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

Abstract

<b>Background:</b> 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. <b>Objective:</b> The objective of this study was to determine interrater reliability of the Pediatric NRS to classify motor capacity in children after SCI. <b>Methods:</b> 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. <b>Results:</b> 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 <i>W</i> ≥ 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. <b>Conclusion:</b> Strong interrater reliability was demonstrated by pediatric clinicians who scored children with SCI using the Pediatric NRS.