Furlan Julio C, Fehlings Michael G, Tator Charles H, Davis Aileen M
Toronto Western Research Institute, 399 Bathurst Street McL 12-407, [corrected] Toronto, Canada.
J Neurotrauma. 2008 Nov;25(11):1273-301. doi: 10.1089/neu.2008.0617.
With the resurgence of clinical trials in spinal cord injury (SCI), there is intense interest in whether the American Spinal Injury Association (ASIA) standards are sensitive enough to discriminate neurological recovery. We conducted a systematic review to examine the psychometric properties of the ASIA Standards in assessing motor and sensory function of individuals with acute traumatic SCI. Papers, which examined the psychometric properties of the ASIA Standards, were obtained from Medline, CINAHL, and EMBASE databases (1982-2008). Of 39 publications primarily identified, 18 fulfilled the inclusion and exclusion criteria. An additional 51 publications were captured in a secondary search using the bibliographies from original articles and published reviews. The 2000 version of the ASIA Standards appear to be more reliable than the previous versions, although two prospective studies indicate that the ASIA Standards do not reliably assess children less than 4 years with SCI. Responsiveness studies indicate that (a) a detailed neurological examination using the ASIA Standards at 72 h should be obtained for comparison with subsequent neurological assessments following SCI; (b) the use of ASIA upper- and lower-extremity motor subscores instead of a single ASIA motor score is recommended; (c) further investigation of the minimal clinically important difference of the ASIA Standards is required; and (d) the functionally meaningful ASIA score threshold to document the benefit of a novel therapeutic intervention varies according to the level and severity of SCI. Although the ASIA Standards cannot be evaluated in terms of criterion validity, several studies suggested their divergent and convergent construct validity. Therefore, the ASIA Standards represent an appropriate instrument to discriminate and evaluate patients with SCI in a longitudinal manner. Nonetheless, further investigation of the ASIA Standards is recommended due to a paucity of studies focused on some key elements of the measurement responsiveness, including minimal clinically important difference.
随着脊髓损伤（SCI）临床试验的再度兴起，人们对美国脊髓损伤协会（ASIA）标准能否灵敏地鉴别神经功能恢复情况产生了浓厚兴趣。我们开展了一项系统评价，以检验ASIA标准在评估急性创伤性SCI患者运动和感觉功能方面的心理测量特性。检索了Medline、CINAHL和EMBASE数据库（1982 - 2008年），获取了检验ASIA标准心理测量特性的论文。在最初识别出的39篇出版物中，18篇符合纳入和排除标准。通过对原始文章和已发表综述的参考文献进行二次检索，又获取了51篇出版物。2000版ASIA标准似乎比之前版本更可靠，不过两项前瞻性研究表明，ASIA标准不能可靠地评估4岁以下的SCI儿童。反应性研究表明：（a）应在伤后72小时采用ASIA标准进行详细的神经学检查，以便与SCI后续的神经学评估结果作比较；（b）建议使用ASIA上肢和下肢运动亚评分而非单一的ASIA运动评分；（c）需要进一步研究ASIA标准的最小临床重要差异；（d）记录新型治疗干预效果的具有功能意义的ASIA评分阈值因SCI的损伤平面和严重程度而异。尽管无法依据标准效度对ASIA标准进行评估，但多项研究提示了其发散效度和聚合效度。因此，ASIA标准是纵向鉴别和评估SCI患者的适宜工具。尽管如此，鉴于针对测量反应性的一些关键要素（包括最小临床重要差异）的研究较少，建议对ASIA标准开展进一步研究。
