Patient preferences for order of the sensory portion of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2019.1582602 · Published: January 1, 2019

Spinal Cord Injury Patient Experience Neurology

Simple Explanation

This study investigates patient comfort during the sensory portion of the ISNCSCI exam, specifically light touch (LT) and pinprick (PP) testing. The research aimed to determine if the order of these tests affects patient comfort and to identify patient preferences for the testing order. The findings suggest that first-time examinees may experience more pain from PP testing, especially when it's done first, indicating that LT should be tested first to improve patient comfort.

Study Duration

8 Months

Participants

91 adults with traumatic SCI

Evidence Level

Not specified

Key Findings

1
All subjects reported that light touch testing was not painful.
2
First-time examinees were more likely to report pinprick testing as 'very painful.'
3
Examinees who had pinprick testing performed first reported more 'very painful' experiences.

Research Summary

The study evaluated patient pain perception and preferences regarding the order of light touch (LT) and pinprick (PP) sensory testing during the ISNCSCI examination. Results indicated that first-time examinees experienced more pain from PP testing, particularly when administered first, suggesting that LT should be tested first. The majority of participants had no preference for the testing order, but those who did preferred the modality they experienced first.

Practical Implications

Standardizing Exam Order

The ISNCSCI examination could be standardized to test light touch before pinprick to enhance patient comfort, especially for first-time examinees.

Informing Clinical Practice

Clinicians should consider the patient's history and potential anxiety when performing sensory testing, particularly for first-time examinees.

Improving Patient Experience

By prioritizing light touch testing first, clinicians can create a more comfortable and cooperative environment for patients undergoing neurological examinations.

Study Limitations

1
A larger sample size would provide more detailed information regarding the differences in pain perception among different severities of incomplete injuries.
2
Information regarding patients’ history of neuropathic pain and pain medication was not elicited, and may be a confounding factor.
3
The force used by each examiner during the PP test was not measured for each patient.

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