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

Background: In synergy with the mounting scientific evidence for the capacity of recovery after spinal cord injury (SCI) and training, new evidence-based therapies advancing neuromuscular recovery are emerging. There is a parallel need for outcome instruments that specifically address recovery. The Pediatric Neuromuscular Recovery Scale (Pediatric NRS) is one example with established content validity to assess neuromuscular capacity within task performance. Objective: The objective of this study was to determine interrater reliability of the Pediatric NRS to classify motor capacity in children after SCI. Methods: Pediatric physicians (3), occupational therapists (5), and physical therapists (6) received standardized training in scoring the scale, then rated video assessments of 32 children post SCI, 2-12 years of age, 78% non-ambulatory. Interrater reliability was analyzed using Kendall coefficient of concordance for individual Pediatric NRS items and overall score. Results: 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). 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. Interrater reliability was equivalent among groups defined by age and neurological level, but lower among non-ambulatory individuals. Conclusion: Strong interrater reliability was demonstrated by pediatric clinicians who scored children with SCI using the Pediatric NRS.
Competing Interests: Conflicts of Interest Dr. Ardolino reports grants from the Craig H. Neilsen Foundation during the conduct of the study and non-financial support from NeuroRecovery Training Institute outside the submitted work. Dr. Behrman reports grants from the Craig H. Neilsen Foundation and from Kosair Charities during the conduct of the study and personal fees from NeuroRecovery Training Institute, other from NeuroRecovery Learning, Inc., and personal fees from Shriners Research Foundation outside the submitted work. Dr. Mulcahey reports grants from Jefferson University (Philadelphia University + Thomas Jefferson University) during the conduct of the study and personal fees from Topics in Spinal Cord Injury Rehabilitation, grants from Craig H. Neilsen Foundation, and personal fees from Craig H. Neilsen Foundation outside the submitted work. Dr. Roberts reports grants from NeuroRecovery Network during the conduct of the study. Ms. Clayton, Ms. Gregg, and Dr. Lorenz have nothing to disclose.