK, Wecht JM, Wuermser LA, Mathias CJ, Marino RJ. Assessment of autonomic dysfunction following spinal cord injury: rationale for additions to International Standards for Neurological Assessment. J Rehabil Res Dev. 2007;44:103–12.

    Article  PubMed  Google Scholar 

  6. Reitz A, Tobe V, Knapp PA, Schurch B. Impact of spinal cord injury on sexual health and quality of life. Int J Impot Res. 2004;16:167–74.

    Article  CAS  PubMed  Google Scholar 

  7. Alexander MS, Biering-Sorensen F, Bodner D, Brackett NL, Cardenas D, Charlifue S, et al. International Standards to Document Remaining Autonomic Function after Spinal Cord Injury. Spinal Cord. 2009;47:36–43.

    Article  CAS  PubMed  Google Scholar 

  8. Krassioukov A, Biering-Sorensen CF, Donovan W, Kennelly M, Kirshblum S, Krogh K, et al. International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI). First Edition 2012. Top Spinal Cord Inj Rehabil. 2012;18:283–96.

    Article  Google Scholar 

  9. Wecht JM, Wilson J, Previnaire JG. Using the autonomic standards to assess orthostatic hypotension in persons with SCI: a case series. Spinal Cord Ser Cases. 2017;3:17087.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Previnaire JG, Soler JM, Alexander MS, Courtois F, Elliott S, McLain A. Prediction of sexual function following spinal cord injury: a case series. Spinal Cord Ser Cases. 2017;3:17096.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Beano HM, Kennelly M. Lower urinary tract autonomic dysfunction evaluation in spinal cord injury patients: an applied example. Spinal Cord Ser Cases. 2017;3:17098.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Alexander M, Carr C, Alexander J, Chen YY, McLain A. Assessing the ability of the Sacral Autonomic Standards to document bladder and bowel function based upon the ASIA Impairment Scale. Spinal Cord Ser Cases. 2019;5:85.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Montesinos-Magraner L, Castellano-Tejedor C, Frías A, Launois P, Rojas-Cuotto K, González-Viejo MA. Spanish validation of the Autonomic Standards Assessment Form in spinal cord injuries. Rehabilitacion (Madr). 2019;53:20–7.

    Article  PubMed  Google Scholar 

  14. Davidson RA, Carlson M, Fallah N, Noonan VK, Elliott SL, Joseph J, et al. Inter-rater reliability of the international standards to document remaining autonomic function after spinal cord injury. J Neurotrauma. 2017;34:552–8.

    Article  PubMed  Google Scholar 

  15. Wecht JM, Krassioukov A, Alexander M, Handrakis JP, McKenna SL, Kennelly M, et al. International Standards to Document Autonomic Function Following SCI (ISAFSCI): Second Edition. Top Spinal Cord Inj Rehabil. 2021;27:23–49.

    Article  PubMed  PubMed Central  Google Scholar 

  16. American Spinal Injury Association. Autonomic Standards Assessment Worksheet (General and Sacral). https://asia-spinalinjury.org/wp-content/uploads/2022/02/ISAFSCI-Autonomic-General-and-Sacral-Exam-Worksheets.pdf. Accessed: March, 2022.

  17. Kimberlin CL, Winterstein AG. Validity and reliability of measurement instruments used in research. Am J Health Syst Pharm. 2008;65:2276–84.

    Article  PubMed  Google Scholar 

  18. Fayers PM, Machin D. Quality of life: assessment, analysis and interpretation. 1st ed. Chichester: John Wiley and Sons. 2000; 43–71.

  19. Suarez GA, Opfer-Gehrking TL, Offord KP, Atkinson EJ, O’Brien PC, Low PA. The Autonomic Symptom Profile: a new instrument to assess autonomic symptoms. Neurology. 1999;52:523–8.

    Article  CAS  PubMed  Google Scholar 

  20. Costa P, Perrouin-Verbe B, Colvez A, Didier J, Marquis P, Marrel A, et al. Quality of life in spinal cord injury patients with urinary difficulties, development and validation of Qualiveen. Eur Urol. 2001;39:107–13.

    Article  CAS  PubMed  Google Scholar 

  21. Krogh K, Christensen P, Sabroe S, Laurberg S. Neurogenic Bowel Dysfunction Score. Spinal Cord. 2006;44:625–31.

    Article  CAS  PubMed  Google Scholar 

  22. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.

    Article  CAS  PubMed  Google Scholar 

  23. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208.

    Article  CAS  PubMed  Google Scholar 

  24. Bonniaud V, Parratte B, Amarenco G, Jackowski D, Didier J-P, Guyatt G. Measuring quality of life in multiple sclerosis patients with urinary disorders using the Qualiveen questionnaire. Arch Phys Med Rehabil. 2004;85:1317–23.

    Article  PubMed  Google Scholar 

  25. Alexander MS, Brackett NL, Bodner D, Elliot S, Jackson A, Sonksen J, et al. Measurement of sexual functioning after spinal cord injury: preferred instruments. Spinal Cord Med. 2009;32:226–36.

    Article  Google Scholar 

  26. McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–63.

    Article  CAS  PubMed  Google Scholar 

  27. Claydon VE, Krassioukov A. Orthostatic hypotension and autonomic pathways after spinal cord injury. J Neurotrauma. 2006;23:1713–25.

    Article  PubMed  Google Scholar 

  28. West C, Bellantoni A, Krassioukov A. Cardiovascular function in individuals with incomplete spinal cord injury: a systematic review. Top Spinal Cord Inj Rehabil. 2013;19:267–78.

    Article  PubMed  PubMed Central  Google Scholar 

  29. West W, Wong S, Krassioukov A. Autonomic cardiovascular control in Paralympic athletes with spinal cord injury. Med Sci Sports Exerc. 2014;46:60–8.

    Article  PubMed  Google Scholar 

  30. Ravensbergen HJ, de Groot S, Post MW, Slootman HJ, van der Woude LH, Claydon VE. Cardiovascular function after spinal cord injury: prevalence and progression of dysfunction during inpatient rehabilitation and 5 years following discharge. Neurorehabilit Neural Repair. 2014;28:219–29.

    Article  Google Scholar 

  31. Welk L, Morrow S, Madarasz W, Baverstock R, Macnab J, Sequeira K. The validity and reliability of the Neurogenic Bladder Symptom Score. J Urol. 2014;192:452–7.

    Article  PubMed  Google Scholar 

  32. Wyndaele JJ. Neuroanatomy and neurophysiology of sexual function after spinal cord lesion. Spinal Cord. 2010;48:181.

    Article  CAS  PubMed  Google Scholar 

  33. Previnaire JG, Soler JM, Alexander MS, Courtois F, Elliott S, McLain A. Prediction of sexual function following spinal cord injury: a case series. Spinal Cord Ser Cases. 2017;3:1–7.

    Article  Google Scholar 

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Acknowledgements

We would like to acknowledge all the study participants.

Funding

This work was supported by a grant from the Praxis Spinal Cord Institute which receives funding from Western Economic Diversification Canada and British Columbia government. The study was also supported by a grant from the BC Rehab Foundation.

Author information

Authors and Affiliations

  1. Praxis Spinal Cord Institute, Vancouver, BC, Canada

    Dilnur Kurban, Vanessa K. Noonan & Nader Fallah

  2. Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada

    Ross A. Davidson & Andrei V. Krassioukov

  3. Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada

    Karen M. Smith

  4. GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada

    Marie Carlson, Stacy Elliott & Andrei V. Krassioukov

  5. Lakeridge Health, Oshawa, ON, Canada

    Jay Joseph

  6. International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada

    Stacy Elliott, Vanessa K. Noonan & Andrei V. Krassioukov

  7. Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    Nader Fallah

Authors
  1. Dilnur Kurban
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  4. Marie Carlson
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  7. Vanessa K. Noonan
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  9. Andrei V. Krassioukov
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Contributions

DK was responsible for statistical analysis, interpreting the results and writing the manuscript. RD and MC contributed to the study design, generated the hypotheses, collected data, interpreted the results and edited the manuscript. KS and JJ supervised data collection, interpreted the results and edited the manuscript. SE contributed to the study design, generated the hypotheses, interpreted the results and edited the manuscript. VN provided input on the analysis plan, hypotheses generation, interpreting the results and edited the manuscript. NF provided feedback on the analysis and edited the manuscript. AK supervised the project and study design, provided feedback on the generation of hypotheses and edited the manuscript.

Corresponding author

Correspondence to Andrei V. Krassioukov.

Ethics declarations

Competing interests

DK, NF and VN are employees of the Praxis Spinal Cord Institute. The other authors declare that there are no competing financial interests or conflict of interests in relation to the work described.

Ethical Approval and Consent to Participate

Research Ethics Board (REB) approval from the hospital and university was obtained for this work. We further certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research and that informed consent was obtained from all participants.

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Supplementary information

41393_2023_932_MOESM1_ESM.pdf

The International Standards to Document Remaining Autonomic Function  after Spinal Cord Injury (ISAFSCI) Assessment Forms (versions 1 and 2).

41393_2023_932_MOESM2_ESM.docx

Standard Questions for the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI)

Reproducibility checklist

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Kurban, D., Davidson, R.A., Smith, K.M. et al. Construct validity of the international standards to document remaining autonomic function after spinal cord injury (ISAFSCI) (1st edition). Spinal Cord 61, 644–651 (2023). https://doi.org/10.1038/s41393-023-00932-z

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