Interrater Reliability of the Pediatric Neuromuscular Recovery Scale for Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2019 · DOI: 10.1310/sci2502–121 · Published: April 1, 2019

Spinal Cord Injury Pediatrics Rehabilitation

Simple Explanation

The Pediatric Neuromuscular Recovery Scale (Pediatric NRS) is designed to assess neuromuscular capacity within task performance in children with spinal cord injury (SCI). It aims to capture incremental changes in a child's ability to execute movements during functional activities without compensation or assistive devices. This study sought to determine how well different clinicians agree when scoring the Pediatric NRS for children with SCI. The clinicians included pediatric physicians, occupational therapists, and physical therapists who received standardized training in using the scale. The results showed strong agreement among the clinicians in scoring the Pediatric NRS, indicating that it is a reliable tool for assessing motor capacity in children with SCI. However, the reliability was lower among non-ambulatory individuals.

Study Duration

14 months

Participants

32 children post SCI, 2-12 years of age, 78% non-ambulatory

Evidence Level

Not specified

Key Findings

1
The interrater reliability coefficient was determined to be near 1 for the overall Pediatric NRS score (ICC = 0.966; 95% CI, 0.89-0.98).
2
Twelve of 16 individual items exhibited high concordance coefficients (Kendall’s W ≥ 0.8) and four items demonstrated concordance coefficients, < 0.8 and > 0.69.
3
Interrater reliability was equivalent among groups defined by age and neurological level, but lower among non-ambulatory individuals.

Research Summary

The study evaluated the interrater reliability of the Pediatric Neuromuscular Recovery Scale (Pediatric NRS) for children with spinal cord injury (SCI). Clinicians with pediatric experience were trained to use the scale and then rated videos of children with SCI performing various tasks. The results demonstrated strong interrater reliability for the overall Pediatric NRS score, indicating good agreement among raters. However, some individual items exhibited lower concordance, particularly for non-ambulatory individuals. The authors conclude that the Pediatric NRS is a reliable tool for assessing motor capacity in children with SCI, and further research is warranted to evaluate its test-retest reliability and responsiveness to therapeutic intervention.

Practical Implications

Clinical Practice

The Pediatric NRS can be used by clinicians to assess motor recovery in children with SCI, providing a standardized and reliable measure of their abilities.

Research

The Pediatric NRS can be used as an outcome measure in clinical trials evaluating the effectiveness of neurotherapeutic interventions for children with SCI.

Training

The online training course developed for this study provides a standardized method for training clinicians in the administration and scoring of the Pediatric NRS.

Study Limitations

1
Not all item levels of recovery, however, were illustrated by the study population with 78% non-ambulatory.
2
The sample reflected only the range of 2-12 years. Thus, we were unable to test the youngest of ages, age 1, for interrater reliability with the Pediatric NRS.
3
Video presentations may not have aptly captured a child’s movements as if viewed in person.

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