Techaworarak Phantira, Eitivipart Aitthanatt C, Pattanakuhar Sintip, Waongenngarm Pooriput
Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand.
Accessibility and Assistive Technology Research Team, Assistive Technology and Medical Devices Research Center, National Science and Technology Development Agency, Pathum Thani, Thailand.
Spinal Cord. 2025 Aug 1. doi: 10.1038/s41393-025-01109-6.
Psychometric study.
To introduce a novel, simple, tele-assessment tool designed to report the level and severity of spinal cord injury (SCI) and to assess its reliability and validity.
Two academic-affiliated rehabilitation facilities in Thailand.
The Tele-Neurological Assessment for the level, severity, and completeness of Spinal Cord Injury (TNASCI) was designed to assess the SCI level and severity according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) using telecommunication. This study comprised three phases: (1) the development process involving three experts using the Delphi method, (2) a face validity examination of each TNASCI item's comprehension and suitability, and (3) an evaluation of the concurrent validity, intra-rater reliability, and inter-rater reliability using data from 40 participants with chronic SCI (>12 months post-injury).
The Thai version of TNASCI, was developed to contain four sections, including sensory, motor, anorectal function, and summary sections to determine the SCI level and severity grade. The assessment tool exhibited good face validity. When compared with the ISNCSCI, the TNASCI showed good to excellent inter-rater and intra-rater reliability, with an intraclass correlation coefficient (ICC) (2,1) of 0.791-0.941 and an ICC (3,1) of 0.785-1.00, and good to excellent validity in almost all sections except for the sensory-related components (r = 0.764-0.986).
Our TNASCI tool, which was assessed by trained clinicians, demonstrated acceptable inter-rater and intra-rater reliability, face validity, and concurrent validity. It serves as an alternative tool to evaluate the SCI level and severity predominantly in people with chronic, motor-complete SCI who cannot be evaluated using the hands-on ISNCSCI in person. However, this study is an initial step in validating a novel tele-assessment tool, with future studies needed to confirm its utility in other conditions and settings.
心理测量学研究。
引入一种新颖、简单的远程评估工具，用于报告脊髓损伤（SCI）的程度和严重程度，并评估其可靠性和有效性。
泰国的两家学术附属康复机构。
脊髓损伤水平、严重程度和完整性的远程神经学评估（TNASCI）旨在根据国际脊髓损伤神经分类标准（ISNCSCI），利用电信评估SCI水平和严重程度。本研究包括三个阶段：（1）采用德尔菲法，由三位专家参与的开发过程；（2）对TNASCI每个项目的理解和适用性进行表面效度检查；（3）使用40名慢性SCI患者（受伤后超过12个月）的数据，评估同时效度、评分者内信度和评分者间信度。
TNASCI的泰语版本包含四个部分，包括感觉、运动、肛门直肠功能和总结部分，以确定SCI水平和严重程度等级。该评估工具表现出良好的表面效度。与ISNCSCI相比，TNASCI显示出良好至优秀的评分者间和评分者内信度，组内相关系数（ICC）（2,1）为0.791 - 0.941，ICC（3,1）为0.785 - 1.00，除感觉相关成分外，几乎所有部分的效度良好至优秀（r = 0.764 - 0.986）。
我们的TNASCI工具经训练有素的临床医生评估，显示出可接受的评分者间和评分者内信度、表面效度和同时效度。它是一种替代工具，主要用于评估慢性、运动完全性SCI患者的SCI水平和严重程度，这些患者无法亲自使用实践操作的ISNCSCI进行评估。然而，本研究是验证一种新型远程评估工具的初步步骤，未来需要进一步研究以确认其在其他情况和环境中的效用。
